Chapter 9 : Acquired Antibiotic Resistances in Enterococci

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This chapter provides an overview of the most clinically relevant acquired antibiotic resistance mechanisms in enterococci. Enterococci possess a natural, intrinsic resistance to β-lactam antibiotics that is due to the low affinity of their penicillin-binding proteins (PBPs) for the β-lactam agents. Enterococci possess at least five and at times more than nine different PBPs. Enterococci intrinsically possess a low level of resistance to aminoglycosides by limiting transport of the drugs across the cell membrane. The glycopeptide antibiotics vancomycin and teicoplanin are used to treat serious infections due to resistant gram-positive organisms. The most common acquired resistance mechanism among enterococci to the macrolide antibiotics is the production of an enzyme that methylates an adenine residue in the 23S ribosomal RNA of the 50S ribosomal subunit. The high prevalence of multidrug-resistant enterococci in many hospitals has led to an interest in using chloramphenicol as an alternative therapeutic agent. There are two major mechanisms of tetracycline resistance in enterococci: (i) active efflux of the drug across the cell membrane, and (ii) ribosomal protection. The oxazolidinones are a new class of antimicrobial agents developed for use against multidrug-resistant gram-positive bacteria. Evemimicin is an oligosaccharide antimicrobial agent that has shown excellent in vitro activity against enterococci. Ciprofloxacin's activity against enterococci is moderate at best, and quinolone resistance is common among clinical enterococcal isolates.

Citation: Kak V, Chow J. 2002. Acquired Antibiotic Resistances in Enterococci, p 355-383. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch9
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Figure 1

Vancomycin resistance operons. Adapted from reference .

Citation: Kak V, Chow J. 2002. Acquired Antibiotic Resistances in Enterococci, p 355-383. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch9
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Figure 2

Induction of VanA/VanB type of resistance. Adapted from reference .

Citation: Kak V, Chow J. 2002. Acquired Antibiotic Resistances in Enterococci, p 355-383. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch9
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Figure 3

Biochemical overview of vancomycin resistance. Adapted from reference .

Citation: Kak V, Chow J. 2002. Acquired Antibiotic Resistances in Enterococci, p 355-383. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch9
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Table 1

Overview of vancomycin resistance genotypes

Citation: Kak V, Chow J. 2002. Acquired Antibiotic Resistances in Enterococci, p 355-383. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch9
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Table 2

Overview of gene functions in operon

Citation: Kak V, Chow J. 2002. Acquired Antibiotic Resistances in Enterococci, p 355-383. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch9

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