Resistance Mechanism and Epidemiology of Vancomycin-resistant Enterococci

Wee Gyo Lee

doi:10.5145/kjcm.2008.11.2.71

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Lee: Resistance Mechanism and Epidemiology of Vancomycin-resistant Enterococci

Original Article

Korean J Clin Microbiol 2008;11(2):71-77.

Published online: 20 October 2008

DOI: https://doi.org/10.5145/kjcm.2008.11.2.71

Resistance Mechanism and Epidemiology of Vancomycin-resistant Enterococci

Wee Gyo Lee

Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Korea

Correspondence: Wee Gyo Lee, Department of Laboratory Medicine, Ajou University School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon 442-749, Korea. (Tel) 82-31-219-5785, (Fax) 82-31-219-5778, (E-mail) weegyo@ajou.ac.kr

Received 21 July 2008 Accepted 30 August 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Since vancomycin-resistant enterococci (VRE) were first isolated in Europe, rates of VRE colonization and infection have risen steadily. Today VRE have emerged as important nosocomial pathogens worldwide; hence, it is crucial to understand the underlying mechanism in the spreading of VRE. This article reviews the mechanism of resistance to vanco-mycin and global epidemiology of VRE, as well as the current molecular techniques that are being ap-plied to the epidemiological studies of VRE.

Keywords: Enterococci, Vancomycin, Epidemiology, Molecular techniques

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Fig. 1.

Peptidoglycan biosynthesis and mechanism of action of vancomycin. Binding of the antibiotic to the C-terminal D-Ala-D-Ala of late peptidoglycan precursors prevents reactions catalyzed by trans-glycosylases, transpeptidases, and D,D-carboxypeptidases. Ddl, D-Ala: D-Ala ligase; MurF, a synthetase protein; UDP, uracil diphosphate. Adapted from reference 16.

Fig. 2.

eBURST diagram of the analysis of the sequence types (STs) of the entire public E. faecium MLST database. The circle indicates the CC17. Adapted from MLST web sites. http://www.mlst.net (last visited on 26 June 2008).

Table 1.

Level and type of resistance to vancomycin in enterococci. Adapted from reference 16

Strain characteristic	Acquired resistance level, type					Intrinsic resistance, low level, type VanC1/C2/C3
	High VanA	Variable, VanB	Moderate, VanD	Low
	High VanA	Variable, VanB	Moderate, VanD	VanG	VanE
MIC, mg/L
Vancomycin	64#x223C;100	4#x223C;1,000	64#x223C;128	16	8#x223C;32	2#x223C;32
Teicoplanin	16#x223C;512	0.5#x223C;1	4#x223C;64	0.5	0.5	0.5#x223C;1
Conjugation	Positive	Positive	Negative	Positive	Negative	Negative
Mobile element	Tn1546	Tn1547 or Tn1549	…	…	…	…
Expression	Inducible	Inducible	Constitutive	Inducible	Inducible	Constitutive inducible
Location	Plasmid chromosome	Plasmid chromosome	Chromosome	Chromosome	Chromosome	Chromosome
Modified target	_D-Ala-_D-Lac	_D-Ala-_D-Lac	_D-Ala-_D-Lac	_D-Ala-_D-Ser	_D-Ala-_D-Ser	_D-Ala-_D-Ser

Note. _D-Ala-_D-Lac, _D-alanine-_D-lactate; _D-Ala-_D-Ser, _D-alanine-_D-serine.

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