Clinical Relevance of the ESKAPE Pathogens

Jack N Pendleton; Sean P Gorman; Brendan F Gilmore


Expert Rev Anti Infect Ther. 2013;11(3):297-308. 

In This Article

Abstract and Introduction


In recent years, the Infectious Diseases Society of America has highlighted a faction of antibiotic-resistant bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) – acronymically dubbed 'the ESKAPE pathogens' – capable of 'escaping' the biocidal action of antibiotics and mutually representing new paradigms in pathogenesis, transmission and resistance. This review aims to consolidate clinically relevant background information on the ESKAPE pathogens and provide a contemporary summary of bacterial resistance, alongside pertinent microbiological considerations necessary to face the mounting threat of antimicrobial resistance.


Since their clinical introduction in the 1930s, antibiotics have greatly influenced life on Earth.[1] Over the past 80 years, antibiotics have enabled tremendous advances in modern medicine and revolutionized agricultural and industrial practice. Antibiosis is now deeply integrated into a modern way of life, with the widespread use of antibiotics and biocides resembling the ubiquity of bacteria themselves. Ironically, antibiotics have facilitated the very developments in travel and trade through economic globalization that have contributed to the rapid dissemination of antimicrobial resistance (AMR). Warnings of resistance preceded the clinical use of antibiotics,[201] and since then the introduction of every antimicrobial product has been closely followed by the emergence of resistance against it. Four decades of exorbitant antibiotic use has applied unprecedented selective pressure towards high-level AMR and multiple-drug resistance (MDR), rendering entire classes of antibiotics redundant and threatening to bring about the end of the 'antibiotic era'.[1,2] The traditional response to emerging resistance has been the timely introduction of a new class of compounds, temporarily assuaging the concerns of modern medicine. However, over the last two decades, there has been a significant retraction of investment towards antimicrobial R&D by the major pharmaceutical companies. This has resulted in a substantial decline in novel antimicrobials, and a production rate currently failing to keep pace with the coinciding escalation in global resistance.[3]

It has been predicted that the absence of such compounds would have multifarious ramifications on a global scale, not only on public health but furthermore, upon national security and international political stability.[4] Having recognized that a dry 'pipeline' leads to the formidable future of a 'postantibiotic era', leading health authorities including the WHO,[4,202] the European Centre for Disease Prevention and Control[5,6] and the Infectious Diseases Society of America (IDSA)[7] have promoted industrial incentives and initiatives in an attempt to stimulate research into new antimicrobial compounds, improve antibiotic stewardship drives to safeguard the remaining therapeutic options left to physicians and encourage a focused, concerted effort against key human pathogens.