Hemolysin, HipA and virulence proteins have been involved in acute bacterial pathogenesis [1,2]. However, recent trends to blame mdr genes (amp, bla, cat, aac, dhfr, str, aph, aad, mcr) and drug effl ux genes (tet, mac, acr, mex, mtr) in bacterial pathogenesis have roared due to drug void [3-5]. We blame many toxins and regulatory genes as acute problem in recent bacterial pathogenesis while tremendous amount of transposes and insertion sequences may be serious concern for the alteration and transmission of genes. Now MDR bacteria were detected in river, sea and air as well as in hospital surgical and household matters, claiming 2000,000 deaths per year likely among the neonatal and elderly with weak immune system where 10-20 potent antibiotic therapy were failed [6-9]. So, we re-evaluated the status of mdr genes in plasmids and genome islands in association of toxins and regulatory genes. Before 1600s we do not know that microorganisms (virus,