Antimicrobial Resistance in Nosocomial Infections

Antimicrobial resistance in nosocomial infections presents a critical challenge to modern healthcare, undermining the efficacy of standard therapies and prolonging hospital stays. The principal culprits are the so-called ESKAPE pathogens—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species—which collectively account for a high proportion of multidrug-resistant (MDR) hospital-acquired infections. Resistance mechanisms range from enzyme-mediated drug inactivation and target modification to active efflux and permeability changes. The clinical consequences include increased mortality, higher costs and greater use of broad-spectrum agents. Effective responses combine rapid diagnostics, stringent infection-control measures, antimicrobial stewardship and the development of novel agents. Surveillance data reveal geographical variation in resistance gene prevalence, while stewardship programmes and optimised dosing regimens have demonstrated reductions in transmission. Continued progress will depend on integrating mechanistic insights, real-time epidemiology and innovative therapeutic strategies to curb the global burden of antimicrobial resistance in the hospital environment.

Research from Nature Portfolio

Recent advances in structure-guided antibiotic discovery have yielded a novel family of compounds targeting acyl carrier protein synthase (AcpS), a conserved enzyme essential for bacterial lipid biosynthesis. A library of over 700 molecules was screened computationally and refined experimentally, leading to 33 candidates that inhibit growth of Gram-positive pathogens at low microgram concentrations. Select compounds also synergise with colistin to extend activity against Gram-negative species. In vitro efficacy against multidrug-resistant isolates was confirmed, and in vivo models of difficult-to-treat infections—including diabetic foot ulcer analogues—demonstrated significant bacterial burden reduction. This work exemplifies the potential of computer-aided design to expand the antimicrobial armamentarium against nosocomial MDR organisms.

Antimicrobial Resistance in Nosocomial Infections publication trend

The graph below shows the total number of articles in antimicrobial resistance in nosocomial infections across all publications each year (not limited to Nature Index journals).

Technical terms

Nosocomial infection: Infection contracted within a hospital or other healthcare setting.

Multidrug-resistant (MDR): Bacteria resistant to three or more classes of antimicrobial agents.

Acyl carrier protein synthase (AcpS): Conserved bacterial enzyme involved in fatty-acid synthesis and a novel antibiotic target.

Carbapenemase: Enzyme produced by bacteria that hydrolyses carbapenem antibiotics, conferring high-level resistance.

Extended-spectrum β-lactamase (ESBL): Enzyme that deactivates penicillins and cephalosporins, leading to broad β-lactam resistance.

Empirical therapy: Initial antimicrobial treatment administered before specific pathogen identification.

References

1. Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens. BioMed Research International (2016).
2. Emerging Strategies to Combat ESKAPE Pathogens in the Era of Antimicrobial Resistance: A Review. Frontiers in Microbiology (2019).
3. The negative impact of antibiotic resistance. Clinical Microbiology and Infection (2015).
4. Computer-aided drug design to generate a unique antibiotic family. Nature Communications (2024).
5. Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study. The Lancet Microbe (2023).
6. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Eurosurveillance (2023).