How can we escape the ESKAPEs: Antimicrobial resistance mechanisms and what lies ahead?

The ESKAPE pathogens are a group of 6 nosocomial pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., and are so-called, due to their ability to "escape" from our current arsenal of antimicrobials via a variety of mechanisms, leading them to be multidrug resistant (MDR) 1.ESKAPE pathogens can possess the ability to exchange plasmid-encoded resistance genes by horizontal gene transfer, which leads to the continual rise of antimicrobial resistance (AMR) in these pathogens.The ESKAPE pathogens are in the critical or high-priority pathogen lists according to the World Health Organisation (WHO) 2 and are listed as urgent or serious threats to public health by the Centre for Disease Control and Prevention (CDC) 3.Unfortunately, if nothing changes, we will be facing the consequences of a "post-antibiotic era," with staggering effect on increasing global healthcare costs and worsening clinical outcomes 4.Despite the differences between species (gram-positive and gram-negative) within the ESKAPE group, some of the overall strategies of resistance employed are conserved between them.This article summarises the intrinsic and acquired antimicrobial resistance mechanisms of the ESKAPE pathogens and discusses the future therapeutic avenues that are being explored in our global fight against AMR.