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. 2001 Mar-Apr;7(2):183–187. doi: 10.3201/eid0702.010205

Emergence of vancomycin-resistant enterococci.

L B Rice 1
PMCID: PMC2631700  PMID: 11294702

Abstract

Vancomycin and ampicillin resistance in clinical Enterococcus faecium strains has developed in the past decade. Failure to adhere to strict infection control to prevent the spread of these pathogens has been well established. New data implicate the use of specific classes of antimicrobial agents in the spread of vancomycin-resistant enterococci (VRE). Extended-spectrum cephalosporins and drugs with potent activity against anaerobic bacteria may promote infection and colonization with VRE and may exert different effects on the initial establishment and persistence of high-density colonization. Control of VRE will require better understanding of the mechanisms by which different classes of drugs promote gastrointestinal colonization.

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Selected References

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  1. Arthur M., Reynolds P., Courvalin P. Glycopeptide resistance in enterococci. Trends Microbiol. 1996 Oct;4(10):401–407. doi: 10.1016/0966-842X(96)10063-9. [DOI] [PubMed] [Google Scholar]
  2. Bartlett J. G., Chang T. W., Gurwith M., Gorbach S. L., Onderdonk A. B. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978 Mar 9;298(10):531–534. doi: 10.1056/NEJM197803092981003. [DOI] [PubMed] [Google Scholar]
  3. Boyce J. M., Mermel L. A., Zervos M. J., Rice L. B., Potter-Bynoe G., Giorgio C., Medeiros A. A. Controlling vancomycin-resistant enterococci. Infect Control Hosp Epidemiol. 1995 Nov;16(11):634–637. doi: 10.1086/647028. [DOI] [PubMed] [Google Scholar]
  4. Boyce J. M., Opal S. M., Chow J. W., Zervos M. J., Potter-Bynoe G., Sherman C. B., Romulo R. L., Fortna S., Medeiros A. A. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol. 1994 May;32(5):1148–1153. doi: 10.1128/jcm.32.5.1148-1153.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Boyce J. M. Vancomycin-resistant enterococcus. Detection, epidemiology, and control measures. Infect Dis Clin North Am. 1997 Jun;11(2):367–384. doi: 10.1016/s0891-5520(05)70361-5. [DOI] [PubMed] [Google Scholar]
  6. Brogard J. M., Jehl F., Pâris-Bockel D., Blicklé J. F., Adloff M., Monteil H. Biliary elimination of ceftazidime. J Antimicrob Chemother. 1987 May;19(5):671–678. doi: 10.1093/jac/19.5.671. [DOI] [PubMed] [Google Scholar]
  7. Carias L. L., Rudin S. D., Donskey C. J., Rice L. B. Genetic linkage and cotransfer of a novel, vanB-containing transposon (Tn5382) and a low-affinity penicillin-binding protein 5 gene in a clinical vancomycin-resistant Enterococcus faecium isolate. J Bacteriol. 1998 Sep;180(17):4426–4434. doi: 10.1128/jb.180.17.4426-4434.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chirurgi V. A., Oster S. E., Goldberg A. A., McCabe R. E. Nosocomial acquisition of beta-lactamase--negative, ampicillin-resistant enterococcus. Arch Intern Med. 1992 Jul;152(7):1457–1461. [PubMed] [Google Scholar]
  9. Coudron P. E., Markowitz S. M., Wong E. S. Isolation of a beta-lactamase-producing, aminoglycoside-resistant strain of Enterococcus faecium. Antimicrob Agents Chemother. 1992 May;36(5):1125–1126. doi: 10.1128/aac.36.5.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Donskey C. J., Hanrahan J. A., Hutton R. A., Rice L. B. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis. 1999 Aug;180(2):384–390. doi: 10.1086/314874. [DOI] [PubMed] [Google Scholar]
