Clinical Microbiology of Multidrug-Resistant Enterobacteriaceae

Enterobacteriaceae are a family of Gram-negative bacilli responsible for a broad range of community-acquired and healthcare-associated infections. In recent decades, strains producing extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases and carbapenemases—most notably New Delhi metallo-β-lactamase (NDM) variants—have emerged as a critical threat. Resistance determinants often reside on conjugative plasmids and integrons, facilitating rapid horizontal gene transfer between species. Mechanisms such as upregulated efflux pumps, porin loss and target-site alteration further compound multidrug resistance. Clinical laboratories now integrate phenotypic assays with molecular diagnostics, including multiplex PCR and whole-genome sequencing, to detect resistance genes and guide therapy. The global dissemination of high-risk clones underscores the necessity of robust antimicrobial stewardship, stringent infection control measures and real-time epidemiological surveillance. Therapeutic strategies increasingly rely on combination regimens, novel β-lactamase inhibitors and repurposed agents, while research into alternative modalities—such as bacteriophages and antimicrobial peptides—advances. A coordinated international response is essential to curb the spread of these pathogens and preserve the efficacy of existing antibiotics.

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Clinical Microbiology of Multidrug-Resistant Enterobacteriaceae publication trend

The graph below shows the total number of articles in clinical microbiology of multidrug-resistant enterobacteriaceae across all publications each year (not limited to Nature Index journals).

Technical terms

AmpC β-lactamase: A class C enzyme that hydrolyses extended-spectrum cephalosporins and penicillins, often inducible and capable of plasmid-mediated transfer.
New Delhi metallo-β-lactamase (NDM): A zinc-dependent carbapenemase that inactivates a wide range of β-lactam antibiotics, including carbapenems.
Plasmid-mediated resistance: The carriage of resistance genes on mobile DNA elements that can transfer between bacterial cells by conjugation.
Fractional inhibitory concentration index (FIC index): A metric used in checkerboard assays to quantify antibiotic interactions, where values ≤ 0.5 indicate synergy.
Integron: A genetic mechanism that captures and expresses gene cassettes, frequently encoding antibiotic resistance determinants.

References

1. Characterization of Two Novel AmpC Beta-Lactamases from the Emerging Opportunistic Pathogen, Cedecea neteri. Antibiotics (2023).
2. Occurrence of blaNDM Variants Among Enterobacteriaceae From a Neonatal Intensive Care Unit in a Northern India Hospital. Frontiers in Microbiology (2018).
3. Efficacy of Novel Combinations of Antibiotics against Multidrug-Resistant—New Delhi Metallo-Beta-Lactamase-Producing Strains of Enterobacterales. Antibiotics (2023).