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Vancomycin-resistant enterococci
1Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, USA.
Abstract:
Vancomycin-resistant enterococci (VRE) are a major problem in numerous institutions in the United States. Most VRE are resistant to all available antimicrobial agents, resulting in serious therapeutic dilemmas. The resistance genes are transmitted on transposons, so the potential for dissemination to other species is significant. Risk factors associated with VRE infection and colonization are vancomycin and cephalosporin use, but numerous patient-related factors also contribute. Although resistant strains appear to arise from the patient's endogenous flora, VRE may be spread through direct contact with contaminated environmental surfaces and hands of caregivers. Published guidelines for preventing such spread suggest implementing infection-control practices and vancomycin restrictions. The ideal drug regimen for the treatment of VRE is unknown. Various drug combinations have been studied in the laboratory, but patient treatment data are scarce. There is an urgent need for new antimicrobial agents.
Insights
Vancomycin-resistant enterococci (VRE) pose a significant threat due to widespread resistance, necessitating new antimicrobial treatments. Understanding transmission and risk factors is crucial for effective infection control strategies against these difficult-to-treat bacteria.
Area of Science:
- Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Vancomycin-resistant enterococci (VRE) present a critical challenge in healthcare settings, with many strains exhibiting resistance to all current antimicrobial agents.
- The genetic elements conferring VRE resistance are often located on transposons, indicating a substantial risk for interspecies dissemination.
Purpose of the Study:
- To highlight the therapeutic dilemmas posed by VRE infections.
- To discuss the known risk factors for VRE colonization and infection.
- To emphasize the urgent need for novel antimicrobial agents to combat VRE.
Main Methods:
- Review of existing literature on VRE epidemiology, resistance mechanisms, and transmission routes.
- Analysis of risk factors, including antimicrobial use and patient-specific elements.
- Assessment of current infection control recommendations and treatment strategies.
Main Results:
- VRE infections are difficult to treat due to broad antimicrobial resistance.
- Risk factors include vancomycin/cephalosporin use and patient-related factors.
- VRE can spread via contaminated surfaces and healthcare worker hands.
Conclusions:
- Effective infection control practices and judicious antimicrobial use are essential for VRE prevention.
- Current treatment options for VRE are limited, with scarce clinical data on drug combinations.
- There is a critical and unmet need for the development of new antimicrobial drugs effective against VRE.