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The invisible enemy of doom: How did enterococci become the culprit for drug-resistant infections?
Enterococcus faecium is a Gram-positive, non-haemolytic or gamma-haemolytic bacterium that normally inhabits and coexists in the intestines of humans and animals. However, it can also become a pathogen, causing diseases such as neonatal meningitis or endocarditis.
Increasing resistance of enterococci, especially to vancomycin (VRE), has made treatment more challenging.
The reason why enterococci can become pathogenic bacteria is closely related to their various pathogenic characteristics. It is multidrug resistant and can increase its pathogenicity by aggregation and secretion of factors. Enterococcal surface proteins (Esp) enable the bacteria to aggregate and form biofilms, while aggregating substances (AS) enable them to attach to target cells and promote gene transfer. These properties not only enable enterococci to effectively defend themselves against the host's immune system, but also help them survive in the highly competitive intestinal environment.
Studies have shown that enterococci can produce specific antibiotics to fight other pathogenic intestinal microorganisms, which significantly enhances their advantages in the intestine.
Although Enterococci are widely used as probiotics in animal feed, long-term exposure to the bacteria may lead to immunosuppression, making the raised animals more susceptible to attack by other pathogens such as Salmonella.
Vancomycin-resistant Enterococci (VRE)
Enterococcus faecalis is the leading cause of multidrug-resistant enterococcal infections in the United States, with infection rates far higher than Enterococcus faecalis. According to reports, approximately 40% of patients treated in medical intensive care units are affected by VRE infections, leaving clinicians facing a dilemma of urgent need for effective antibiotics.
In some cases, VRE bloodstream infections have a mortality rate as high as 37%, while enterococci have a mortality rate of 32%.
Symptoms of VRE infection vary depending on where the infection occurs, including bloodstream infections, urinary tract infections, and catheter- or surgery-related wound infections. Wound infection may cause redness, swelling, fever and discharge from the wound, while urinary tract infection may be accompanied by symptoms such as frequent urination and painful urination.
Tolerance to alcohol disinfectants
A 2018 study showed that multidrug-resistant enterococci showed tolerance to alcohol-based disinfectants, which may be one of the reasons for the increase in infections with the bacteria. The study noted that enterococci's tolerance to alcohol-based disinfectants has increased significantly since 2010. Although 70% isopropyl alcohol hand sanitizer remains effective against these resistant strains, this finding highlights the urgency of controlling VRE transmission in healthcare settings.
Scientists are beginning to question whether it is possible for microbes to tolerate alcohol at all, a question that deserves further exploration.
Treatment methods
Currently, treatment options for VRE are limited, but some drugs such as Linezolid, Daptomycin and Tigecycline have a certain effect on VRE. Recent studies have shown that with the rise of drug resistance in enterococci, new treatments are urgently needed to combat this invisible enemy. Many healthcare organizations are working hard to find effective solutions, however, will this be enough to stop the spread of this global health threat?
With the increasing incidence of drug-resistant bacteria, we are faced with a question: How can we effectively combat drug-resistant infections caused by enterococci?