  11. Donskey C. J., Hanrahan J. A., Hutton R. A., Rice L. B. Effect of parenteral antibiotic administration on the establishment of colonization with vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis. 2000 May 15;181(5):1830–1833. doi: 10.1086/315428. [DOI] [PubMed] [Google Scholar]
  12. Donskey C. J., Schreiber J. R., Jacobs M. R., Shekar R., Salata R. A., Gordon S., Whalen C. C., Smith F., Rice L. B. A polyclonal outbreak of predominantly VanB vancomycin-resistant enterococci in northeast Ohio. Northeast Ohio Vancomycin-Resistant Enterococcus Surveillance Program. Clin Infect Dis. 1999 Sep;29(3):573–579. doi: 10.1086/598636. [DOI] [PubMed] [Google Scholar]
  13. Edmond M. B., Ober J. F., Weinbaum D. L., Pfaller M. A., Hwang T., Sanford M. D., Wenzel R. P. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis. 1995 May;20(5):1126–1133. doi: 10.1093/clinids/20.5.1126. [DOI] [PubMed] [Google Scholar]
  14. Eliopoulos G. M., Wennersten C., Moellering R. C., Jr Resistance to beta-lactam antibiotics in Streptococcus faecium. Antimicrob Agents Chemother. 1982 Aug;22(2):295–301. doi: 10.1128/aac.22.2.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Emori T. G., Gaynes R. P. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev. 1993 Oct;6(4):428–442. doi: 10.1128/cmr.6.4.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Evers S., Sahm D. F., Courvalin P. The vanB gene of vancomycin-resistant Enterococcus faecalis V583 is structurally related to genes encoding D-Ala:D-Ala ligases and glycopeptide-resistance proteins VanA and VanC. Gene. 1993 Feb 14;124(1):143–144. doi: 10.1016/0378-1119(93)90779-3. [DOI] [PubMed] [Google Scholar]
  17. Fontana R., Cerini R., Longoni P., Grossato A., Canepari P. Identification of a streptococcal penicillin-binding protein that reacts very slowly with penicillin. J Bacteriol. 1983 Sep;155(3):1343–1350. doi: 10.1128/jb.155.3.1343-1350.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Fontana R., Grossato A., Rossi L., Cheng Y. R., Satta G. Transition from resistance to hypersusceptibility to beta-lactam antibiotics associated with loss of a low-affinity penicillin-binding protein in a Streptococcus faecium mutant highly resistant to penicillin. Antimicrob Agents Chemother. 1985 Nov;28(5):678–683. doi: 10.1128/aac.28.5.678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Fraimow H. S., Venuti E. Inconsistent bactericidal activity of triple-combination therapy with vancomycin, ampicillin, and gentamicin against vancomycin-resistant, highly ampicillin-resistant Enterococcus faecium. Antimicrob Agents Chemother. 1992 Jul;36(7):1563–1566. doi: 10.1128/aac.36.7.1563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Grayson M. L., Eliopoulos G. M., Wennersten C. B., Ruoff K. L., De Girolami P. C., Ferraro M. J., Moellering R. C., Jr Increasing resistance to beta-lactam antibiotics among clinical isolates of Enterococcus faecium: a 22-year review at one institution. Antimicrob Agents Chemother. 1991 Nov;35(11):2180–2184. doi: 10.1128/aac.35.11.2180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hanrahan J., Hoyen C., Rice L. B. Geographic distribution of a large mobile element that transfers ampicillin and vancomycin resistance between Enterococcus faecium strains. Antimicrob Agents Chemother. 2000 May;44(5):1349–1351. doi: 10.1128/aac.44.5.1349-1351.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hayton W. L., Schandlik R., Stoeckel K. Biliary excretion and pharmacokinetics of ceftriaxone after cholecystectomy. Eur J Clin Pharmacol. 1986;30(4):445–451. doi: 10.1007/BF00607958. [DOI] [PubMed] [Google Scholar]
