Cited by 567Antimicrobial Resistance in StaphylococcusAntibiotic Resistance in BacteriaBacterial Genetics and Biotechnology

Mechanisms of vancomycin resistance in Staphylococcus aureus

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Gardete, Susana, Tomasz, Alexander·2014·Journal of Clinical Investigation

Abstract

Vancomycin is a glycopeptide antibiotic used for the treatment of Gram-positive bacterial infections. Traditionally, it has been used as a drug of last resort; however, clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) strains with decreased susceptibility to vancomycin (vancomycin intermediate-resistant S. aureus [VISA]) and more recently with high-level vancomycin resistance (vancomycin-resistant S. aureus [VRSA]) have been described in the clinical literature. The rare VRSA strains carry transposon Tn1546, acquired from vancomycin-resistant Enterococcus faecalis, which is known to alter cell wall structure and metabolism, but the resistance mechanisms in VISA isolates are less well defined. Herein, we review selected mechanistic aspects of resistance in VISA and summarize biochemical studies on cell wall synthesis in a VRSA strain. Finally, we recapitulate a model that integrates common mechanistic features of VRSA and VISA strains and is consistent with the mode of action of vancomycin.

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Crossref · 10.1172/jci68834

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  • Phenotypically, hVISA/VISA strains exhibit distinct metabolic characteristics that may include increased fructose utilization, increased fatty acid metabolism, impaired acetate metabolism and tricarboxylic acid cycle, decreased glutamate availability, and increased expression of cell wall synthesis genes.

    “Phenotypically, hVISA/VISA strains exhibit distinct metabolic characteristics that may include i) increase in fructose utilization, ii) increased fatty acid metabolism, iii) impaired acetate metabolism and tricarboxylic acid cycle, iv) decrease in glutamate availability, and iv) increase expression of cell wall synthesis genes.”

    From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [104]

  • The available evidence shows that the regulatory systems most consistently implicated in hVISA/VISA resistance are YycFG (WalKR), VraSR (homolog of LiaFSR), and GraRS.

    “However, the available evidence shows that the regulatory systems most consistently implicated in this mechanism of resistance are YycFG (WalKR), VraSR (homolog of LiaFSR), and GraRS (104).”

    From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [104]

  • These global homeostatic changes appear to lead to reduced autolytic activity with thickened cell wall and an increased amount of free D-Ala-D-Ala dipeptides with less peptidoglycan cross-linking.

    “These global homeostatic changes appear to lead to a reduced autolytic activity with thickened cell wall and an increase amount of free D-Ala-D-Ala dipeptides with less peptidoglycan cross-linking (101, 104).”

    From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [104]

  • VISA strains bind vancomycin more avidly than their non-VISA counterparts, but diffusion of the antibiotic molecule into the inner part of the cell wall appears to be impaired.

    “In addition, VISA strains bind vancomycin more avidly than their non –VISA counterparts, however, diffusion of the antibiotic molecule into the inner part of the cell wall appears to be impaired.”

    From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [104]

  • A striking feature of many hVISA/VISA strains is the ability to revert from one phenotype to another (or even to a fully vancomycin susceptible phenotype) in the absence of vancomycin exposure.

    “Finally, a striking feature of many hVISA/VISA strains is the ability to revert from one phenotype to another (or even to a fully vancomycin susceptible phenotype) in the absence of vancomycin exposure.”

    From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [104]

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Research works printed but not linked: 4

  1. Price J, Atkinson S, Llewelyn M, Paul J. Paradoxi- cal relationship between the clinical outcome of Staphylococcus aureus bacteremia and the mini- mum inhibitory concentration of vancomycin. Clin Infect Dis. 2009;48(7):997-998.
  2. Matsuo M, Cui L, Kim J, Hiramatsu K. 2013. Com- prehensive identification of mutations responsible for hVISA-to-VISA conversion in laboratory-gener- ated VISA strains from hVISA clinical strain Mu3. Antimicrob Agents Chemother. 2013;57(12):5843-5853.
  3. McEvoy CR, et al. Decreased vancomycin suscep- tibility in Staphylococcus aureus caused by IS256 tempering of WalKR expression. Antimicrob Agents Chemother. 2013;57(7):3240-3249.
  4. Smith TL, et al. Emergence of vancomycin resis- tance in Staphylococcus aureus. Glycopeptide- Intermediate Staphylococcus aureus Working Group. N Engl J Med. 1999;340(7):493-501.

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Authors
Gardete, S., & Tomasz, A.
Affiliations
Rockefeller University (US)
Corresponding author
Tomasz, Alexander
Venue
Journal of Clinical Investigation
Published
2014-07-01
Volume
124
Issue
7
Pages
2836-2840
ISSN
0021-9738 (ISSN-L)
OpenAlex
W1983784984
Cited by
565
References
66
Citations by year
2026: 26 · 2025: 53 · 2024: 71 · 2023: 48 · 2022: 53 · 2021: 57 · 2020: 49 · 2019: 66 · 2018: 40 · 2017: 43 · 2016: 29 · 2015: 25 · 2014: 4
FWCI
4.68
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Allergy and Infectious Diseases (2 R01 AI457838-14)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Bacterial Genetics and Biotechnology
Keywords
vancomycin resistance, Staphylococcus aureus, vancomycin-intermediate Staphylococcus aureus, vancomycin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Tn1546 transposon, vancomycin-resistant Enterococcus faecalis, cell wall biosynthesis, glycopeptides, antibiotic resistance mechanisms, cell wall metabolism
MeSH terms
Cell Wall, DNA Transposable Elements, DNA, Bacterial, Genes, Bacterial, Humans, Microbial Sensitivity Tests, Models, Biological, Mutation, Staphylococcal Infections, Staphylococcus aureus, Virulence, Vancomycin Resistance, Methicillin-Resistant Staphylococcus aureus

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