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Understand  –  Antibiotic resistance

Resistance mechanisms

This section describes common antibiotic resistance mechanisms in bacteria.

Antibiotics disrupt essential structures or processes in bacteria. This in turn either kills the bacteria or stops them from multiplying. Bacteria have in turn evolved many antibiotic resistance mechanisms to withstand the actions of antibiotics.

How bacteria resist antibiotics

There are two main ways for bacteria to withstand the effects of an antibiotic:

  1. To stop the antibiotic from reaching its target at a high enough concentration
  2. To modify or bypass the target that the antibiotic acts on

Over time bacteria have evolved many different antibiotic resistance strategies to accomplish this.

Antibiotic resistance mechanisms

1. Stop the antibiotic from reaching its target:

  • Pump the antibiotic out from the bacterial cell. Bacteria can produce pumps that sit in their membrane or cell wall. These so-called efflux pumps are very common in bacteria and can transport a variety of compounds such as signal molecules and nutrients. Some of these pumps can also transport antibiotics out from the bacterium, in this way lowering the antibiotic concentration inside the bacterial cell. In some cases mutations in the bacterial DNA can make the bacteria produce more of a certain pump, which in turn increases resistance.
  • Decrease permeability of the membrane that surrounds the bacterial cell. Certain changes in the bacterial membrane make it more difficult to pass through. In this way, less of the antibiotic gets into the bacteria.
  • Destroy the antibiotic. There are bacterial enzymes that can inactivate antibiotics. One example is β-lactamase that destroys the active component (the β-lactam ring) of penicillins, extremely important antibiotics for treating human infections. In later years, bacteria that produce extended-spectrum β-lactamases, so called ESBL-producing bacteria, have become a major problem. They can degrade a wide spectrum of β-lactam antibiotics, sometimes also the last resort drugs available for infections with these bacteria.
  • Modify the antibiotic. Bacteria can sometimes produce enzymes that are capable of adding different chemical groups to antibiotics. This in turn prohibits binding between the antibiotic and its target in the bacterial cell.
Different antibiotic resistance mechanisms in bacteria are shown in relation to where they take place in the bacterial cell. Bacteria can modify the cell membranes to take in less antibiotics or pump out antibiotics from the cell. Bacteria can also produce factors that break down antibiotics or change processes inside the cell to resist antibiotic action.
Figure 1. Antibiotic resistance strategies in bacteria. Courtesy of E. Wistrand-Yuen.

2. Modify or bypass the target of the antibiotic:


  • Camouflage the target. Changes in the composition or structure of the target in the bacterium (resulting from mutations in the bacterial DNA) can stop the antibiotic from interacting with the target. Alternatively, the bacteria can add different chemical groups to the target structure, in this way shielding it from the antibiotic.
  • Express alternative proteins. Some bacteria are able to produce alternative proteins that can be used instead of the ones that are inhibited by the antibiotic. For example, the bacterium Staphylococcus aureus can acquire the resistance gene mecA and produce a new penicillin-binding protein. These proteins are needed for bacterial cell wall synthesis and are the targets of β-lactam antibiotics. The new penicillin-binding protein has low affinity to β-lactam antibiotics and is thus resistant to the drugs, and the bacteria survive treatment. This type of resistance is the basis in MRSA (methicillin-resistant Staphylococcus aureus).
  • Reprogram target. Sometimes bacteria can produce a different variant of a structure it needs. For example, Vancomycin-resistant bacteria make a different cell wall compared to susceptible bacteria. The antibiotic is not able to interact as well with this type of cell wall.

Some bacteria are naturally resistant to certain antibiotics. Imagine for example an antibiotic that destroys the cell wall of the bacteria. If a bacterium does not have a cell wall, the antibiotic will have no effect. This phenomenon is called intrinsic resistance. When a bacterium that was previously susceptible to an antibiotic evolves resistance it is called acquired resistance.

Selected Resources

Resource Description
Armando Hasudungan: Bacteria Antibiotic Resistance Video that explains the basics of some different antibiotic resistance mechanisms in bacteria (13 min) and how resistance genes can be transferred between bacteria.
Eric’s Medical Lectures: Antibiotic Resistance Slide show. Narrated lecture (31 min) covering e.g. bacterial resistance mechanisms and susceptibility testing.
Understanding the basis of antibiotic resistance Video. Professor Laura Piddock gives a more advanced lecture on the mechanisms underlying resistance.
Society for General Microbiology. Professor Laura Piddock: ‘Understanding the basis of antibiotic resistance’. (2014).
Eric Strong. Eric’s Medical Lectures. Antibiotic Resistance (Antibiotics - Lecture 9). (2013).
Armando Hasudungan. Microbiology - Bacteria Antibiotic Resistance. (2014).
Martínez, J. L. & Baquero, F. Emergence and spread of antibiotic resistance: setting a parameter space. Ups. J. Med. Sci. 119, 68–77 (2014).
Walsh, C. Molecular mechanisms that confer antibacterial drug resistance. Nature 406, 775–781 (2000).