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Update on vancomycin resistance

B Perichon1, P Courvalin

  • 1Unité des Agents Antibactériens, Pasteur Institute, Paris, France.

International Journal of Clinical Practice
|July 27, 2000
PubMed

Insights

Enterococci cause severe infections and are a major source of nosocomial infections. Antibiotic resistance, including to glycopeptides like vancomycin, is a growing concern due to modified cell wall precursors.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Enterococci are significant pathogens causing severe infections like endocarditis, meningitis, and septicaemia.
  • They are a leading cause of hospital-acquired (nosocomial) infections.
  • Antibiotic resistance in enterococci is a critical issue, particularly resistance to glycopeptides since 1986.

Purpose of the Study:

  • To review the mechanisms and types of glycopeptide resistance in enterococci.
  • To discuss the origins of glycopeptide resistance in these bacteria.
  • To highlight the clinical implications of vancomycin and teicoplanin resistance.

Main Methods:

  • Literature review of studies on enterococcal resistance mechanisms.
  • Analysis of biochemical pathways involved in peptidoglycan synthesis.
  • Examination of data on glycopeptide resistance types and origins.

Main Results:

  • Glycopeptide resistance in enterococci involves altered peptidoglycan precursors, blocking antibiotic action.
  • Five distinct types of glycopeptide resistance and their biochemical mechanisms are identified.
  • Enterococcal strains can exhibit resistance to vancomycin and teicoplanin, or vancomycin alone.
  • Vancomycin-dependent enterococcal strains have been isolated from clinical settings.
  • Resistance may originate from intrinsic resistance in enterococci or glycopeptide-producing organisms.

Conclusions:

  • Glycopeptide resistance in enterococci poses a significant threat due to diverse resistance mechanisms.
  • Understanding these mechanisms is crucial for developing effective treatment strategies.
  • The emergence of vancomycin-dependent strains warrants further investigation and clinical vigilance.

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