Review article

Enterococcal resistance to antibiotics and recommendations for treatment

Selma Pintarić orcid.org/0000-0002-1687-9158 ; Veterinarski fakultet Sveučilišta u Zagrebu, Hrvatska
Branka Šeol Martinec orcid.org/0000-0003-1337-8443 ; Veterinarski fakultet Sveučilišta u Zagrebu, Hrvatska

Abstract

Enterococci are Gram-positive bacteria that are part of the normal intestinal flora of humans and animals. They are intrinsically resistant to many antimicrobial agents commonly used in human and veterinary medicine, such as cephalosporins, clindamycin and trimethoprim/sulfamethoxazole. Enterococci also exhibit low-level resistance to penicillins and aminoglycosides. As commensals, they are often accidentally exposed to antimicrobial agents in the course of therapy for infections caused by other bacteria. Under appropriate circumstances, due to their intrinsic resistance, enterococci can easily spread to other parts of the body and cause a range of infections, such as urinary tract infections, skin and wound infections. In human medicine, enterococci are the causative agents of serious and often life-threatening infections, including endocarditis and meningitis. In addition to intrinsic resistance, enterococci have a great ability to develop resistance to all currently available antibiotics, either by mutation or by receipt of foreign genetic material. In general, antibiotic pressure is the main cause for developmentofmultiresistantstrains.Among enterococci, there are two main pathogenic
species: Enterococcus faecium and Enterococcus faecalis. There are certain naturally occurring differences in the susceptibility of these species, though both are capable of becoming multiresistant. Such multiresistant strains have become increasingly prevalent in hospital- acquired infections (both humans and animals). The incidence of vancomycin resistance among enterococci, particularly E. faecium, is a particular cause of concern. The World Health Organization (WHO) has published a list of bacteria for which new antibiotics are urgently needed, and vancomycin-resistant E. faecium is among them. An important factor associated with the occurrence of resistant and multiresistant enterococci are antimicrobials used at subtherapeutic doses as a growth promoter in food-producing animals. For example, the extensive use of avoparcin, a glycopeptide antimicrobial drug, as a growth promotor has created food animals as reservoirs of vancomycin resistant enterococci. Croatia, as a European Union Member State, has banned the use of avoparcin as a growth promotor in food animals.

Keywords

enterococci; resistance; vancomycin-resistant enterococci (VRE); therapy

Hrčak ID:

223025

URI

https://hrcak.srce.hr/223025

Publication date:

2.4.2018.

Article data in other languages: croatian

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