Cited by 400Antibiotic Resistance in BacteriaAntimicrobial Resistance in StaphylococcusAntibiotic Use and Resistance

Vancomycin-resistant enterococci: why are they here, and where do they come from?

Bonten, Marc JM, Willems, Rob, Weinstein, Robert A·2001·The Lancet Infectious Diseases

Abstract

Vancomcyin-resistant enterococci (VRE) have emerged as nosocomial pathogens in the past 10 years, causing epidemiological controversy. In the USA, colonisation with VRE is endemic in many hospitals and increasingly causes infection, but colonisation is absent in healthy people. In Europe, outbreaks still happen sporadically, usually with few serious infections, but colonisation seems to be endemic in healthy people and farm animals. Vancomycin use has been much higher in the USA, where emergence of ampicillin-resistant enterococci preceded emergence of VRE, making them very susceptible to the selective effects of antibiotics. In Europe, avoparcin, a vancomycin-like glycopeptide, has been widely used in the agricultural industry, explaining the community reservoir in European animals. Avoparcin has not been used in the USA, which is consistent with the absence of colonisation in healthy people. From the European animal reservoir, VRE and resistance genes have spread to healthy human beings and hospitalised patients. However, certain genogroups of enterococci in both continents seem to be more capable of causing hospital outbreaks, perhaps because of the presence of a specific virulence factor, the variant esp gene. By contrast with the evidence of a direct link between European animal and human reservoirs, the origin of American resistance genes remains to be established. Considering the spread of antibiotic-resistant bacteria and resistance genes, the emergence of VRE has emphasised the non-existence of boundaries between hospitals, between people and animals, between countries, and probably between continents.

Integrity signals

Registry

Crossref · 10.1016/s1473-3099(01)00145-1

Cites

103 of 103 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Antibiotic-induced disturbance can lead to the growth and expansion of pathogens within the intestine, including antibiotic-resistant pathogens.

    “This disturbance can lead to the growth and expansion of pathogens within the intestine (including antibiotic-resistant pathogens), where these pathogens can exploit the absence of competitors and the nutrient-enriched gut environment.”
  • Antibiotic treatment promotes intestinal colonization (and even domination) by pathogens such as Clostridioides difficile, carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE).

    “This promotes intestinal colonization (and even domination) by pathogens such as Clostridioides difficile , carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE) [30–32].”
  • Antibiotic treatment - especially treatment with broad-spectrum antibiotics - kills members of the gut microbiota and disrupts colonization resistance.

    “Antibiotic treatment – especially treatment with broad-spectrum antibiotics – kills members of the gut microbiota and disrupts colonization resistance (Fig. 1).”

Cites

Flagged first, then by citations

1 of the 104 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Authors
Bonten, M. J., Willems, R., & Weinstein, R. A.
Affiliations
  • University Medical Center Utrecht (NL)
  • National Institute for Public Health and the Environment (NL)
  • John H. Stroger, Jr. Hospital of Cook County (US)
Corresponding author
Bonten, Marc JM
Venue
The Lancet Infectious Diseases
Publisher
Elsevier BV
Published
2001-12
Volume
1
Issue
5
Pages
314-325
ISSN
1473-3099 (ISSN-L)
OpenAlex
W1998796942
Cited by
400
References
104
Citations by year
2026: 4 · 2025: 4 · 2024: 10 · 2023: 17 · 2022: 6 · 2021: 10 · 2020: 17 · 2019: 12 · 2018: 14 · 2017: 18 · 2016: 17 · 2015: 11 · 2014: 18 · 2013: 28 · 2012: 25
FWCI
1.20
Type
journal article
Language
en
Open access
closed
Locations
  • The Lancet Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
vancomycin-resistant enterococci, nosocomial infections, antibiotic resistance, avoparcin, reservoir hosts, human colonization, hospital outbreak, virulence genes, esp gene, resistance gene spread, antimicrobial use
MeSH terms
Animals, Animal Husbandry, Anti-Bacterial Agents, Bacterial Proteins, Cross Infection, Disease Outbreaks, Europe, Humans, Membrane Proteins, North America, Vancomycin, Gram-Positive Bacterial Infections, Enterococcus, Enterococcus faecium, Infection Control, Vancomycin Resistance

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review