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2026№1

A modern view of the pathogenesis of ESKAPE-caused sepsis

DOI
https://dx.doi.org/10.18565/epidem.2026.16.1.80-87

Morozov A.M., Sergeev A.N., Rodionova Yu.Ya., Uzhov M.A.

1) Tver State Medical University, Ministry of Health of the Russia, Tver, Russia; 2) City Clinical Hospital №. 7, Tver, Russia
This article presents a review of current literature on the pathogenesis of ESKAPE-caused sepsis. eLibrary and PubMed databases for the past 5 years were used. The methodology included a systematic search using keywords, selection of peer-reviewed articles, analysis of data on etiology and antibacterial resistance, and systematization of information to identify general trends and formulate recommendations.
Despite the rapid advancement of medicine and the introduction of modern diagnostic and treatment methods, sepsis remains a pressing issue. The WHO has identified several key bacterial pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomanas aeruginosa, and Enterobacter spp., and grouped them under the acronym ESKAPE. As a result of excessive and not always justified use of antibacterial therapy, the most common pathogens, grouped into the ESKAPE complex, have acquired resistance to most classes of antibacterial drugs, in some cases reaching panresistance, significantly complicating treatment.

Keywords

sepsis
pathogenesis
infection
ESKAPE
antibiotic resistance
infections
Full text (in Russian)

