Vancomycin-resistant Enterococcus faecium: A High Priority Pathogen

Abstract

Enterococcus faecium has rapidly acquired antibiotic resistance to several classes of antibiotics and has become a serious public health menace. A growing challenge has been imposed by E. faecium globally, in terms of development of resistance to different antibiotics including vancomycin. Of the operons related to vancomycin resistance in enterococci, VanA and VanB are globally reported in vancomycin-resistant Enterococcus (VRE) clinical isolates. VRE faecium (VREfm) strains increase the duration of hospital stay, infection recurrence, treatment costs, and mortality. The alarming emergence of VREfm over the last two decades poses a serious threat to current health-care practices. Shift in the epidemiology of E. faecium to cause severe infections is attributed to global dissemination of high-risk clonal complex 17 which has accumulated both virulence and antibiotic resistance determinants. This review discusses the dimension of the emergence of VREfm strains, the van resistance genetic determinants, molecular epidemiology of VREfm, rise of the Enterococcus beyond vancomycin resistance to the newer antimicrobials and its significance in terms of public health, management of VREfm, with the objective of raising awareness of the need of new strategies including development of new antimicrobials, better care coordination for patients presenting with an VREfm infection, implement surveillance programs, and strengthening of antibiotic stewardship.