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Novel Strategies for the Management of Vancomycin-Resistant Enterococcal Infections

  • Antimicrobial Development and Drug Resistance (K Claeys and A Vega, Section Editors)
  • Published:
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Abstract

Purpose of Review

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that commonly affect critically ill patients. VRE have a remarkable genetic plasticity allowing them to acquire genes associated with antimicrobial resistance. Therefore, the treatment of deep-seated infections due to VRE has become a challenge for the clinician. The purpose of this review is to assess the current and future strategies for the management of recalcitrant deep-seated VRE infections and efforts for infection control in the hospital setting.

Recent Findings

Preventing colonization and decolonization of multidrug-resistant bacteria are becoming the most promising novel strategies to control and eradicate VRE from the hospital environment. Fecal microbiota transplantation (FMT) has shown remarkable results on treating colonization and infection due to Clostridiodes difficille and VRE, as well as to recover the integrity of the gut microbiota under antibiotic pressure. Initial reports have shown the efficacy of FMT on reestablishing patient microbiota diversity in the gut and reducing the dominance of VRE in the gastrointestinal tract. In addition, the use of bacteriophages may be a promising strategy in eradicating VRE from the gut of patients. Until these strategies become widely available in the hospital setting, the implementation of infection control measures and stewardship programs are paramount for the control of this pathogen and each program should provide recommendations for the proper use of antibiotics and develop strategies that help to detect populations at risk of VRE colonization, prevent and control nosocomial transmission of VRE, and develop educational programs for all healthcare workers addressing the epidemiology of VRE and the potential impact of these pathogens on the cost and outcomes of patients. In terms of antibiotic strategies, daptomycin has become the standard of care for the management of deep-seated infections due to VRE. However, recent evidence indicates that the efficacy of this antibiotic is limited, and higher (10–12 mg/kg) doses and/or combination with β-lactams is needed for therapeutic success. Clinical data to support the best use of daptomycin against VRE are urgently needed.

Summary

This review provides an overview of recent developments regarding the prevention, treatment, control, and eradication of VRE in the hospital setting. We aim to provide an update of the most recent therapeutic strategies to treat deep-seated infections due to VRE.

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Acknowledgements

CA is funded through an NIH-NIAID grant K24 AI-AI121296, R01-AI134637, R01-AI093749 and R21AI121519.

JM is funded through the Millennium Science Initiative of the Ministry of Economy, Development and Tourism, and the Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT), FONDECYT regular 1171805, Government of Chile.

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Authors and Affiliations

  1. Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics (CARMiG), UTHealth McGovern Medical School, Houston, TX, USA

    German A. Contreras & Cesar A. Arias

  2. Department of Internal Medicine, UTHealth McGovern Medical School, Houston, TX, USA

    German A. Contreras & Cesar A. Arias

  3. Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago, Chile

    Jose M. Munita

  4. Genomics and Resistant Microbes Group, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile

    Jose M. Munita & Cesar A. Arias

  5. Department of Microbiology and Molecular Genetics, UTHealth McGovern Medical School, Houston, TX, USA

    Cesar A. Arias

  6. Center for Infectious Diseases, UTHealth School of Public Health, Houston, TX, USA

    Cesar A. Arias

  7. Molecular Genetics and Antimicrobial Resistance Unit—International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia

    Cesar A. Arias

  8. University of Texas Health Science Center, 6431 Fannin St. MSB 2.112, Houston, TX, 77030, USA

    Cesar A. Arias

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  1. German A. Contreras
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Correspondence to Cesar A. Arias.

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Contreras, G.A., Munita, J.M. & Arias, C.A. Novel Strategies for the Management of Vancomycin-Resistant Enterococcal Infections. Curr Infect Dis Rep 21, 22 (2019). https://doi.org/10.1007/s11908-019-0680-y

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