Understanding epidemics of antibiotic-resistant Enterococci

Antibiotic resistance in bacteria, in particular Vancomycin resistance in enterococci, is a growing problem in hospitals. Two research letters in this week's issue of THE LANCET give new insights into how bacteria acquire vancomycin resistance, how they cause epidemics, and suggest new strategies for monitoring and possibly controlling infections.

Timothy Stinear and colleagues from Austin & Repatriation Medical Centre Heidelberg, Melbourne, Australia, found the vanB gene, which codes for vancomycin resistance, in two normally non-pathogenic species of anaerobic bacteria suggesting that transfer of resistance might occur among bacteria in the gut.

In the second research letter - posted on THE LANCET's website earlier this week - Rob Willems and colleagues from the National Institute of Public Health, Bilthoven, Netherlands, studied vancomycin resistant Enterococcus faecium from epidemic and non-epidemic isolates in the USA and Europe. They found that a particular subpopulation was associated with epidemic outbreaks and that these epidemic strains carried a variant of the esp gene, which codes for a cell surface protein required for attachment of the bacteria to gut cells. They suggest that the variant esp gene might be a marker of epidemic strains, and possibly a target for therapy.

Contact: Dr Paul Johnson, Department of Infectious Diseases, Austin & Repatriation Medical Centre Heidelberg, 3084, Melbourne, Australia; T) +61 3 9496 6678; F) +61 3 9496 5123;
E) Paul.Johnson@armc.org.au

Dr Rob Willems, Research Laboratory for Infectious Diseases, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands; T) +31 30 274 4050; F) +31 30 274 4449;
E) rob.willems@rivm.nl or Dr Marc Bonten, T) +31 30 250 9111; F) +31 30 25 23 741; E) bonte023@wxs.nl

Lancet. March 2001.