The Antibiotic Resistance Era in Enterobacteriaceae: Mechanisms, Epidemiology, and Emerging Countermeasures

Enterobacteriaceae—Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae—are major causes of both community- and hospital-acquired infections. The rise of antibiotic resistance within this family, particularly via extended-spectrum β-lactamases (ESBLs), carbapenemases (e.g., NDM 1, KPC), and plasmid-mediated determinants, has drastically reduced treatment options. The global dissemination of resistance elements such as mcr 1 further compounds the challenge. This review synthesizes key mechanisms, including emerging heteroresistance, traces current epidemiological trends across diverse regions, and examines promising strategies such as phage therapy, rapid diagnostics, and next-generation agents. Addressing this crisis demands multidisciplinary solutions that span molecular innovation, diagnostic advancements, and stewardship strategies to mitigate the mounting threat posed by resistant Enterobacteriaceae.