Spread of vancomycin-resistant enterococci: differences between the United States and Europe

There are major differences in the epidemiology of vancomycin-resistant enterococci (VRE) between the United States and Europe. In contrast with Europe, VRE in the United States are resistant to many antibiotics, and there appears to be less genetic variability among these isolates. European VRE of human origin are usually susceptible to many other antibiotics and are highly polyclonal. These clinical isolates have the same susceptibility profiles as VRE isolated from animals. The differences in the spread of VRE between the United States and Europe might be explained by the overconsumption of glycopeptides and other antibiotics in hospitals in the United States and the use of avoparcin as a growth promotor in Europe.