Abstract
Increased incidences of multidrug-resistant (MDR) microorganisms has
become a global health concern for humans, animals, and agriculture. The advent of
newer resistance mechanisms evolving in microorganisms at a high rate compared to
the treatments available urges the need to understand its origin and reservoirs. The
expanded use of antimicrobial drugs, inefficient diagnosis as well as broad use in
agriculture and veterinary contributes to the emergence of resistance in
microorganisms. Presently, almost all infectious agents (bacteria, fungi, and viruses)
have developed MDR. About 7 lac people die of bacterial resistance to antibiotics
every year, with an estimated ~10 million deaths by 2050. Similarly, MDR arising in
pathogenic fungi like Candida, Aspergillus, or Fusarium to the limited therapeutic
options is highly challenging. Bacteria and fungi develop resistance mainly due to
biofilm formation, increased efflux pump activity, drug target mutations, drug binding
alterations, chromosome abnormalities, and the ability to escape host immune defenses.
The co-existence of MDR bacteria and fungi forming biofilms is even much of an
alarm in medicinal applications. Apart from these, drug resistance to current antiviral
therapeutics has imposed significant risk amidst life-threatening diseases caused due to
viruses like HIV and influenza A. Owing to its severity and complexity, we aim to
illustrate the detailed mechanism and evolution of MDR in bacteria, fungi, and viruses.
We also review different approaches to deal with MDR, emphasizing alternatives,
vaccine development, global surveillance programs and stewardship measures to
combat resistance.