Interplay between ESKAPE Pathogens and Immunity in Skin Infections: An Overview of the Major Determinants of Virulence and Antibiotic Resistance

Abstract

The skin is the largest organ in the human body, acting as a physical and immunological barrier against pathogenic microorganisms. The cutaneous lesions constitute a gateway for microbial contamination that can lead to chronic wounds and other invasive infections. Chronic wounds are considered as serious public health problems due the related social, psychological and economic consequences. The group of bacteria known as ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter sp.) are among the most prevalent bacteria in cutaneous infections. These pathogens have a high level of incidence in hospital environments and several strains present phenotypes of multidrug resistance. In this review, we discuss some important aspects of skin immunology and the involvement of ESKAPE in wound infections. First, we introduce some fundamental aspects of skin physiology and immunology related to cutaneous infections. Following this, the major virulence factors involved in colonization and tissue damage are highlighted, as well as the most frequently detected antimicrobial resistance genes. ESKAPE pathogens express several virulence determinants that overcome the skin’s physical and immunological barriers, enabling them to cause severe wound infections. The high ability these bacteria to acquire resistance is alarming, particularly in the hospital settings where immunocompromised individuals are exposed to these pathogens. Knowledge about the virulence and resistance markers of these species is important in order to develop new strategies to detect and treat their associated infections.

The Future of Functional Clothing for an Improved Skin and Textile Microbiome Relationship

“…The skin is the largest organ in the human body [5]. Its complex surface and semipermeable membranes interact with the immune system and inner body as well as the outer environment.…”

ESKAPE Act Plus: Pathway Activation Analysis for Bacterial Pathogens

“…The group of bacteria collectively known as ESKAPE ( E nterococcus faecium , S taphylococcus aureus , K lebsiella pneumoniae , A cinetobacter baumannii , P seudomonas aeruginosa and E nterobacter sp.) pathogens are of high medical concern due to their virulence and ability to develop antibiotic resistance ( 1 , 2 ). Collectively, they are the major cause of life-threatening hospital-acquired infections worldwide ( 3 ).…”

Isolation and characterization of lytic bacteriophages from sewage at an egyptian tertiary care hospital against methicillin-resistant Staphylococcus aureus clinical isolates

“…Globally, the Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE) pathogens lead to healthcare-associated infections. Staphylococcus aureus is one of them ( Vale de Macedo et al, 2021 , El-Far et al, 2021 ). MRSA is responsible for a variety of diseases ranging from soft tissue and skin infections to life-threatening situations such as pneumonia, bacteremia, and sepsis ( Boswihi and Udo, 2018 ).…”