Progresses on the prevalence and mechanism of vancomycin- resistant bacteria

Vancomycin, a glycopeptide antibiotic, serves as the last-resort treatment for infections caused by methicillin- resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and Clostridium difficile. However, the emergence of various vancomycin-resistant bacterial strains worldwide poses a significant challenge to clinical therapy. Adopting the "One Health" concept, we mainly present the prevalence of vancomycin-resistant bacteria over the past decade from 40 human, animal, environmental, and food sources across various regions, both domestically and internationally. The statistical results indicate that vancomycin-resistant bacteria are primarily concentrated in hospitals and their surrounding environments. The prevalence of resistant bacteria in hospital wastewater in South Africa reaches as high as 96.77%, followed by Pakistan and China's Taiwan region, where the resistance rates are 56.5% and 29.02%, respectively. The vancomycin average resistance rate in domestic human-source bacteria (1.41%) is overall higher than that in international human-source bacteria (0.47%). The prevalence of resistant bacteria in pediatric patients across various regions is relatively low (<1%). It is worth noting that although the use of vancomycin is prohibited in livestock farming, vancomycin- resistant bacteria can still be detected in livestock, related products and environment, posing a potential threat to human health. Based on the statistical analysis results, we summarize several common vancomycin resistance mechanisms and the transmission mechanisms, and clarify the differences in the prevalence of resistant bacteria across the "human-animal-food-environment" interface for further analyzing the distribution and transmission risks of vancomycin-resistant bacteria in different hosts worldwide. This review can also provide references for the prevention and control of antimicrobial resistance.