Cited by 1,776Antibiotic Resistance in BacteriaAntimicrobial Resistance in StaphylococcusInfections and bacterial resistance

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The rise of the Enterococcus: beyond vancomycin resistance

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Arias, Cesar A., Murray, Barbara E.·2012·Nature Reviews Microbiology

DOI 10.1038/nrmicro2761PMC PMC3621121

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Abstract

The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci.

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ace , Which Encodes an Adhesin in Enterococcus faecalis , Is Regulated by Ers and Is Involved in Virulence
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Role of Methionine Sulfoxide Reductases A and B of Enterococcus faecalis in Oxidative Stress and Virulence
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Analysis of a Gene Cluster ofEnterococcus faecalisInvolved in Polysaccharide Biosynthesis
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The Enterococcus faecalis fsrB Gene, a Key Component of the fsr Quorum-Sensing System, Is Associated with Virulence in the Rabbit Endophthalmitis Model
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Conservation of Ebp-Type Pilus Genes among Enterococci and Demonstration of Their Role in Adherence of Enterococcus faecalis to Human Platelets
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The 2.4-Å crystal structure of the penicillin-resistant penicillin-binding protein PBP5fm from Enterococcus faecium in complex with benzylpenicillin
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Evidence that the Enterococcal Polysaccharide Antigen Gene ( epa ) Cluster Is Widespread in Enterococcus faecalis and Influences Resistance to Phagocytic Killing of E. faecalis
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Glycolipids are involved in biofilm accumulation and prolonged bacteraemia in Enterococcus faecalis
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High-Quality Draft Genome Sequences of 28 Enterococcus sp. Isolates
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Gelatinase Is Important for Translocation of Enterococcus faecalis across Polarized Human Enterocyte-Like T84 Cells
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Opsonic Antibodies to Enterococcus faecalis Strain 12030 Are Directed against Lipoteichoic Acid
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Cotransfer of Antibiotic Resistance Genes and a hyl Efm -Containing Virulence Plasmid in Enterococcus faecium
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Glycopeptide ResistancevanAOperons inPaenibacillusStrains Isolated from Soil
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Ligand-Signaled Upregulation of Enterococcus faecalis ace Transcription, a Mechanism for Modulating Host- E. faecalis Interaction
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Bicarbonate enhances expression of the endocarditis and biofilm associated pilus locus, ebpR-ebpABC, in Enterococcus faecalis
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Structural basis for streptogramin B resistance in Staphylococcus aureus by virginiamycin B lyase
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Reply
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An AraC-Type Transcriptional Regulator Encoded on the Enterococcus faecalis Pathogenicity Island Contributes to Pathogenesis and Intracellular Macrophage Survival
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Screening of In Vivo Activated Genes in Enterococcus faecalis during Insect and Mouse Infections and Growth in Urine
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Importance of theepaLocus ofEnterococcus faecalisOG1RF in a Mouse Model of Ascending Urinary Tract Infection
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Tn5386, a Novel Tn916-Like Mobile Element inEnterococcus faeciumD344R That Interacts with Tn916To Yield a Large Genomic Deletion
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Authors: Arias, C. A., & Murray, B. E.
Corresponding author: Murray, Barbara E.
ORCID: Murray, Barbara E.
Venue: Nature Reviews Microbiology
Publisher: Springer Science and Business Media LLC
Published: 2012-03-16
Volume: 10
Issue: 4
Pages: 266-278
ISSN: 1740-1526 (ISSN-L)
1740-1534
DOI: 10.1038/nrmicro2761
PMC: PMC3621121
OpenAlex: W1976667730
Cited by: 1,776
References: 154
Citations by year: 2026: 160 · 2025: 147 · 2024: 140 · 2023: 132 · 2022: 163 · 2021: 122 · 2020: 143 · 2019: 133 · 2018: 117 · 2017: 110 · 2016: 104 · 2015: 95 · 2014: 114 · 2013: 75 · 2012: 19
FWCI: 5.68
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: www.springer.com/tdm (tdm)
Locations: Nature Reviews Microbiology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion)
Funders: National Institute of Allergy and Infectious Diseases (R00 AI72961, R37AI47923, R37AI047923, R01AI093749, R00AI072961, R01AI067861)
Topics: Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
Health Sciences › Medicine › Microbiology (medical) › Infections and bacterial resistance
Keywords: Enterococcus, Enterococcus faecium, vancomycin resistance, nosocomial infections, multidrug resistance, gut microbiota, antibiotic-induced dysbiosis, genetic lineages, antibiotic resistance mechanisms
MeSH terms: Animals, Anti-Bacterial Agents, Bacterial Proteins, Cross Infection, Enteritis, Humans, Vancomycin, Gram-Positive Bacterial Infections, Enterococcus faecium, Vancomycin Resistance, Drug Resistance, Multiple, Bacterial, Virulence Factors, Gastrointestinal Tract, Microbial Interactions

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The rise of the Enterococcus: beyond vancomycin resistance

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