The alarming antimicrobial resistance in ESKAPEE pathogens: Can essential oils come to the rescue?

Abstract

Antibiotics, considered as a backbone of modern clinical-medicines, are facing serious threats from emerging antimicrobial-resistance (AMR) in several bacteria from nosocomial and community origins and is posing a serious human-health concern. Recent commitment by the Heads of States at the United Nations General Assembly (UNGA, 2016) for coordinated efforts to curb such infections illustrates the scale of this problem. Amongst the drug-resistant microbes, major threat is posed by the group named as ESKAPEE, an acronym for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli, comprising high to critical drug-resistant, World Health Organization Critical Priority I and II pathogens. The drying pipeline of effective and new antibiotics has worsened the situation with looming threat of heading to a 'post-antibiotic era'. This necessitates novel and effective approaches to combat this life-threatening issue. Medicinal and aromatic plants are hailed as the reservoir of bioactive compounds and can serve as a source of antimicrobial compounds, and some recent leads show that essential oils (EOs) may provide an effective solution for tackling AMR. EOs have shown wide-spectrum antimicrobial potentials via targeting the major determinants of pathogenicity, drug-resistance and its spread including cell membrane, drug efflux pumps, quorum sensing, biofilms and R-plasmids. Latest reports confirm the EOs having strong direct-killing or re-sensitizing potentials to replace or rejuvenate otherwise fading antibiotics arsenal. We discuss herein possibilities of using EOs directly for antimicrobial potentials or in combination with antibiotics to potentiate the later for combating AMR in ESKAPEE pathogens. The current understandings, success stories and challenges for translational success have also been discussed.

Keywords: Antimicrobial resistance; Biofilm; Drug potentiation; Drug-resistance reversal; ESKAPEE pathogens; Efflux pumps; Essential oils; Quorum sensing; R-plasmids.