Brian Morgan – ESKAPE bacteria : Antibiotic resistance and the elephant in the room – Nov 2025
We have bacteria all around us, and they vary from actually helping us, as with our digestion for example, to just being present, as on our skin surfaces, and so on. They also vary from being harmless to being highly dangerous to us, as with the bacteria responsible for past epidemics, like cholera, smallpox and typhoid diseases.
However, many of the problems caused by harmful bacteria in the past were the result of unsanitary conditions such as crowded housing, contaminated water and low-grade sewage disposal, and the evidence of this can still be seen in the crowded cemeteries of the industrial towns, like Sheffield and Manchester. This situation also led in Victorian times to the countrywide development of Isolation Hospitals, and of wealthy employers building their own house on isolated hills, not as emblems of their social position and status as many of them were dissenters, but to protect their families.
Today, the causes of some of our currently predominant diseases are also man-made.
Historically, traditional treatments were used to tackle these diseases, but none were as effective as antibiotics when they first arrived, starting with sulphonamides and the penicillins. This gave us the “Golden Age” of antibiotics, especially as more were designed and developed. The Golden Age lasted from about 1938 to 1960, fortunately embracing the years of WW2, but finally dying away by approximately the late 1980’s due to antibiotic resistance developing in the diseases that they were treating.
Many new antibiotics were brought in after that, but antibiotic resistance led to their own doom as well. All forms of life face challenges, and part of the evolutionary process has included the ability to develop self-protective measures like the shells of turtles, the poison of some snakes, horns on cattle, etc., and taking many thousands of years to develop.
But with bacteria, that process is extremely quick, taking anywhere from days to months or a few years. Bacteria are able to develop ingenious methods of self-protection, like thickening their outer cell walls, developing enzymes to destroy invasive toxins, and creating internal “pumps” to expel the antibiotic out of the cell.
They have also greatly increased the protection they have when hiding away in biofilms. In a ‘biofilm’, cells of bacteria cluster together and protect their cluster by developing a thick outer layer, and attach themselves, mostly, to the stems of underwater plants and to river sediments, but can exist in any environment that provides moisture and a surface to adhere to.
Biofilms also increase the pathogenicity (danger) of bacteria to us, and this increase is known as antibiotic or antimicrobial resistance. Most of the bacteria which have troubled us are now highly resistant to most of our treatments. This has led to higher levels of disease, and the emergence of new diseases.
This was first described in 2008 by an American microbiologist named Louis B. Rice, and he introduced the concept of ESKAPE diseases, new virulent pathogenic forms of a group of bacteria starting with those letters. Here I will only use the initial names, as there are many sub-varieties that do not concern us here for the moment.
Enterococcus: as in Intestinal Enterococcus (IE), and used as an indicator of faecal contamination by the Environment Agency.
Staphylococcus: in two main forms MRSA and MSSA.
Klebsiella: a relatively new disease in the UK, so little early data available.
Acinetobacter: another relatively new disease here, although there have been a few earlier outbreaks, again with no early data.
Pseudomonas: now changed from a minor disease to a significant one.
Enterobacteria: also now changed to a significant disease in the UK.
ESKAPE bacteria.
Due to a degree of disagreement over classification, another ‘E’ has been added in some places to include E Coli (Escherichia coli), which is also used as an indicator of faecal contamination by the Environment Agency.
From this followed a stark warning in 2017 by the World Health Organisation about the developing dangers of these diseases, which have emerged in clinical settings in Europe and other parts of the world as a result of the widespread use and misuse of antibiotics. The WHO updated its warning in 2024.
These diseases are responsible for bloodstream infections, respiratory infections, urinary infections, as well as lodging in existing wounds where the skin is broken.
The whole picture of river-borne bacterial pathogenspathogens A virus, bacterium or parasite which causes disease is a pathogen. Disease causing pathogens live in the environment, and both humans and animals are hosts to them. Pathogenic viruses, bacteria and parasites are present in sewage, originating from humans and animals, and thus it is essential that sewage is given proper treatment in order to disable (kill) these pathogens before the end-products of sewage treatment (solids and water effluent) are returned to the environment. has changed completely over recent years, as was first admitted this year in government data. So also has our knowledge of how these diseases, predominantly from poorly treated sewage, are transmitted throughout our communities.
Apart from being carried by wildlife and birds, they are also going directly into the wind at lower levels across our communities. If you watch any river surface, you will often see small bubbles rising to the surface, known as bioaerosols. These also carry small particles of organic and inorganic matter, with bacteria attached, and they can be carried many miles.
