[Resistance to antibiotics caused by decrease of the permeability in gram-negative bacteria].

Due to their outer membrane, Gram negative bacteria are the only germs which can resist antibiotics by a mechanism of reduced permeability. This outer hydrophobic membrane allows hydrophilic molecules to pass only through its aqueous pores. The transmembrane pores have a trimere structure with a monomere component acting as an aqueous channel. Mean pore diameter is 1 to 1.2 nm. Changes in the absolute number of pores or in qualitative function reduce the diffusion of antibiotics entering the cell. This mechanism of reduced permeability can lead to cross resistance to several families of antibiotics. It is difficult to determine the clinical incidence since such resistances are not always detected. The species most often involved are enterobacteria including Klebsiella, Enterobacter, Serratia and Salmonella. For Pseudomonas aeruginosa, resistance to imipenem by reduced permeability results from a deficit in protein D2 and concerns 12 to 15% of the strains identified in French Hospitals. Reduced permeability is particularly effective when associated with another mechanism of resistance allowing the bacteria to express a higher level of resistance.