Alternatives to Fight Vancomycin-Resistant Staphylococci and Enterococci

Abstract

Gram positive pathogens are a significant cause of healthcare-associated infections, with Staphylococci and Enterococci being the most prevalent ones. Vancomycin, a last resort glycopeptide, is used to fight these bacteria but the emergence of resistance against this drug leaves some patients with few therapeutic options. To counter this issue, new generations of antibiotics have been developed but resistance has already been reported. In this article, we review the strategies in place or in development to counter vancomycin-resistant pathogens. First, an overview of traditional antimicrobials already on the market or in the preclinical or clinical pipeline used individually or in combination is summarized. The second part focuses on the non-traditional antimicrobials, such as antimicrobial peptides, bacteriophages and nanoparticles. The conclusion is that there is hitherto no substitute equivalent to vancomycin. However, promising strategies based on drugs with multiple mechanisms of action and treatments based on bacteriophages possibly combined with conventional antibiotics are hoped to provide treatment options for vancomycin-resistant Gram-positive pathogens.

Antibacterial Activity of Metallic Nanoparticles against Multidrug-Resistant Pathogens Isolated from Environmental Samples: Nanoparticles/Antibiotic Combination Therapy and Cytotoxicity Study

“…This result agrees with the study of Jasim et al 70 where they reported that some ZnONPs were effective against vancomycin-resistant enter-ococci (VRE) and S. aureus. In addition, Baeẗz et al 71 documented promising results of zinc oxide NPs on enterococci used in combination with vancomycin conventional antibiotics, which is similar to our findings. It has been discovered that zinc oxide nanoparticles with insignificant particle size demonstrated improved efficiency of biological effect because of the increase in the specific surface area to volume ratio and surface reaction of zinc oxide NPs.…”

Vancomycin Resistance in Enterococcus and Staphylococcus aureus

“…Unfortunately, resistance to each of these antibiotics has emerged. As such, the use of modified glycopeptide derivatives such as dalbavancin, oritavancin, and telavancin, and/or combinational antibiotic therapy is typically exercised as a way to overcome AMR [ 485 ]. While there remains a limited supply of novel antibiotics in development [ 486 , 487 , 488 , 489 ], the emergence of resistance to future approved antibiotic treatment regimens is expected [ 490 ].…”

Computational Screening of Approved Drugs for Inhibition of the Antibiotic Resistance Gene mecA in Methicillin-Resistant Staphylococcus aureus (MRSA) Strains

“…The global dissemination of the multidrug-resistant MRSA strain over the past few decades is primarily attributed to the extensive use of vancomycin as a treatment for MRSA infections, which has considerably intensified selective pressure and led to decreased susceptibility to this antibiotic [ 19 ]. Hence, there are fears that MRSA may become completely resistant to vancomycin or any other chemotherapy in the future [ 3 , 4 , 20 ]. Some researchers have investigated combinations of antibiotics that could be effective against MRSA but, unfortunately, most of the resulting data from these combinations are not sufficient to recommend these therapies for critical MRSA infections [ 7 ].…”

“…Some researchers have investigated combinations of antibiotics that could be effective against MRSA but, unfortunately, most of the resulting data from these combinations are not sufficient to recommend these therapies for critical MRSA infections [ 7 ]. Therefore, there is an urgent need to find antibiotics that are effective in treating critical MRSA infections [ 3 , 4 , 20 ].…”