  23. Ingerman M., Pitsakis P. G., Rosenberg A., Hessen M. T., Abrutyn E., Murray B. E., Levison M. E. beta-Lactamase production in experimental endocarditis due to aminoglycoside-resistant Streptococcus faecalis. J Infect Dis. 1987 Jun;155(6):1226–1232. doi: 10.1093/infdis/155.6.1226. [DOI] [PubMed] [Google Scholar]
  24. Kees F., Strehl E., Dominiak P., Grobecker H., Seeger K., Seidel G., Neuhaus B., Safrany L. Cefotaxime and desacetyl cefotaxime in human bile. Infection. 1983 Mar-Apr;11(2):118–120. doi: 10.1007/BF01641077. [DOI] [PubMed] [Google Scholar]
  25. Ligozzi M., Aldegheri M., Predari S. C., Fontana R. Detection of penicillin-binding proteins immunologically related to penicillin-binding protein 5 of Enterococcus hirae ATCC 9790 in Enterococcus faecium and Enterococcus faecalis. FEMS Microbiol Lett. 1991 Oct 15;67(3):335–339. doi: 10.1016/0378-1097(91)90498-y. [DOI] [PubMed] [Google Scholar]
  26. Ligozzi M., Pittaluga F., Fontana R. Identification of a genetic element (psr) which negatively controls expression of Enterococcus hirae penicillin-binding protein 5. J Bacteriol. 1993 Apr;175(7):2046–2051. doi: 10.1128/jb.175.7.2046-2051.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Linden P. K., Pasculle A. W., Manez R., Kramer D. J., Fung J. J., Pinna A. D., Kusne S. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium. Clin Infect Dis. 1996 Apr;22(4):663–670. doi: 10.1093/clinids/22.4.663. [DOI] [PubMed] [Google Scholar]
  28. Massidda O., Kariyama R., Daneo-Moore L., Shockman G. D. Evidence that the PBP 5 synthesis repressor (psr) of Enterococcus hirae is also involved in the regulation of cell wall composition and other cell wall-related properties. J Bacteriol. 1996 Sep;178(17):5272–5278. doi: 10.1128/jb.178.17.5272-5278.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Moellering R. C., Jr Enterococcal infections in patients treated with moxalactam. Rev Infect Dis. 1982 Nov-Dec;4 (Suppl):S708–S711. doi: 10.1093/clinids/4.supplement_3.s708. [DOI] [PubMed] [Google Scholar]
  30. Moreno F., Grota P., Crisp C., Magnon K., Melcher G. P., Jorgensen J. H., Patterson J. E. Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium during its emergence in a city in southern Texas. Clin Infect Dis. 1995 Nov;21(5):1234–1237. doi: 10.1093/clinids/21.5.1234. [DOI] [PubMed] [Google Scholar]
  31. Morris J. G., Jr, Shay D. K., Hebden J. N., McCarter R. J., Jr, Perdue B. E., Jarvis W., Johnson J. A., Dowling T. C., Polish L. B., Schwalbe R. S. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Ann Intern Med. 1995 Aug 15;123(4):250–259. doi: 10.7326/0003-4819-123-4-199508150-00002. [DOI] [PubMed] [Google Scholar]
  32. Murray B. E., Mederski-Samaroj B. Transferable beta-lactamase. A new mechanism for in vitro penicillin resistance in Streptococcus faecalis. J Clin Invest. 1983 Sep;72(3):1168–1171. doi: 10.1172/JCI111042. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Murray B. E. The life and times of the Enterococcus. Clin Microbiol Rev. 1990 Jan;3(1):46–65. doi: 10.1128/cmr.3.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pallares R., Pujol M., Peña C., Ariza J., Martin R., Gudiol F. Cephalosporins as risk factor for nosocomial Enterococcus faecalis bacteremia. A matched case-control study. Arch Intern Med. 1993 Jul 12;153(13):1581–1586. [PubMed] [Google Scholar]
