Enteroccoccus

CLINICAL MICROBIOLOGY REVIEWS, Oct. 2000, p. 686–707 0893-8512/00/$04.00 0 Copyright © 2000, American Society for Microbiology. All Rights Reserved.

Vol. 13, No. 4

Vancomycin-Resistant Enterococci
YESIM CETINKAYA, PAMELA FALK,
AND

C. GLEN MAYHALL*

Department of Healthcare Epidemiology and Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Galveston,Texas 77555-0835 INTRODUCTION .......................................................................................................................................................686 MECHANISMS OF RESISTANCE..........................................................................................................................687 -Lactam Resistance..............................................................................................................................................687 Aminoglycoside Resistance ....................................................................................................................................687 Vancomycin Resistance..........................................................................................................................................687 Phenotypic description .......................................................................................................................................687 Genotypic classification and resistance mechanisms ....................................................................................688 (i) Action of vancomycin on peptidoglycan synthesis................................................................................688 (ii) VanA glycopeptide resistance .................................................................................................................688 (iii) VanB glycopeptide resistance ................................................................................................................689 (iv) VanC glycopeptide resistance................................................................................................................689 (v) VanD glycopeptide resistance .................................................................................................................689 (vi) VanE glycopeptideresistance.................................................................................................................689 (vii) Other resistance classes and organisms .............................................................................................689 (viii) Vancomycin-dependent enterococci ....................................................................................................690 EPIDEMIOLOGY ANDCONTROL........................................................................................................................690 Geographic Distribution and Spread within Hospitals.....................................................................................690 VRE in Long-Term-Care Facilities.......................................................................................................................690 VRE in theCommunity..........................................................................................................................................690 Risk Factors.............................................................................................................................................................691 Colonization and Infection....................................................................................................................................692 Reservoirs.................................................................................................................................................................692 Modes of Transmission..........................................................................................................................................693 Prevention and...