References

  1. Dyck B., Unterber, M., Adamzik M., Koos B. The Impact of Pathogens on Sepsis Prevalence and Outcome. Pathogens (Basel, Switzerland) 2024; 13(1): 89. DOI: 10.3390/pathogens13010089
  2. Петухова И.Н., Григорьевская З.В., Сытов А.В., Багирова Н.С., Агинова В.В., Кононец П.В. Сепсис, септический шок. Возбудитель инфекции: есть ли разница в подходах? Как быть с карбапенем-резистентными возбудителями? Злокачественные опухоли 2022; 3(1): 76–87. [Petukhova I.N., Grigorievskaya Z.V., Sitov A.V., Bagirova N.S., Aginova V.V., Kononets P.V. Sepsis, septic shock. The causative agent of infection: is there a difference in approaches? What about carbapenem-resistant pathogens? Malignant tumours 2022; 12(3s1): 76–87. (In Russ.)]. DOI: 10.18027/2224-5057-2022-12-3s1-76-87
  3. Liu D., Huang S.Y., Sun J.H., Zhang H.C., Cai Q.L., Gao C. Sepsis-induced immunosuppression: mechanisms, diagnosis and current treatment options. Mil. Med. Res. 2022; 9(1): 56. DOI: 10.1186/s40779-022-00422-y
  4. Борисов И.В., Митиш В.А., Пасхалова Ю.С. Анализ раневых инфекций при боевой травме в США (обзор литературы). Раны и раневые инфекции. Журнал имени профессора Б.М. Костюченка 2024; 11(2): 6–12. [Borisov I.V., Mitish V.A., Paskhalova Yu.S. Analysis of wound infections in combat injuries in US (literature review). Wounds and wound infections. The prof. B.M. Kostyuchenok journal 2024; 11(2): 6¬12. (In Russ.)]. DOI: 10.25199/2408-9613-2024-11-2-6-12
  5. Багненко С.Ф., Горобец Е.С., Гусаров В.Г., Дехнич А.В., Дибиров М.Д., Ершова О.Н. и др. Клинические рекомендации «Сепсис (у взрослых)». Вестник анестезиологии и реаниматологии 2025; 22(1): 81–109. [Bagnenko S.F., Gorobets E.S., Gusarov V.G., Dekhnich A.V., Dibirov M.D., Ershova O.N. et al. Clinical guidelines «Sepsis (in adults)». Messenger of anesthesiology and resuscitation 2025; 22(1): 80–109. (In Russ.)]. DOI: 10.24884/2078-5658-2025-22-1-81-109
  6. Srzić I., Nesek Adam V., Tunjić Pejak D. Sepsis definition: what’s new in the treatment guidelines. Acta Clin. Croat. 2022; 61(Suppl 1): 67–72. DOI: 10.20471/acc.2022.61.s1.11
  7. Притуло Л.Ф., Акмоллаев Д.С. Современные представления о диагностике сепсиса у детей. Таврический медико-биологический вестник 2023; 26(2): 92–100. [Pritullo L.F., Akmollaev D.S. Modern concepts of the diagnosis of sepsis in children. Tavricheskiy Mediko-Biologicheskiy Vestnik 2023; 26(2): 92–100. (In Russ)]. DOI: 10.29039/2070-8092-2023-26-2-92-100
  8. Котив Б.Н., Гумилевский Б.Ю., Иванов Ф.В. Современные представления о сепсисе (обзор литературы). Вестник новых медицинских технологий 2022; (3): 32–37. [Kotiv B.N., Gumilevsky B.Y., Ivanov F.V. Modern ideas about sepsis (literature review). Journal of New Medical Technologies 2022; (3): 32–37. (In Russ)]. DOI: 10.24412/1609-2163-2022-3-32-37.
  9. Ayobami O., Brinkwirth S., Eckmanns T., Markwart R. Antibiotic resistance in hospital-acquired ESKAPE-E infections in low- and lower-middle-income countries: a systematic review and meta-analysis. Emerg. Microbes Infect. 2022; 11(1): 443–451. DOI: 10.1080/22221751.2022.2030196
  10. Holmes C.L., Anderson M.T., Mobley H.L.T., Bachman M.A. Pathogenesis of Gram-Negative Bacteremia. Clin. Microbiol. Rev. 2021; 34(2): e00234-20. DOI: 10.1128/CMR.00234-20
  11. Swets M.C., Bakk Z., Westgeest A.C., Berry K., Cooper G., Sim W. et al. Clinical Subphenotypes of Staphylococcus aureus Bacteremia. Clin. Infect. Dis. 2024; 79(5): 1153–1161. DOI: 10.1093/cid/ciae338
  12. Mancuso G., Midiri A., Gerace E., Biondo C. Bacterial Antibiotic Resistance: The Most Critical Pathogens. Pathogens 2021; 10(10): 1310. DOI: 10.3390/pathogens10101310
  13. Орлова О.А., Семененко Т.А., Акимкин В.Г., Юмцунова Н.А. Клинико-эпидемиологическая характеристика катетер-ассоциированных инфекций кровотока у пациентов онкогематологического профиля. Медицинский алфавит 2020; (34): 9–12. [Orlova O.A., Semenenko T.A., Akimkin V.G., Yumtsunova N.A. Clinical and epidemiological characteristics of catheter-associated bloodstream infections in patients with hematological profile. Medical alphabet 2020; (34): 9–12. (In Russ.)]. DOI: 10.33667/2078-5631-2020-34-9-12
