Horizontal gene transfer
Horizontal gene transfer (HGT) is the transfer of genetic elements between cells other than parental inheritance. HGT is responsible for much of the spread of antibiotic resistance among bacteria. Gene cassettes containing antibiotic resistance genes, or other virulence factors such as exotoxins, can be transferred from cell to cell via phage, transduction, taken up from the environment, transformation, or by bacterial conjugation. The ability to transfer gene cassettes between organisms has played a large role in the evolution of prokaryotes. Many commensal organisms, such as "E. coli", regularly harbor one or more gene cassettes that convey antibiotic resistance. Horizontal transfer of genetic elements from non-pathogenic commensals to unrelated species results in highly virulent pathogens that can carry multiple antibiotic resistance genes. The increasing prevalence of resistance creates challenging questions for researchers and physicians.