Glycopeptide resistant enterococci: What's the problem?

Enterococci are cocci gram-positive bacteria belonging to the bowel flora. Since the end of the 80s, glycopeptide resistant enterococci (GRE) have emerged in healthcare facilities. It has become a major public health issue in several countries. In USA, the rate of GRE was in 2003 about 30% of Enterococci isolated in intensive care units. In UK, 910 GRE bacteraemia has been reported by hospitals during 2007 with a majority of Enterococcus faecium owning the vanA phenotype. The emergence of the resistance to glycopeptides has increased difficulties in treating infected patients. Collectively, the potential transfer of the resistance gene to others pathogens like meticillin resistant Staphylococcus aureus is feared. The application of infection control guidelines and an appropriate use of antimicrobial agents could allow avoiding infections. This article had the aim to give an overview on problems associated to the spread of GRE and to provide some recommendation about the management of infected or colonized patients.