  14. Alshahrani K.M., Alhuwaishel A.Z., Alangari N.M., Asiri M.A., Al-Shahrani N.A., Alasmari A.A. et al. Clinical Impacts and Risk Factors for Central Line-Associated Bloodstream Infection: A Systematic Review. Cureus 2023; 15(6): e40954. DOI: 10.7759/cureus.40954
  15. Catho G., Rosa Mangeret F., Sauvan V., Chraïti M.N., Pfister R., Baud O. et al. Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters. J. Hosp. Infect. 2023; 139: 6–10. DOI: 10.1016/j.jhin.2023.06.011
  16. Huang H., Chang Q., Zhou Y., Liao L. Risk factors of central catheter bloodstream infections in intensive care units: A systematic review and meta-analysis. PLoS One 2024; 19(4): e0296723. DOI: 10.1371/journal.pone.0296723
  17. Moriyama K., Ando T., Kotani M., Tokumine J., Nakazawa H., Motoyasu A. et al. Risk factors associated with increased incidences of catheter-related bloodstream infection. Medicine (Baltimore) 2022; 101(42): e31160. DOI: 10.1097/MD.0000000000031160
  18. Морозов А.М., Сергеев А.Н., Червинец Ю.В., Фисюк Е.А. Актуальные возбудители инфекций области хирургического вмешательства. Эпидемиол. инфекц. болезни. Актуал. Вопр. 2025; 15(2): 90–97. [Morozov A.M., Sergeev A.N., Chervinets J.V., Fisyuk E.A. Current pathogens of surgical site infections. Epidemiology and infectious diseases. Current items. 2025; 15(2): 90–97. (In Russ.)]. DOI: 10.18565/epidem.2025.15.2.90-97
  19. Морозов А.М., Аскеров Э.М., Алоян С.А., Бутнару А.П., Морозова А.Д. Триггерные факторы развития инфекции области хирургического вмешательства. Врач 2024; 35(5): 78–84. [Morozov А.М., Askerov E.М., Aloyan S.А., Butnaru А.P., Morozova А.D. Triggering factors for the development of infection areas of surgical intervention. Vrach 2024; 35(5): 78–84. (In Russ.)]. DOI: 10.29296/25877305-2024-05-14
  20. Самодова О.В., Кригер Е.А., Емельянцев А.В., Якушева Е.Е., Харитонова К.В. Фульминантная пурпура – менингококковая инфекция или постспленэктомический сепсис. Журнал инфектологии 2023; 15(4): 140–147. [Samodova O.V., Krieger E.A., Emel’yancev A.V., Yakusheva E.E., Haritonova K.V. Purpura fulminans – meningococcal infection or postsplenectomy sepsis. Journal Infectology 22023; 15(4): 140–147. (In Russ.)]. DOI: 10.22625/2072-6732-2023-15-4-140-147
  21. Kwiecinski J.M., Horswill A.R. Staphylococcus aureus bloodstream infections: pathogenesis and regulatory mechanisms. Curr. Opin. Microbiol. 2020; 53: 51–60. DOI: 10.1016/j.mib.2020.02.005
  22. Bai A.D., Lo C.K.L., Komorowski A.S., Suresh M., Guo K., Garg A. et al. Staphylococcus aureus bacteraemia mortality: a systematic review and meta-analysis. Clin. Microbiol. Infect. 2022; 28(8): 1076–1084. DOI: 10.1016/j.cmi.2022.03.015
  23. Chen H., Zhang J., He Y., Lv Z., Liang Z., Chen J. et al. Exploring the Role of Staphylococcus aureus in Inflammatory Diseases. Toxins (Basel) 2022; 14(7): 464. DOI: 10.3390/toxins14070464
  24. Pucci R., Cassoni A., Di Carlo D., Bartolucci P., Della Monaca M. Odontogenic-Related Head and Neck Infections: From Abscess to Mediastinitis: Our Experience, Limits, and Perspectives-A 5-Year Survey. Int. J. Environ. Res. Public Health 2023; 20(4): 3469. DOI: 10.3390/ijerph20043469
  25. Yoshizawa K., Hanihara M., Harada D., Myose N., Sakata H., Moriguchi T. et al. Meningitis with septic shock resulting from odontogenic infection misdiagnosed as closed-lock in temporomandibular disorder: A case report and literature review. Medicine (Baltimore) 2023; 102(27): e34177. DOI: 10.1097/MD.0000000000034177
  26. Chen Z., Ye T., He Y., Pan A., Mei Q. Use of pus metagenomic next-generation sequencing for efficient identification of pathogens in patients with sepsis. Folia Microbiol. (Praha) 2024; 69(5): 1003–1011. DOI: 10.1007/s12223-024-01134-7
  27. Castillo Y., Delgadillo N.A., Neuta Y., Hernández A., Acevedo T., Cárdenas E. et al. Antibiotic Susceptibility and Resistance Genes in Oral Clinical Isolates of Prevotella intermedia, Prevotella nigrescens and Prevotella melaninogenica. Antibiotics 2022; 11(7): 888. DOI: 10.3390/antibiotics11070888
