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Enterococcis: pathogens of the 90s
D E Low1, B M Willey, S Betschel
1Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
The European Journal of Surgery. Supplement. : = Acta Chirurgica. Supplement
|January 1, 1994
Summary
Enterococci, once overlooked, are now recognized as significant pathogens causing hospital infections. Their rising antimicrobial resistance, including high-level aminoglycoside resistance (HLAR) and vancomycin resistance, poses a critical threat to effective treatment.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Enterococci are common bacteria, with E. faecalis and E. faecium dominating clinical isolates.
- Historically not considered major pathogens due to lacking common virulence factors.
- Now recognized as the second leading cause of nosocomial infections.
Purpose of the Study:
- To highlight the evolving role of enterococci as true pathogens.
- To discuss the impact of increasing antimicrobial resistance on treatment strategies.
- To address emerging resistance patterns like high-level aminoglycoside resistance (HLAR) and vancomycin resistance.
Main Methods:
- Literature review and synthesis of current knowledge on enterococcal infections and resistance.
- Analysis of prevalence data for HLAR and glycopeptide resistance.
- Discussion of the clinical implications of these resistance patterns.
Main Results:
- Enterococci are increasingly implicated in serious infections, particularly healthcare-associated infections.
- High-level aminoglycoside resistance (HLAR) prevalence ranges from 15% to 55%.
- Vancomycin resistance is widespread and often co-occurs with resistance to other antibiotics.
Conclusions:
- Enterococci are significant pathogens requiring careful management.
- Antimicrobial resistance in enterococci, especially HLAR and vancomycin resistance, presents a major clinical challenge.
- The spread of resistance could lead to untreatable infections in Gram-positive organisms.