ESKAPEE Microorganisms and the Art of Escape: From Antimicrobial Resistance Mechanisms to the One Health Approach

Abstract

Antimicrobial resistance (AMR) is a global public health challenge with remarkable impacts on human, animal, and environmental health within the One Health framework. Among the pathogens most frequently associated with healthcare-associated infections are bacteria belonging to the ESKAPEE group, which comprises Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli. These microorganisms are the main cause of severe infections and difficult-to-treat infections due to multidrug resistance phenotypes driven by complex molecular mechanisms, including enzymatic inactivation, target-site modification, permeability alterations, and biofilm formation. Through a One Health lens, this narrative review synthesizes current evidence on ESKAPEE microorganisms, bridging environmental reservoirs (such as wastewater) with clinical resistance mechanisms, their relevance in hospital settings, and therapeutic strategies. This review highlights the relationship between AMR in ESKAPEE bacteria and the One Health approach, emphasizing the need for integrated strategies to mitigate the spread of resistant pathogens across human, animal, and environmental interfaces.