Similar bioaerosols are carried from the surfaces of the sewage treatment works. I have developed my own small home laboratory, using the bacteriological knowledge that I also used in the Plymouth Marine Laboratory. By means of traditional stained agar plates and a microscope, I have personally checked and tested for these bioaerosols above the surfaces of rivers and throughout our communities, and have found these highly contagious bacteria to be present not only in bioaerosols, but also on bus and shop handrails, and in many other places.
These have led to community-based infections, and then leading, in turn, to hospital-spread and acquired infections. This is not due to lack of diligent care by the authorities. This is because they are now facing new challenges as the biofilms are highly resistant to even strong disinfectants.
Another issue is that of ‘double infections’, known as co-morbidities, which are becoming increasingly common. These are mostly, but not always, combinations of A and K bacteria (Acinetobacter and Klebsiella), and as no one is sure which of these is responsible, they are now classified as BSI’s (Blood Stream Infections). As a result, we lack current data on these rising diseases.
These pathogenic developments are now linked also to the overload in the critical care facilities in hospitals. Another issue is the parallel development of highly fatal sepsis, which is currently leading to approximately 48,500 deaths per year, along with another 26,203 cases of fatality, according to the Academy of Medical Colleges, where sepsis was mentioned on the same death certificate.
The prime cause of antibiotic-resistant bacteria, escalating to ESKAPE bacteria, has been the continuing overuse of antibiotics in farming and in our healthcare systems, regardless of the consequences.
Also, there is widescale and ongoing manufacture of traditional antibiotics in the Far East, and these products are being imported, too often illegally, into Europe.
Also, due to the potentially short use-period of newly developed antibiotics, there is little financial interest in creating new ones.
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References
Howard et al 2012. Acinetobacter baumannii: An emerging opportunistic pathogenpathogens A virus, bacterium or parasite which causes disease is a pathogen. Disease causing pathogens live in the environment, and both humans and animals are hosts to them. Pathogenic viruses, bacteria and parasites are present in sewage, originating from humans and animals, and thus it is essential that sewage is given proper treatment in order to disable (kill) these pathogens before the end-products of sewage treatment (solids and water effluent) are returned to the environment. PMC
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Elwakil et al 2023: Multidrug-Resistant Acinetobacter baumannii Infections in the United States versus Egypt: Trends and Potential Natural Products Solutions. https://pmc.ncbi.nlm.nih.gov/articles/PMC9854726/
ESKAPE- Wikipedia: https://wikipedia.org/wiki/ESKAPE
Ferreira et al 2025: Pathogen-pathogen interactions during co-infections. ISME Journal PMC : https://pmc.ncbi.nlm.nih.gov/articles/PMC12145878/
UK Government, 2023, Anti-microbial resistance in bioaerosols – towards a national surveillance strategy – report: https://assets.publishing.service.gov.uk/media/65366e760b53920013a92b7e/Antimicrobial_resistance_in_bioaerosols_-_towards_a_national_surveillance_strategy_-_report.pdf
Huang 2025:Global Trends in antimicrobial resistance of enterococcus faecium; a systematic review and meta-analysis of clinical isolates. Nat Inst Health: https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2025.1505674/full
UK Health and Security Agency (HSA) 2025, Bacteraemia case numbers and 30-day all cause mortalities: https://www.gov.uk/government/statistics/mrsa-mssa-and-e-coli-bacteraemia-and-c-difficile-infection-30-day-all-cause-fatality/30-day-all-cause-mortality-following-mrsa-mssa-and-gram-negative-bacteraemia-and-c-difficile-infections-2022-to-2023-report
UK HSA 2025, Laboratory Surveillance of blood stream infections in CCU’s May 2016 to Mar 2024: https://www.gov.uk/government/statistics/surveillance-of-bloodstream-infections-in-critical-care-england/surveillance-of-bloodstream-infections-in-critical-care-units-england-may-2016-to-march-2025
Fahy et al 2023, Hospital reservoirs of Multidrug resistant Acinetobacter species – The Elephant in the Room. Br J Biomed Sci vol 80: https://pubmed.ncbi.nlm.nih.gov/37020476/
Borchaloee 2023; Antibiotic Resistance and Biofilm Formation of Pseudomonas aeruginosa; a therapeutic challenge. Acquaint Publications: https://www.acquaintpublications.com/article/antibiotic_resistance_and_biofilm_formation_of_pseudomonas_aeruginosa_a_therapeutic_challenge_narrative_review
