The rise of the Enterococcus: beyond vancomycin resistance
Key Points Enterococci are some of the most versatile organisms found to infect hospitalized patients. The epidemiology of enterococcal infections has evolved since the emergence of these pathogens and has seen the rise of Enterococcus faecium as a nosocomial pathogen with serious clinical implicati...
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| Published in: | Nature reviews. Microbiology Vol. 10; no. 4; pp. 266 - 278 |
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| Main Authors: | , |
| Format: | Journal Article |
| Language: | English |
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01.04.2012
Nature Publishing Group |
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| ISSN: | 1740-1526, 1740-1534, 1740-1534 |
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| Abstract | Key Points
Enterococci are some of the most versatile organisms found to infect hospitalized patients. The epidemiology of enterococcal infections has evolved since the emergence of these pathogens and has seen the rise of
Enterococcus faecium
as a nosocomial pathogen with serious clinical implications.
The effect of antibiotics on the microbiota of the gastrointestinal tract and subsequent alterations in the regulation of the gut immune system can favour colonization by multidrug-resistant enterococci.
Enterococcal genomes are extremely malleable, with the ability to exchange large fragments of chromosomal DNA. In addition, the lack of CRISPR (clustered regularly interspaced short palindromic repeats) elements has a potential role in the adaptation of hospital-associated enterococci.
Specific pathogenicity factors contribute to the ability of enterococci to produce disease and/or survive in the gastrointestinal tract of mammals. The major factors include secreted and cell surface-associated determinants.
Antibiotic resistance is widespread for the anti-enterococcal antibiotics that are most commonly used in clinical practice, and the mechanisms of resistance for many of these antibiotics are known. These antibiotics include ampicillin, linezolid, daptomycin and quinupristin–dalfopristin, and there is also high-level resistance to aminoglycosides. Such resistances have important therapeutic implications.
Arias and Murray discuss the factors that may have contributed to the rise of enterococci as nosocomial pathogens, with an emphasis on the epidemiology and pathogenesis of these species and their mechanisms of resistance to the most relevant anti-enterococcal agents used in clinical practice.
The genus
Enterococcus
includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on
Enterococcus faecium
as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of Gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an
E. faecium
clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci. |
|---|---|
| AbstractList | The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of Gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci. Key Points Enterococci are some of the most versatile organisms found to infect hospitalized patients. The epidemiology of enterococcal infections has evolved since the emergence of these pathogens and has seen the rise of Enterococcus faecium as a nosocomial pathogen with serious clinical implications. The effect of antibiotics on the microbiota of the gastrointestinal tract and subsequent alterations in the regulation of the gut immune system can favour colonization by multidrug-resistant enterococci. Enterococcal genomes are extremely malleable, with the ability to exchange large fragments of chromosomal DNA. In addition, the lack of CRISPR (clustered regularly interspaced short palindromic repeats) elements has a potential role in the adaptation of hospital-associated enterococci. Specific pathogenicity factors contribute to the ability of enterococci to produce disease and/or survive in the gastrointestinal tract of mammals. The major factors include secreted and cell surface-associated determinants. Antibiotic resistance is widespread for the anti-enterococcal antibiotics that are most commonly used in clinical practice, and the mechanisms of resistance for many of these antibiotics are known. These antibiotics include ampicillin, linezolid, daptomycin and quinupristin–dalfopristin, and there is also high-level resistance to aminoglycosides. Such resistances have important therapeutic implications. Arias and Murray discuss the factors that may have contributed to the rise of enterococci as nosocomial pathogens, with an emphasis on the epidemiology and pathogenesis of these species and their mechanisms of resistance to the most relevant anti-enterococcal agents used in clinical practice. The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of Gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci. The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci.The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci. |
| Audience | Academic |
| Author | Arias, Cesar A. Murray, Barbara E. |
| AuthorAffiliation | 1 Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Re-emerging Pathogens, Houston, Texas 77030, USA 3 Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Carrera 7B Bis # 132-11, Edificio Rectoria, Bogotá, Colombia 4 Laboratory of Enterococcal Research, University of Texas Medical School at Houston 2 Laboratory for Antimicrobial Research, University of Texas Medical School at Houston 5 Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, 6431 Fannin Street, Room 2.112MSB, Houston, Texas 77030, USA |
| AuthorAffiliation_xml | – name: 2 Laboratory for Antimicrobial Research, University of Texas Medical School at Houston – name: 4 Laboratory of Enterococcal Research, University of Texas Medical School at Houston – name: 1 Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Re-emerging Pathogens, Houston, Texas 77030, USA – name: 3 Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Carrera 7B Bis # 132-11, Edificio Rectoria, Bogotá, Colombia – name: 5 Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, 6431 Fannin Street, Room 2.112MSB, Houston, Texas 77030, USA |
| Author_xml | – sequence: 1 givenname: Cesar A. surname: Arias fullname: Arias, Cesar A. email: cesar.arias@uth.tmc.edu organization: Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Re-emerging Pathogens, Laboratory for Antimicrobial Research, University of Texas Medical School at Houston, Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque – sequence: 2 givenname: Barbara E. surname: Murray fullname: Murray, Barbara E. email: bem.asst@uth.tmc.edu organization: Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Re-emerging Pathogens, Laboratory of Enterococcal Research, University of Texas Medical School at Houston, Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22421879$$D View this record in MEDLINE/PubMed |
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Enterococci are some of the most versatile organisms found to infect hospitalized patients. The epidemiology of enterococcal infections has evolved... The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are... |
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| Title | The rise of the Enterococcus: beyond vancomycin resistance |
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