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Diversity among multidrug-resistant enterococci
1University of Texas Houston-Medical School, Houston 77030, USA.
Abstract:
Enterococci are associated with both community- and hospital-acquired infections. Even though they do not cause severe systemic inflammatory responses, such as septic shock, enterococci present a therapeutic challenge because of their resistance to a vast array of antimicrobial drugs, including cell-wall active agents, all commercially available aminoglycosides, penicillin and ampicillin, and vancomycin. The combination of the latter two occurs disproportionately in strains resistant to many other antimicrobial drugs. The propensity of enterococci to acquire resistance may relate to their ability to participate in various forms of conjugation, which can result in the spread of genes as part of conjugative transposons, pheromone-responsive plasmids, or broad host-range plasmids. Enterococcal hardiness likely adds to resistance by facilitating survival in the environment (and thus enhancing potential spread from person to person) of a multidrug-resistant clone. The combination of these attributes within the genus Enterococcus suggests that these bacteria and their resistance to antimicrobial drugs will continue to pose a challenge.
Insights
Enterococci cause infections and are difficult to treat due to widespread antimicrobial resistance. Their ability to acquire and spread resistance genes makes them a persistent public health challenge.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Enterococci are significant pathogens in both community- and hospital-acquired infections.
- Despite not typically causing severe systemic inflammation, enterococci exhibit extensive resistance to numerous antimicrobial agents.
- This resistance profile complicates treatment strategies for enterococcal infections.
Purpose of the Study:
- To highlight the challenges posed by enterococcal antimicrobial resistance.
- To explore the mechanisms underlying enterococcal resistance acquisition and spread.
- To underscore the ongoing threat of multidrug-resistant enterococci.
Main Methods:
- Literature review and synthesis of existing data on enterococcal resistance.
- Analysis of genetic mechanisms of resistance transfer (conjugation, transposons, plasmids).
- Evaluation of enterococcal hardiness and environmental survival.
Main Results:
- Enterococci demonstrate resistance to cell-wall active agents, aminoglycosides, penicillins, ampicillin, and vancomycin.
- Co-resistance to multiple drugs is common, particularly with vancomycin resistance.
- Enterococci readily acquire resistance genes via conjugation, facilitated by plasmids and transposons.
Conclusions:
- Enterococcal antimicrobial resistance, driven by gene acquisition and transfer, presents a significant therapeutic challenge.
- Bacterial hardiness contributes to the environmental persistence and spread of multidrug-resistant enterococcal clones.
- Enterococci will continue to be a formidable challenge in clinical settings due to their resistance.