Current perspectives on glycopeptide resistance

Abstract

In the last 5 years, clinical isolates of gram-positive bacteria with intrinsic or acquired resistance to glycopeptide antibiotics have been encountered increasingly. In many of these isolates, resistance arises from an alteration of the antibiotic target site, with the terminal D-alanyl-D-alanine moiety of peptidoglycan precursors being replaced by groups that do not bind glycopeptides. Although the criteria for defining resistance have been revised frequently, the reliable detection of low-level glycopeptide resistance remains problematic and is influenced by the method chosen. Glycopeptide-resistant enterococci have emerged as a particular problem in hospitals, where in addition to sporadic cases, clusters of infections with evidence of interpatient spread have occurred. Studies using molecular typing methods have implicated colonization of patients, staff carriage, and environmental contamination in the dissemination of these bacteria. Choice of antimicrobial therapy for infections caused by glycopeptide-resistant bacteria may be complicated by resistance to other antibiotics. Severe therapeutic difficulties are being encountered among patients infected with enterococci, with some infections being untreatable with currently available antibiotics.

Drug resistance in fecal enterococci in Hong Kong

“…10 In 1993, similar strains were isolated in the eastern United States, 11 and VRE have now become a worldwide problem. 12 There has been a steady increase in the incidence of VRE associated with nosocomial infections, especially in intensive care unit (ICU) patients. 12,13 There have been limited reports of clinical isolates of VRE in Hong Kong, although the incidence of these strains has remained low.…”

“…12 There has been a steady increase in the incidence of VRE associated with nosocomial infections, especially in intensive care unit (ICU) patients. 12,13 There have been limited reports of clinical isolates of VRE in Hong Kong, although the incidence of these strains has remained low. 14,15 The major risk factor for colonization or infection with VRE appears to be the use of vancomycin or thirdgeneration cephalosporins.…”

Surveillance of bacterial resistance among isolates in Shanghai in 1999

“…Because the susceptibility of MR strains to antibiot- 8 It is generally realized that resistance to glycopeptides has spread primarily in E. fecium strains. 9,10 The reason that larger numbers of vancomycin-resistant strains of E. fecalis are being isolated in China needs to be further investigated.…”

Kommentierte Zusammenfassung der Leitlinien der European Society of Cardiology zur Infektiösen Endokarditis (Neuauflage 2009)

“…Bei der Therapie der Enterokokkenendokarditis wird dagegen aufgrund einer angenommenen Wirkungsverstärkung eine Mehrfachgabe in Kombination mit einem Aminopenicillin empfohlen. Die Wirkungsverstär-kung wird auch angenommen bei einer fast immer vorhandenen Low-level-Resistenz von E. faecalis gegenüber Gentamicin, nicht jedoch bei E. faecium oder bei einer High-level-Resistenz [21].…”