The resistance is driven by the production of ?-lactamases (such as OXA-10 and PER-1), efflux pumps like the AcrAB-TolC system, and mutations in the gyrA and parC genes, which decrease fluoroquinolone effectiveness. The bacterium also forms biofilms on medical devices, providing protection against both antibiotics and the host immune system. In recent years, extensively drug-resistant (XDR) strains have emerged, showing very limited susceptibility to most available antibiotics.

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