Gregory Burkman


The complexities of infectious diseases are not limited to one specialty, but rather encompass all types of physician care. One of the many present difficulties is the prevention, management, and treatment of microorganism resistance. In this review article, one method of acquired resistance possible to many bacteria, in particular Pseudomonas aeruginosa is described. This gram negative bacterium is able to induce an overexpression of efflux pumps that can eject intracellular antibiotics into the extracellular space, thereby avoiding cellular death. In P. aeruginosa four efflux pumps have been studied, which all have the ability to extrude specific classes of antibiotics. This has important clinical considerations, in particular for the hospitalized or convalescent patient, where P. aeruginosa is highly prevalent. Treatment modalities are progressively requiring combinations of antibiotics to circumvent this and other resistance mechanisms. Additionally, recognizing that patients usually have other comorbidities that can affect medication dosing, metabolism, and excretion, make the effective eradication of P. aeruginosa all the more difficult.



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