  28. Neal T.W., Schlieve T. Complications of Severe Odontogenic Infections: A Review. Biology (Basel) 2022; 11(12): 1784. DOI: 10.3390/biology11121784
  29. Морозов А.М., Беляк М.А., Соболь Е.А., Пискарева М.Е., Морозова А.Д. Анализ микробиоты кожи пациента и его роль в клинической практике. Врач 2023; 34(2): 10–14. [Morozov A.M., Belyak M.A., Sobol E.A., Piskareva M.E., Morozova A.D. Skin microbiota analysis in a patient and its role in clinical practice. Vrach 2023; 34(2): 10–14. (In Russ.)]. DOI: 10.29296/25877305-2023-02-02
  30. Assoni L., Girardello R., Converso T.R., Darrieux M. Current Stage in the Development of Klebsiella pneumoniae. Infect. Dis. Ther. 2021; 10(4): 2157–2175. DOI: 10.1007/s40121-021-00533-4
  31. Li Y., Kumar S., Zhang L., Wu H., Wu H. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae. Open. Med. (Wars) 2023; 18(1): 20230707. DOI: 10.1515/med-2023-0707
  32. Seo H., Bae S., Kim M.J., Chong Y.P., Kim S.H., Lee S.O. et al. Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia. Infect. Chemother. 2021; 53(3): 528–538. DOI: 10.3947/ic.2021.0083
  33. Обедин А.Н., Васильев А.Ю. Значимость новых маркеров для диагностики неонатального сепсиса. Анестезиология и реаниматология 2021; (2): 45–49. [Obedin A.N., Vasiliev A.Yu. Significance of new markers for the diagnosis of neonatal sepsis. Russian Journal of Anesthesiology and Reanimatology 2021; (2): 45–49. (In Russ.)]. DOI: 10.17116/anaesthesiology202102145
  34. Образцов И.В., Жиркова Ю.В., Черникова Е.В., Крапивкин А.И., Брунова О.Ю., Абдраисова А.Т. и др. Значение функционального анализа фагоцитов для диагностики неонатального сепсиса. Российский вестник перинатологии и педиатрии 2023; 68(1): 24–29. [Obraztsov I.V., Zhirkova Yu.V., Chernikova E.V., Krapivkin A.I., Brunova O.Yu., Abdraisova A.T. et al. Feasibility of phagocytes functional testing in neonatal sepsis diagnostics. Russian Bulletin of Perinatology and Pediatrics 2023; 68(1): 24–29. (In Russ.)]. DOI: 10.21508/1027-4065-2023-68-1-24-29
  35. Hensler E., Petros H., Gray C.C., Chung C.S., Ayala A., Fallon E.A. The Neonatal Innate Immune Response to Sepsis: Checkpoint Proteins as Novel Mediators of This Response and as Possible Therapeutic/Diagnostic Levers. Front. Immunol. 2022; 13: 940930. DOI: 10.3389/fimmu.2022.940930
  36. Gonzalez-Ferrer S., Peñaloza H.F., Budnick J.A., Bain W.G., Nordstrom H.R., Lee J.S. et al. Finding Order in the Chaos: Outstanding Questions in Klebsiella pneumoniae Pathogenesis. Infect. Immun. 2021; 89(4): e00693-20. DOI: 10.1128/IAI.00693-20
  37. Shi J., Cheng J., Liu S., Zhu Y., Zhu M. Acinetobacter baumannii: an evolving and cunning opponent. Front. Microbiol. 2024; 15: 1332108. DOI: 10.3389/fmicb.2024.1332108
  38. Gedefie A., Demsis W., Ashagrie M., Kassa Y., Tesfaye M., Tilahun M. et al. Acinetobacter baumannii Biofilm Formation and Its Role in Disease Pathogenesis: A Review. Infect. Drug Resis. 2021; 14: 3711–3719. DOI: 10.2147/IDR.S332051
  39. Баранцевич Н.Е., Иванова Л.В., Баранцевич Е.П. Acinetobacter baumannii: механизмы антимикробной резистентности. Антибиотики и Химиотерапия 2024; 69(11–12): 93–100. [Barantsevich N.E., Ivanova L.V., Barantsevich E.P. Acinetobacter baumannii: Mechanisms of Antimicrobial Resistance. Antibiotics and Chemotherapy 2024; 69(11–12): 93–100. (In Russ.)]. DOI: 10.37489/0235-2990-2024-69-11-12-93-100
  40. Castanheira M., Mendes R.E., Gales A.C. Global Epidemiology and Mechanisms of Resistance of Acinetobacter baumannii-calcoaceticus Complex. Clin. Infect. Dis. 2023; 76(Suppl 2): S166–S178. DOI: 10.1093/cid/ciad109
  41. Садеева З.З., Новикова И.Е., Алябьева Н.М., Лазарева А.В., Комягина Т.М., Карасева О.В. и др. Acinetobacter baumannii при инфекциях кровотока и центральной нервной системы у детей в отделениях реанимации и интенсивной терапии: молекулярно-генетическая характеристика и клиническая значимость. Инфекция и иммунитет 2023; 13(2): 289–301. [Sadeeva Z.Z., Novikova I.E., Alyabyeva N.M., Lazareva A.V., Komyagina T.M., Karaseva O.V. et al. Acinetobacter baumannii in blood-borne and central nervous system infections in intensive care unit children: molecular and genetic characteristics and clinical significance]. Russian Journal of Infection and Immunity 2023; 13(2): 289–301. (In Russ.)]. DOI: 10.15789/2220-7619-ABI-2091
