title: Vancomycin-resistant enterococci: Troublemaker of the 21st century.
abstract: The emergence of multidrug-resistant and vancomycin-resistant enterococci during the last decade has made it difficult to treat nosocomial infections. Although various enterococcal species have been identified, only two (Enterococcus faecalis and Enterococcus faecium) are responsible for the majority of human infections. Vancomycin is an important therapeutic alternative against multidrug-resistant enterococci but is associated with a poor prognosis. Resistance to vancomycin dramatically reduces the therapeutic options for enterococcal infections. The bacterium develops resistance by modifying the C-terminal d-alanine of peptidoglycan to d-lactate, creating a d-Ala-d-Lac sequence that effectively reduces the affinity of vancomycin for the peptidoglycan by 1000-fold. Moreover, the resistance genes can be transferred from enterococci to Staphylococcus aureus, thereby posing a threat to patient safety and also a challenge for treating physicians. Judicious use of vancomycin and broad-spectrum antibiotics must be implemented, but strict infection control measures must also be followed to prevent nosocomial transmission of these organisms. Furthermore, improvements in clinical practice, rotation of antibiotics, herbal drugs, nanoantibiotics and the development of newer antibiotics based on a pharmacogenomic approach may prove helpful to overcome dreadful vancomycin-resistant enterococcal infections.
authors.affiliation: Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), GMCH, Bhangagarh, Guwahati, Assam, India.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Ranotkar
authors.affiliation: Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), GMCH, Bhangagarh, Guwahati, Assam, India. Electronic address: parveen5niper@gmail.com.
authors.forename: Parveen
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), GMCH, Bhangagarh, Guwahati, Assam, India.
authors.forename: Shubhranshu
authors.initials: S
authors.lastname: Zutshi
authors.affiliation: Department of Biotechnology, National Institute of Pharmaceutical Education and Research (NIPER), GMCH, Bhangagarh, Guwahati, Assam, India.
authors.forename: Krishna Shastrula
authors.initials: KS
authors.lastname: Prashanth
authors.affiliation: Department of Pharmacology, Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India.
authors.forename: Babul
authors.initials: B
authors.lastname: Bezbaruah
authors.affiliation: Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), GMCH, Bhangagarh, Guwahati, Assam, India.
authors.forename: Jay
authors.initials: J
authors.lastname: Anand
authors.affiliation: Department of Pharmacology, Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India.
authors.forename: Mangala
authors.initials: M
authors.lastname: Lahkar
keywords: Enterococci; Nosocomial transmission; Resistance; Vancomycin-resistant enterococci