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Vancomycin-resistant enterococci

A S Gin¹, G G Zhanel

¹Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, Manitoba, Canada.

The Annals of Pharmacotherapy

|June 1, 1996

Summary

Vancomycin resistance in enterococci (VRE) is a growing global issue. Understanding its epidemiology, resistance mechanisms (VanA, VanB), and management is crucial for infection control.

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Area of Science:

Microbiology
Infectious Diseases
Clinical Pharmacy

Background:

Vancomycin resistance in enterococci (VRE) has emerged as a significant nosocomial threat.
Enterococcus faecalis and Enterococcus faecium are key species exhibiting vancomycin resistance.

Purpose of the Study:

To comprehensively review the history, epidemiology, resistance mechanisms, and management strategies for vancomycin-resistant enterococci.
To synthesize current knowledge on VRE to inform clinical practice and infection control.

Main Methods:

A systematic literature search of MEDLINE, IDIS, and journals from 1982-1994.
Evaluation of studies on vancomycin-resistant E. faecalis and E. faecium, including case reports and various study designs.
Inclusion of reports with vancomycin minimum inhibitory concentrations of 32 µg/mL or higher.

Main Results:

VRE outbreaks have necessitated intensive infection control measures due to nosocomial spread.
Resistance mechanisms involve the VanA and VanB phenotypes, characterized by depsipeptide D-Ala-D-Lac production.
The vanA gene is linked to Tn1546, facilitating transfer, while vanB appears endogenous.

Conclusions:

VRE prevalence has increased globally, associated with factors like prior antibiotic exposure and prolonged hospitalization.
Effective management requires education, robust infection control, surveillance, and judicious vancomycin use.
Treatment strategies for VRE infections depend on the resistance phenotype, with VanB potentially responsive to teicoplanin and aminoglycosides.

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