  35. Quale J., Landman D., Atwood E., Kreiswirth B., Willey B. M., Ditore V., Zaman M., Patel K., Saurina G., Huang W. Experience with a hospital-wide outbreak of vancomycin-resistant enterococci. Am J Infect Control. 1996 Oct;24(5):372–379. doi: 10.1016/s0196-6553(96)90025-5. [DOI] [PubMed] [Google Scholar]
  36. Quale J., Landman D., Saurina G., Atwood E., DiTore V., Patel K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis. 1996 Nov;23(5):1020–1025. doi: 10.1093/clinids/23.5.1020. [DOI] [PubMed] [Google Scholar]
  37. Rice L. B., Marshall S. H. Evidence of incorporation of the chromosomal beta-lactamase gene of Enterococcus faecalis CH19 into a transposon derived from staphylococci. Antimicrob Agents Chemother. 1992 Sep;36(9):1843–1846. doi: 10.1128/aac.36.9.1843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Roghmann M. C., Qaiyumi S., Johnson J. A., Schwalbe R., Morris J. G., Jr Recurrent vancomycin-resistant Enterococcus faecium bacteremia in a leukemia patient who was persistently colonized with vancomycin-resistant enterococci for two years. Clin Infect Dis. 1997 Mar;24(3):514–515. doi: 10.1093/clinids/24.3.514. [DOI] [PubMed] [Google Scholar]
  39. Rybkine T., Mainardi J. L., Sougakoff W., Collatz E., Gutmann L. Penicillin-binding protein 5 sequence alterations in clinical isolates of Enterococcus faecium with different levels of beta-lactam resistance. J Infect Dis. 1998 Jul;178(1):159–163. doi: 10.1086/515605. [DOI] [PubMed] [Google Scholar]
  40. Schaberg D. R., Culver D. H., Gaynes R. P. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991 Sep 16;91(3B):72S–75S. doi: 10.1016/0002-9343(91)90346-y. [DOI] [PubMed] [Google Scholar]
  41. Shlaes D. M., Etter L., Gutmann L. Synergistic killing of vancomycin-resistant enterococci of classes A, B, and C by combinations of vancomycin, penicillin, and gentamicin. Antimicrob Agents Chemother. 1991 Apr;35(4):776–779. doi: 10.1128/aac.35.4.776. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Slaughter S., Hayden M. K., Nathan C., Hu T. C., Rice T., Van Voorhis J., Matushek M., Franklin C., Weinstein R. A. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med. 1996 Sep 15;125(6):448–456. doi: 10.7326/0003-4819-125-6-199609150-00004. [DOI] [PubMed] [Google Scholar]
  43. Taylor E. W., Poxon V., Alexander-Williams J., Jackson D. Biliary excretion of piperacillin. J Int Med Res. 1983;11(1):28–31. doi: 10.1177/030006058301100106. [DOI] [PubMed] [Google Scholar]
  44. Williamson R., Calderwood S. B., Moellering R. C., Jr, Tomasz A. Studies on the mechanism of intrinsic resistance to beta-lactam antibiotics in group D streptococci. J Gen Microbiol. 1983 Mar;129(3):813–822. doi: 10.1099/00221287-129-3-813. [DOI] [PubMed] [Google Scholar]
  45. Yu V. L. Enterococcal superinfection and colonization after therapy with moxalactam, a new broad-spectrum antibiotic. Ann Intern Med. 1981 Jun;94(6):784–785. doi: 10.7326/0003-4819-94-6-784. [DOI] [PubMed] [Google Scholar]
  46. Zorzi W., Zhou X. Y., Dardenne O., Lamotte J., Raze D., Pierre J., Gutmann L., Coyette J. Structure of the low-affinity penicillin-binding protein 5 PBP5fm in wild-type and highly penicillin-resistant strains of Enterococcus faecium. J Bacteriol. 1996 Aug;178(16):4948–4957. doi: 10.1128/jb.178.16.4948-4957.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]

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