Antimicrobial tolerance and its role in the development of resistance: lessons from enterococci

Rachel Darnell, Olivia Paxie, Francesca Todd Rose, Sali Morris, Alexandra Krause, Ian Monk, Matigan Smith, Timothy Stinear, Gregory M Cook, Susanne Gebhard

Research output: Chapter or section in a book/report/conference proceedingChapter or section

2 Citations (SciVal)


Bacteria have developed resistance against every antimicrobial in clinical use at an alarming rate. There is a critical need for more effective use of antimicrobials to both extend their shelf life and prevent resistance from arising. Significantly, antimicrobial tolerance, i.e., the ability to survive but not proliferate during antimicrobial exposure, has been shown to precede the development of bona fide antimicrobial resistance (AMR), sparking a renewed and rapidly increasing interest in this field. As a consequence, problematic infections for the first time are now being investigated for antimicrobial tolerance, with increasing reports demonstrating in-host evolution of antimicrobial tolerance. Tolerance has been identified in a wide array of bacterial species to all bactericidal antimicrobials. Of particular interest are enterococci, which contain the opportunistic bacterial pathogens Enterococcus faecalis and Enterococcus faecium. Enterococci are one of the leading causes of hospital-acquired infection and possess intrinsic tolerance to a number of antimicrobial classes. Persistence of these infections in the clinic is of growing concern, particularly for the immunocompromised. Here, we review current known mechanisms of antimicrobial tolerance, and include an in-depth analysis of those identified in enterococci with implications for both the development and prevention of AMR.
Original languageEnglish
Title of host publicationAdvances in Microbial Physiology
Publication statusE-pub ahead of print - 19 Jul 2022

Publication series

NameAdvances in Microbial Physiology
ISSN (Print)0065-2911


  • Antimicrobial resistance
  • Antimicrobial tolerance
  • Enterococcus
  • Mechanisms

ASJC Scopus subject areas

  • Microbiology
  • Physiology


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