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Antibiotic-resistant enterococci and the changing face of surgical infections
1Department of Surgery, University of Pittsburgh, Pennsylvania, USA.
Background:
Enterococci have not been thought to play an important role in intra-abdominal infections because of their relatively low virulence. However, this notion is changing because of the recent emergence of these microbes as significant nosocomial pathogens.
Objectives:
To review the mechanisms of antibiotic resistance of enterococci and to discuss the significance of multidrug-resistant enterococci in surgical infections.
Data Sources:
Medical and basic science literature relating to enterococci.
Data Synthesis:
In addition to having intrinsic resistance to a number of antibiotics, enterococci have the ability to acquire resistant genes through the exchange of plasmids or transposons from other bacterial species. Moreover, enterococci have been shown to transmit these genes to other bacterial species in turn. The extensive resistance of these microorganisms has led to their emergence as significant nosocomial pathogens, ranking second only to Escherichia coli in the number of pathogenic isolates recovered from patients in intensive care units. There has also been a marked increase in vancomycin-resistant enterococcal infections in surgical patients in the last 5 years. Some studies associate the prior use of vancomycin or third-generation cephalosporins with the emergence of these strains. Overall, enterococcal infections are associated with increased morbidity and mortality.
Conclusions:
In view of the marked resistance of enterococci to antibiotics and their ability to disseminate resistance genes, these microbes have become important pathogens. Enterococci pose a threat to surgical patients, often causing significant therapeutic dilemmas.
Insights
Enterococci, once considered low-virulence, are now significant nosocomial pathogens due to widespread antibiotic resistance. Their ability to share resistance genes poses a serious threat to surgical patients, complicating treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Enterococci were historically underestimated in intra-abdominal infections due to perceived low virulence.
- Emerging evidence highlights enterococci as significant and increasingly prevalent nosocomial pathogens.
Purpose of the Study:
- To review the mechanisms by which enterococci develop antibiotic resistance.
- To discuss the clinical significance of multidrug-resistant enterococci in surgical site infections.
Main Methods:
- Comprehensive review of existing medical and basic science literature focused on enterococci.
Main Results:
- Enterococci possess intrinsic antibiotic resistance and readily acquire resistance genes via plasmids and transposons.
- These bacteria can transfer resistance genes to other species, contributing to the spread of antimicrobial resistance.
- Enterococci rank second to Escherichia coli as a cause of nosocomial infections in ICUs, with a notable rise in vancomycin-resistant strains in surgical patients.
Conclusions:
- The pronounced antibiotic resistance and gene dissemination capabilities of enterococci establish them as critical pathogens.
- Enterococcal infections present significant therapeutic challenges, particularly for surgical patients.