“Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus
Enterococcus faecium is a difficult-to-treat gram positive organism with increasing rates of resistance to vancomycin which is commonly mediated through the vanA gene cluster. There have been international reports of E. faecium isolates that are genotypically positive for vanA but phenotypically van...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X24004492/type/journal_article |
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| author | Marten R. Hawkins Natalia Medvedeva Hannah Wang Niaz Banaei Marisa K. Holubar |
| author_facet | Marten R. Hawkins Natalia Medvedeva Hannah Wang Niaz Banaei Marisa K. Holubar |
| author_sort | Marten R. Hawkins |
| collection | DOAJ |
| description | Enterococcus faecium is a difficult-to-treat gram positive organism with increasing rates of resistance to vancomycin which is commonly mediated through the vanA gene cluster. There have been international reports of E. faecium isolates that are genotypically positive for vanA but phenotypically vancomycin-susceptible. These isolates, commonly called vancomycin-variable enterococci (VVE), can convert to phenotypic vancomycin resistance upon exposure to vancomycin. Multiple mechanisms for this genotypic-phenotypic mismatch have been reported and most commonly involve the regulatory components of the vanA gene cluster. VVE are challenging to identify unless microbiology labs routinely implement both genotypic and phenotypic screening methods. VVE has been associated with outbreaks and has become a prevalent pathogen in several countries. In this review, we summarize the mechanisms, microbiology and epidemiology of VVE. Clinicians must remain vigilant for VVE as diagnosis can be challenging and treatment failure on vancomycin is possible. |
| format | Article |
| id | doaj-art-49c9df1b880d411c8debb11b5b9d06e2 |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-49c9df1b880d411c8debb11b5b9d06e22024-11-11T11:53:14ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2024-01-01410.1017/ash.2024.449“Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable EnterococcusMarten R. Hawkins0https://orcid.org/0000-0002-8387-0823Natalia Medvedeva1https://orcid.org/0000-0003-1037-3209Hannah Wang2https://orcid.org/0000-0002-3712-9188Niaz Banaei3Marisa K. Holubar4https://orcid.org/0000-0002-7585-1809Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USADivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USADepartment of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USADivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA Department of Pathology, Stanford University School of Medicine, Stanford, CA, USADivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USAEnterococcus faecium is a difficult-to-treat gram positive organism with increasing rates of resistance to vancomycin which is commonly mediated through the vanA gene cluster. There have been international reports of E. faecium isolates that are genotypically positive for vanA but phenotypically vancomycin-susceptible. These isolates, commonly called vancomycin-variable enterococci (VVE), can convert to phenotypic vancomycin resistance upon exposure to vancomycin. Multiple mechanisms for this genotypic-phenotypic mismatch have been reported and most commonly involve the regulatory components of the vanA gene cluster. VVE are challenging to identify unless microbiology labs routinely implement both genotypic and phenotypic screening methods. VVE has been associated with outbreaks and has become a prevalent pathogen in several countries. In this review, we summarize the mechanisms, microbiology and epidemiology of VVE. Clinicians must remain vigilant for VVE as diagnosis can be challenging and treatment failure on vancomycin is possible.https://www.cambridge.org/core/product/identifier/S2732494X24004492/type/journal_article |
| spellingShingle | Marten R. Hawkins Natalia Medvedeva Hannah Wang Niaz Banaei Marisa K. Holubar “Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus Antimicrobial Stewardship & Healthcare Epidemiology |
| title | “Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus |
| title_full | “Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus |
| title_fullStr | “Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus |
| title_full_unstemmed | “Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus |
| title_short | “Keeping us on our toes”: a review of what clinicians need to know about vancomycin-variable Enterococcus |
| title_sort | keeping us on our toes a review of what clinicians need to know about vancomycin variable enterococcus |
| url | https://www.cambridge.org/core/product/identifier/S2732494X24004492/type/journal_article |
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