Antibiotic resistance in patients with liver cirrhosis: Prevalence and current approach to tackle

Figure 1 Antibiotic resistance pathways in bacteria. A: Intrinsic resistance mechanisms. 1: Decrease in bacterial wall permeability: suppression of porin expression, 2: Increase in efflux: activation of efflux pumps, 3: Alteration of antibiotic targets, 4: Antibiotic inactivation by enzymatic modifications, 5: Antibiotic hydrolysis; B: Acquired resistance mechanisms. 1: Decrease in bacterial wall permeability: mutations of porin-coding genes, 2: Increase in efflux: enhance efflux pump gene expression by acquiring additional genes via external DNA, 3: Alteration of antibiotic targets: mutations of genes that encode antibiotic targets, 4: Acquisition of additional ARGs via external DNA (plasmids and others), 5: Antibiotic hydrolysis: broadening of the substrate specificity of hydrolyses.