Regulation of virulence and antibiotic resistance in Gram-positive microbes in response to cell wall-active antibioticsEvans, Jessica J.a; Bolz, Devin D.a,bCurrent Opinion in Infectious Diseases: June 2019 - Volume 32 - Issue 3 - p 217–222 doi: 10.1097/QCO.0000000000000542 PATHOGENESIS AND IMMUNE RESPONSE: Edited by Dennis L. Stevens and Dimitri A. Diavatopoulos Buy SDC Abstract Author InformationAuthors Article MetricsMetrics Purpose of review Antibiotic stress can evoke considerable genotypic and phenotypic changes in Gram-positive bacteria. Here, we review recent studies describing altered virulence expression in response to cell wall-acting antibiotics and discuss mechanisms that coordinate regulation of the antibiotic response. Recent findings Pleiotropic effects induced by antibiotic exposure include alterations to bacterial metabolism, cell wall structure and antibiotic resistance. In addition, subinhibitory concentrations of cell wall-active (CWA) antibiotics have increasingly been shown to induce the production of exotoxins and biofilm formation that may influence virulence. Remarkably, phenotypes associated with comparable antibiotic stresses can vary considerably, emphasizing the need to better understand the response to CWA antibiotics. Recent studies support both direct antibiotic recognition and recognition of antibiotic-induced stress to the bacterial cell wall. Specifically, bacterial two-component systems, penicillin-binding protein and serine/threonine kinase-associated kinases and conserved oxidative-stress sensors each contribute to modulating the antibiotic stress response. Summary Bacterial sensory systems and global regulators coordinate signaling in response to CWA antibiotics. Regulation of the antibiotic response is complex and involves integration of signals from multiple response pathways. A better definition of the antibiotic stress response among Gram-positive pathogens may yield novel therapeutic targets to counter antibiotic resistance and virulence factor expression. aIdaho Veterans Research and Education Foundation bInfectious Diseases Section, United States Department of Veterans Affairs, Boise, Idaho, USA Correspondence to Devin D. Bolz, Boise VA Medical Center, 500 W Fort St, MS151 Bldg 117, Boise, ID 83702, USA. Tel: +1 208 422 1000x4143; e-mail: email@example.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.