Epidemiology and mechanisms of glycopeptide resistance in enterococci.
OBJECTIVE
This review updates epidemiologic trends and our understanding of glycopeptide resistance in enterococci.


RESULTS
Colonization and infection rates with vancomycin resistant enterococci continue to increase throughout the world while factors contributing to this rise continue to be defined. While no interventions exist to eradicate colonization, infection control procedures are cost effective and decrease the prevalence of vancomycin resistant enterococcal colonization and infection. New molecular methods show great promise in strengthening our ability to detect colonization with these bacteria. Furthermore, our understanding of the origin of vancomycin resistant enterococci continues to grow. Paenibacillus species found in soil have been found to carry homologues of vanA-associated glycopeptide resistance genes found in enterococci. Also, additional evidence supports previous data that VanB-associated resistance may have been horizontally transferred from gastrointestinal tract bacteria to enterococci. Finally, glycopeptide resistance has been transferred to methicillin-resistant Staphylococcus aureus in clinical practice on several occasions.


CONCLUSIONS
The prevalence of vancomycin resistant enterococci will likely continue to increase. Implementation of infection control strategies, in conjunction with deployment of advanced technologies for detection of vancomycin resistant enterococci, may curb this rise. The emergence of vancomycin resistant S. aureus is of concern.
Zirakzadeh
Ali
A
Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Patel
Robin
R
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016983:Enterococcus / Q000187:drug effects* / Q000235:genetics; D006020:Glycopeptides / Q000494:pharmacology*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D009656:North America / Q000453:epidemiology; D011159:Population Surveillance; D020713:Vancomycin Resistance / Q000235:genetics
D000900:Anti-Bacterial Agents; D006020:Glycopeptides