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Review
. 2010 May 13;362(19):1804-13.
doi: 10.1056/NEJMra0904124.

Hospital-acquired infections due to gram-negative bacteria

Anton Y Peleg  1 , David C Hooper
Affiliations
Review

Hospital-acquired infections due to gram-negative bacteria

Anton Y Peleg et al. N Engl J Med. .
No abstract available

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Conflict of interest statement

No other conflict of interest relevant to this article was reported. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Figures

Figure 1
Figure 1. Mechanisms of Resistance in Gram-Negative Bacteria, and the Antibiotics Affected
Seven mechanisms of resistance are shown in the gram-negative bacterium, with some being mediated by a mobile plasmid. These mechanisms include the loss of porins, which reduces the movement of drug through the cell membrane; the presence of β-lactamases in the periplasmic space, which degrades the β-lactam; increased expression of the transmembrane efflux pump, which expels the drug from the bacterium before it can have an effect; the presence of antibiotic-modifying enzymes, which make the antibiotic incapable of interacting with its target; target site mutations, which prevent the antibiotic from binding to its site of action; ribosomal mutations or modifications, which prevent the antibiotic from binding and inhibiting protein synthesis; metabolic bypass mechanisms, which use an alternative resistant enzyme to bypass the inhibitory effect of the antibiotic; and a mutation in the lipopolysaccharide, which renders the polymyxin class of antibiotics unable to bind this target. Red spheres indicate antibiotics.
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