The rise of the Enterococcus: beyond vancomycin resistance

Area of Science:

• Clinical Microbiology and Infectious Diseases
• Antimicrobial Resistance
• Hospital Epidemiology

Background:

• Enterococcus species are leading causes of multidrug-resistant nosocomial infections.
• These pathogens primarily affect immunocompromised patients with prolonged hospital stays.
• Enterococcus faecium is an increasingly problematic emergent nosocomial pathogen.

Purpose of the Study:

• To review the evolving epidemiology of enterococcal infections.
• To highlight the role of antibiotics in Enterococcus colonization and resistance.
• To discuss genetic factors and resistance mechanisms of vancomycin-resistant enterococci.

Main Methods:

• Review of current literature on enterococcal infections and epidemiology.
• Analysis of genomic data to identify successful genetic lineages.
• Discussion of antibiotic effects on gut microbiota and enterococcal colonization.

Main Results:

• Antibiotic use can promote vancomycin-resistant enterococci colonization by eradicating competing gut bacteria.
• Specific ancient genetic lineages of Enterococcus, particularly E. faecium, are adept at thriving in hospital environments.
• Key genetic determinants and resistance mechanisms against common antibiotics are identified.

Conclusions:

• Enterococcus faecium represents a significant and growing challenge in hospital-acquired infections.
• Understanding the interplay between antibiotics, gut microbiota, and enterococcal virulence is crucial.
• Knowledge of resistance mechanisms is vital for effective treatment strategies against vancomycin-resistant enterococci.