Multi-Drug Resistance (MDR)Pathogenic organisms have mechanisms of resistance to combat the harmful effect of many classes of antimicrobials. MDR is defined as the resistance of pathogenic organisms to one or more antimicrobial agents .Many health organizations such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) have warned that MDR bacterial infections are becoming difficult and costly to treat using expensive medications, and require prolonged treatment regimens (Alenazy, 2022).

One of the most effective mechanisms that confer MDR to bacteria is multi-drug efflux pumps, which prevent the accumulation of antibiotics inside the cell, thereby reducing their concentration to subtoxic levels. Many countries are facing an increased incidence of infections resulting from MDR Gram-negative bacteria, where these organisms caused 80% of all serious bacterial infections ( Abalkhail et al ., 2022; Mitiku et al., 2022; Samreen et al., 2019).

In 2017, the WHO revised its list of MDR pathogens in need of urgent attention. This list indicated that the most critical pathogens are Gram negative bacteria, such as Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae, to which E. coli belongs. There are several issues that underlie the serious danger posed by the emergence of MDR bacteria. First, and most importantly, results are skewed in patients infected with MDR bacterial be worse compared to patients with more susceptible organisms ( Cillóniz et al.,2019).

In this way, Secondly, huge additional costs are associated with these infections. In the United States, the annual additional costs associated with the infections it causes resistant organisms compared to susceptible organisms are estimated at between $21 billion and 34 billion dollars 1Third, the prevalence of MDR bacteria is closely related to use of broad-spectrum antibiotics, both for experimental and definitive therapy. this Increased use in turn leads to higher rates of MDR bacteria, leading to virulent formation turn.

Typically, MDR bacteria are associated with nosocomial infections. However, some MDR bacteria have become very common causes of community-acquired infections. This an important development as the prevalence of MDR bacteria in the community leads to a significant increase in population at risk, and thus an increase in the number of injuries caused by MDR bacteria. In addition, when a specific resistance pattern occurs in bacteria causing a community acquired infection that exceeds a certain threshold, broader spectrum antibacterial and/or combination antibacterial therapy is indicated for trial treatment of community acquired infections. In this review, we will identify trends in and epidemiology of community spread of different MDR bacteria.

Multidrug resistant (MDR) bacteria are well-recognized to be one of the most important current public health problems. The Infectious Diseases Society of America (IDSA) recognizes antimicrobial resistance as ''one of the greatest threats to human health Worldwide'' . (Rippon et al .,2021; Song et al., 2020; Martin-Loeches et al., 2018; Van Duin et al., 2016).

References
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Abalkhail, A., AlYami, A. S., Alrashedi, S. F., Almushayqih, K. M., Alslamah, T., Alsalamah, Y. A., & Elbehiry, A. (2022). The prevalence of multidrug-resistant Escherichia coli producing ESBL among male and female patients with urinary tract infections in Riyadh Region, Saudi Arabia. In Healthcare 10(9):1778.

Alenazy, R. (2022). Drug efflux pump inhibitors: a promising approach to counter multidrug resistance in Gram-negative pathogens by targeting AcrB protein from AcrAB-TolC multidrug efflux pump from Escherichia coli. Biology, 11(9), 1328.

Cillóniz, C., Dominedò, C., & Torres, A. (2019). Multidrug resistant gram negative bacteria in community-acquired pneumonia. Annual Update in Intensive Care and Emergency Medicine 2019, 459-475.

Martin-Loeches, I., Rodriguez, A. H., & Torres, A. (2018). New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs. Europe. Current opinion in critical care, 24(5), 347-352.

Mitiku, A., Aklilu, A., Tsalla, T., Woldemariam, M., Manilal, A., & Biru, M. (2022). Magnitude and antimicrobial susceptibility profiles of Gram Negative bacterial isolates among patients suspected of urinary tract infections in Arba Minch General Hospital, southern Ethiopia. PLoS One, 17(12), e0279887.

Rippon, M. G., Rogers, A. A., & Ousey, K. (2021). Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)-coated wound dressings. Journal of wound care, 30(4), 284-296.

Song, M., Liu, Y., Huang, X., Ding, S., Wang, Y., Shen, J., & Zhu, K. (2020). A broad-spectrum antibiotic adjuvant reverses multidrug-resistant Gram-negative pathogens. Nature Microbiology, 5(8), 1040-1050.

Van Duin, D., & Paterson, D. L. (2016). Multidrug-resistant bacteria in the community: trends and lessons learned. Infectious disease clinics, 30(2), 377-390.