  42. Tuon F.F., Dantas L.R., Suss P.H., Tasca Ribeiro V.S. Pathogenesis of the Pseudomonas aeruginosa Biofilm: A Review. Pathogens 2022; 11(3): 300. DOI: 10.3390/pathogens11030300
  43. Ng Q.X., Ong N.Y., Lee D.Y.X., Yau C.E., Lim Y.L., Kwa A.L.H. et al. Trends in Pseudomonas aeruginosa (P. aeruginosa) Bacteremia during the COVID-19 Pandemic: A Systematic Review. Antibiotics (Basel) 2023; 12(2): 409. DOI: 10.3390/antibiotics12020409
  44. Малыгин А.С., Лысенко М.А., Царенко С.В., Филимонова Е.В. Исследование случаев бактериемии Pseudomonas aeruginosa у больных с тяжелым течением COVID-19. Инфекционные болезни: Новости, Мнения, Обучение 2022; 11(4): 47–55. [Malygin A.S., Lysenko M.A., Tsarenko S.V., Filimonova E.V. Investigation of cases of Pseudomonas aeruginosa bacteremia in patients with severe COVID-19. Infectious diseases: News, Opinions, Education 2022; 11(4): 47–55. (In Russ.)]. DOI: 10.33029/2305-3496-2022-11-4-47-55
  45. Bengtsen M.B., Farkas D.K., Borre M., Sørensen H.T., Nørgaard M. Acute urinary retention and risk of cancer: population based Danish cohort study. BMJ 2021; 375: n2305. DOI: 10.1136/bmj.n2305
  46. Литвинов В.В., Лемкина Л.М., Фрейнд Г.Г., Коробов В.П. Морфологическая характеристика экспериментальной катетер-ассоциированной инфекции на фоне иммуносупрессии и применения низкомолекулярного катионного пептида семейства лантибиотиков – варнерина. Клин. эксп. морфология 2021; 10(4): 14–24. [Litvinov V.V., Lemkina L.M., Freund G.G., Korobov V.P. Morphological characteristics of an experimental catheter-associated infection against the background of immunosuppression and the use of a low-molecular-weight cationic peptide of the lantibiotic family, varnerin. Clinical and Experimental Morphologyy 2021; 10(4): 14–24. (In Russ.)]. DOI: 10.31088/CEM2021.10.4.14-24
  47. Rajaramon S., Shanmugam K., Dandela R., Solomon A.P. Emerging evidence-based innovative approaches to control catheter-associated urinary tract infection: a review. Front. Cell. Infect. Microbiol. 2023; 13: 1134433. DOI: 10.3389/fcimb.2023.1134433
  48. Pakbin B., Brück W.M., Rossen J.W.A. Virulence Factors of Enteric Pathogenic Escherichia coli: A Review. Int. J. Mol. Sci. 2021; 22(18): 9922. DOI: 10.3390/ijms22189922
  49. Shields A., de Assis V., Halscott T. Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis. Obstet. Gynecol. 2021; 138(2): 289–304. DOI: 10.1097/AOG.0000000000004471Nayak
  50. Скворцов В.В., Скворцова Е.М., Стаценко И.Ю., Разваляева О.В., Дурноглазова К.А. Воспалительные заболевания органов малого таза и их терапия в амбулаторных условиях. Врач 2022; 33(8): 19–22. [Skvortsov V.V., Skvortsova E.M., Statsenko I.Yu., Razvalyaeva O.V. Pelvic inflammatory diseases and their treatment in outpatient settings. Vrach 2022; 33(8): 19–22. (In Russ.)]. DOI: 10.29296/25877305-2022-08-03

About the Authors

Artem M. Morozov, Cand. Med. Sci., Associate Professor, Associate Professor of the Department of General Surgery, Tver State Medical University, Ministry of Health of the Russia; Doctor-Surgeon, City Clinical Hospital № 7, Tver, Russia; ammorozovv@gmail.com; https://orcid.org/0000-0003-4213-5379
Alexey N. Sergeev, Cand. Med. Sci., Associate Professor, Head, Department of General Surgery, Tver State Medical University, Ministry of Health of the Russia; Doctor-Surgeon, City Clinical Hospital № 7, Tver, Russia; dr.nikolaevich@mail.ru, https://orcid.org/0000-0002-9657-8063
Yulia Y. Rodionova, 5th year Student, Tver State Medical University, Ministry of Health of the Russia, Tver, Russia; yulay_rodionova1403@mail.ru; https://orcid.org/0009-0005-2613-1310
Matvey A. Uzhov, 5th year Student, Tver State Medical University, Ministry of Health of the Russia, Tver, Russia; uzhov04@mail.ru; https://orcid.org/0009-0006-3550-821X

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