ESKAPE Pathogens

By Ashma Shrestha •  Updated: 05/19/22 •  6 min read

ESKAPE is the acronym for six nosocomial pathogens that can ‘escape’ commonly used antibiotics due to their increasing multi-drug resistance (MDR). These pathogens are; Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.

These are a list of pathogens that possess the highest risk of developing resistance to multiple drugs. The WHO published the lists of pathogens carrying the highest risk of developing multi-drug resistance in 2017 among. This group (ESKAPE) was classified under the status of priority.

ESKAPE bacteria are susceptible to many genetic mutations. Due to this, they have developed resistance to lipopeptides, 𝛽-lactams, tetracyclines, fluoroquinolones, macrolides, and many antibiotics. These antibiotics are the last line in the defense. 

Enterococcus faecium

Staphylococcus aureus

Klebsiella pneumoniae 

Acinetobacter baumannii

Pseudomonas aeruginosa

Enterobacter species

Importance of ESKAPE Pathogens Clinically

How Do these Bacteria Develop Resistance?

The Capability of Modifying Sites of Drug Binding

The Ability to Transfer the Resistant Gene

Studies have shown that Enterococci species can transfer their vancomycin-resistant gene to other bacteria like Staphylococcus aureus, which has led to the generation of vancomycin-intermediate Staphylococcus aureus (VISA) and vancomycin-resistant S. aureus (VRSA).

The Haphazard Use of Antibiotics

Continuous and unsupervised use of antibiotics helps the bacteria develop resistance to different antibiotics. Antibiotics are the best weapon for fighting against bacterial infections, so the rational use of antimicrobial drugs by strengthening antimicrobial stewardship programs is necessary.

Reduction in Accumulation of Intracellular Drugs

One of the mechanisms of susceptibility of bacteria to antibiotics is the balance of uptake and release of the drug. Some bacteria can reduce the uptake of antibiotics through cell membranes leading to developing resistance to those antibiotics. Bacteria achieve this by decreasing protein channels on the outer membrane and the presence of an efflux pump to decrease the amount of accumulating drugs in the cell.

Loss of Porin

This mechanism is seen in gram-negative bacteria. The bacteria can lose proteins in the outer membrane called porins (responsible for forming channels for the passage of hydrophilic substances like antibiotics) from its membrane. Bacteria like Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae exhibit resistance to imipenem, meropenem, and 𝛽-lactams antibiotics, respectively.

Efflux pump

Biofilm Production


Ashma Shrestha

Hello, I am Ashma Shrestha. I am currently pursuing my Master's Degree in Microbiology. Passionate about writing and blogging. Key interest in virology and molecular biology

Keep Reading