The ways that bacteria aquire resistance to antibiotics are explained as two approaches: decreasing the affinity of the target for the antibiotic by mutations in genes encoding them or decreasing the active concentration of the antibiotic inside the cell. For the latter approach, the mechanisms are classified in three categories shown below.
Major mechanisms to decrease the active concentration of the antibiotic inside the cell
Alteration of the cellular permeability to avoid the entry of antibiotics into the cells
Inactivation of antibiotics by enzymatic modification
Expression of efflux pumps to pump out antibiotics from the cellular milieu
Efflux pumps are found in both Gram-positive and -negative bacteria and eukaryotic organisms. The pumps have an enormous impact on medicine owing to their increased resistance to antimicrobial agents. Efflux pumps are mainly grouped into the super-families shown below.
Superfamilies or families of transporter proteins
ATP-binding cassette (ABC) superfamily
Multidrug and toxic compound extraction (MATE) superfamily
Multidrug and toxic compound extraction (MATE) superfamily
Resistance nodulation and cell division (RND) superfamily
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