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Mechanism of action: It targets D-Ala-D-Ala terminal of cell wall (peptidoglycan chain) inhibiting the transpeptidase activity. Thus they prevent the cross linking of peptidoglycans which results in poor cell wall synthesis. The resistance can arise by increasing the thickness of cell wall. Vancomycin binds to the D-ala-D-ala Polish Journal of Microbiology 2004, Vol. 53, No 4, 207-214 Mechanism of Vancomycin Resistance in Methicillin Resistant Staphylococcus aureus KRZYSZTOF SIERADZKI1 and ZDZIS£AW MARKIEWICZ2 1Rockefeller University, 1230 York Ave, 10021 New York, NY, USA 2Institute of Microbiology, Warsaw University, Miecznikowa 1, 02-096 Warsaw, Poland Received 29 August 2004 Germs Develop Antibiotic Resistance Select Germs Showing Resistance Over Time Since the discovery of penicillin more than 90 years ago, Daptomycin-resistant methicillin-resistant . Staphylococcus aureus. 23. 2004. Ceftazidime-avibactam. 2015; Ceftazidime-avibactam-resistant KPC-producing . Klebsiella pneumoniae. 24. 2015. Revised Dec. 2019. An understanding of the mechanism of methicillin resistance has led to the discovery of accessory factors that influence the level and nature of methicllin resistance. Accessory factors, such as Fem factors, provide possible new targets, while compounds that modulate methicillin resistance such as epicatechin gallate, derived from green tea, and corilagin, provide possible lead compounds for Methicillin-resistant S. aureus (MRSA) poses a significant and enduring problem to the treatment of infection by such strains. Resistance is usually conferred by the acquisition of a nonnative gene encoding a penicillin-binding protein (PBP2a), with significantly lower affinity for β-lactams. 21.- Peacock S J, Paterson G K. Mechanisms of methicillin resistance in Staphylococcus aureus. Annu Rev Biochem 2015; 84: 577-601. [ Links ] 22.- Acebrón I, Chang M, Mobashery S, Hermoso J A. The allosteric site for the nascent cell wall in penicillin-binding protein 2a:an Achilles' hell of methicillin-resistant Staphylococcus aureus. Methicillin resistance in Staphylococcus aureus requires glycosylated wall teichoic acids Stephanie Browna, Guoqing Xiab,1, Lyly G. Luhachackc, Jennifer Campbella, Timothy C. Mereditha, Calvin Chena, Volker Winstel b, Cordula Gekeler , Javier E. Irazoquic, Andreas Peschelb, and Suzanne Walkera,1 aDepartment of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115; bCellular Mechanism of RET resistance 1/3 isolates with resistance to RET harbored the lsaE gene, and the remaining two displayed negative findings for all the resistance mechanisms tested (Fig. 1 and Table 2). PFGE The 76 isolates with MUP, FA and/or RET resistance were divided into 16 patterns: type A-P (Fig. 1). β-Lactam-mediated inhibition of PBP TPase. (a) Mechanism of PBP-mediated β-lactam acylation and eventual hydrolysis.(b) Active site close-up of benzylpenicillin-bound Thermosynechococcus elongatus PBPA.The benzylpenicillin-bound PBPA active site (PDB ID: 2JBF) is depicted as a blue cartoon with selected active site residues shown as blue sticks with at