title: [Vancomycin-resistant enterococci (VRE). Recent results and trends in development of antibiotic resistance].
abstract: Enterococci (mainly E. faecalis, E. faecium) are important nosocomial pathogens predominantly affecting older and/or immunocompromised patients. The bacteria possess a broad spectrum of intrinsic and acquired antibiotic resistance properties. Among these, the transferrable glycopeptide resistance of the vanA and vanB genotypes in vancomycin-resistant enterococci (VRE; reservoir: E. faecium) as well as resistance to last resort antibiotics (e.g. linezolid and tigecycline) are of special concern. Enterococci (including VRE) are easily transferred in hospitals; however, colonizations are far more frequent than infections. Resistance frequencies for vancomycin in clinical E. faecium isolates have remained at a relatively constant level of 8-15% (but with local or regional variations) in recent years whereas frequencies for teicoplanin resistance have shown a slight decrease. Glycopeptide resistance trends correlate with a spread of hospital-associated E. faecium strains carrying the vanA and, with rising frequency in recent years, the vanB gene cluster, the latter being associated with teicoplanin susceptibility. This increased occurrence of vanB-positive E. faecium strains may be caused by an increased use of antibiotics selecting enterococci and VRE as well as due to methodological reasons (e.g. reduced EUCAST MIC-breakpoints for glycopeptides; increased use and sensitive performance of chromogenic VRE agars, increased use of molecular diagnostic assays).
authors.affiliation: Nationales Referenzzentrum für Staphylokokken und Enterokokken, Robert Koch-Institut, Burgstrasse 37, Wernigerode, Germany. i.klare@rki.de
authors.forename: I
authors.initials: I
authors.lastname: Klare
authors.forename: W
authors.initials: W
authors.lastname: Witte
authors.forename: C
authors.initials: C
authors.lastname: Wendt
authors.forename: G
authors.initials: G
authors.lastname: Werner
mesh_terms: D000081:Acetamides / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D013293:Enterococcus faecalis / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D000069349:Linezolid; D008826:Microbial Sensitivity Tests; D023303:Oxazolidinones / Q000627:therapeutic use; D011159:Population Surveillance; D012703:Serotyping; D017334:Teicoplanin / Q000627:therapeutic use; D020713:Vancomycin Resistance / Q000235:genetics
chemical_list: D000081:Acetamides; D001426:Bacterial Proteins; D023303:Oxazolidinones; C071437:VanA ligase, Bacteria; C079913:VanB protein, Enterococcus; D017334:Teicoplanin; D019729:Carbon-Oxygen Ligases; D000069349:Linezolid