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

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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

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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.

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Additional file 1 of Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany
Çimen, C., Berends, M. S., Bathoorn, E., Lokate, M., Voss, A., Friedrich, A. W., Glasner, C., & Hamprecht, A. (2024) · Figshare · doi:10.6084/m9.figshare.26610051
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Janjušević, A., Minić, R., & Ćirković, I. (2026) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-026-05644-9

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
ORCID: Bonten, Marc JM
Willems, Rob
Weinstein, Robert A
Venue: The Lancet Infectious Diseases
Publisher: Elsevier BV
Published: 2001-12
Volume: 1
Issue: 5
Pages: 314-325
ISSN: 1473-3099 (ISSN-L)
DOI: 10.1016/s1473-3099(01)00145-1
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
Health Sciences › Medicine › Infectious Diseases › 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

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

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