Review articleOccurrence and spread of antibiotic resistances in Enterococcus faecium
Introduction
Enterococci are Gram-positive, facultative anaerobic bacteria that live as part of the natural flora in the intestinal tract of animals and humans. Enterococci are normally considered as bacteria of low pathogenicity that only infect persons with special predispositions (e.g., immunocompromised patients in oncology, hematology, nephrology, or transplantation units). They can cause different infections, e.g., of the urinary tract and the bile trays, in wounds, and also life-threatening infections such as bacteremia or endocarditis. With about 12% frequency, they are the second to third most important bacterial genus in hospital infections Woodford, 1998, Linden and Miller, 1999. Of the 24 enterococcal species known until now, E. faecalis and E. faecium are the most important ones for infections in humans (Facklam et al., 2002).
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Natural and acquired antibiotic resistances in enterococci
Apart from several insusceptibilities to physico-chemical and environmental factors Murray, 1990, Devriese et al., 1993, Facklam et al., 2002, enterococci (especially E. faecium) possess a broad spectrum of natural and acquired antibiotic resistances Brunton, 1984, Murray, 1990, Woodford et al., 1995, Gold and Moellering, 1996, Rice and Bonomo, 1996, Klare and Witte, 1997, Quintiliani et al., 1999, Kak and Chow, 2002, Klare et al., 2002.
Spread of microbial antibiotic resistance genes
Resistance genes can be disseminated by two different ways: (i) by clonal dissemination of resistant isolates or (ii) by spread of resistance genes between different strains of the same or other species or genera (horizontal gene transfer).
Glycopeptide resistance genes
The first indication of a reservoir for GREF outside the hospital was the isolation of VanA-type E. faecium strains from waste water of a sewage treatment plant in a small German town which had no hospital (Klare et al., 1993). The assumption that the use of AVO as growth promoter in commercial animal husbandry could be responsible for this observation was emphasised by the isolation of VanA-type E. faecium strains from faecal samples of animals (pigs, chicken) in farms in which AVO was used.
Role of antibiotic selective pressure in dissemination of resistance in enterococci
As shown in this paper, different reservoirs exist for antibiotic-resistant enterococci.
First, the hospitals with their broad use of antibiotics, especially in medical intensive care units, appear to be important reservoirs. Because of the broad spectrum of natural and acquired antibiotic resistances, enterococci (and especially E. faecium) can be selected in these ecological niches. In parallel, there is a change in the types of the hospitalised patients during recent years; in connection with
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2022, New Microbes and New InfectionsCitation Excerpt :Vancomycin is a glycopeptide antibiotic which acts by inhibiting the cell wall biosynthesis of Gram-positive bacteria. This inhibition is based on binding to the terminus of the murein pentapeptide precursors, the D-alanyl-D-alanine, which is the target of glycopeptides [2,5]. However, after thirty years of glycopeptide use, the first vancomycin-resistant Enterococcus faecium (VREfm) emerged in 1986 [6].