Macrolide resistance mechanisms in Enterobacteriaceae: Focus on azithromycin

Abstract

From its introduction in 1952 onwards, the clinical use of macrolides has been steadily increasing, both in human and veterinary medicine. Although initially designed to the treatment of Gram-positive microorganisms, this antimicrobial family has also been used to treat specific Gram-negative bacteria. Some of them, as azithromycin, are considered in the armamentarium against Enterobacteriaceae infections. However, the facility that this bacterial genus has to gain or develop mechanisms of antibiotic resistance may compromise the future usefulness of these antibiotics to fight against Enterobacteriaceae infections. The present review is focused on the mechanisms of macrolide resistance, currently described in Enterobacteriaceae.

Keywords:

• 23S rRNA
• methylases
• esterases
• phospotransferases
• ribosomal mutations

Acknowledgements

We thank Nuno Santos for his support in drawing the figures and to Donna Pringle for idiomatic correction.

Disclosure statement

The authors report no declaration of interest.

Funding

CG has a PhD fellowship of the ISCIII [grant number: FI12/00561]. GH has a PhD fellowship from the Schlumberger Foundation – Faculty for The Future Program. LR-R has a PhD fellowship from Sistema Riojano de Innovación del Gobierno de La Rioja. MJP has a postdoctoral fellowship from CONCYTEC [grant number: CG05-2013-FONDECYT]. JR has a fellowship from the program I3, of the ISCIII [grant number: CES11/012].

The study was supported by the Generalitat de Catalunya, Departament d’Universitats, Recerca i Societat de la Informació [2014 SGR 26] and by the Spanish Network for the Research in Infectious Diseases [REIPI RD12/0015].