同: VRE

WordNet

impervious to being affected; "resistant to the effects of heat"; "resistant to persuasion"
an antibiotic (trade name Vancocin) effective against some bacterial infections (同)Vancocin

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/07/07 17:22:45」(JST)

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SEM micrograph of vancomycin-resistant enterococci

Vancomycin-resistant Enterococcus, or vancomycin-resistant enterococci (VRE), are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin.

History and biology of VRE[edit]

To become vancomycin-resistant, vancomycin-sensitive enterococci typically obtain new DNA in the form of plasmids or transposons which encode genes that confer vancomycin resistance. This acquired vancomycin resistance is distinguished from the lower-level, natural vancomycin resistance of certain enterococcal species including E. gallinarum and E. casseliflavus.^[1]

High-level vancomycin-resistant E. faecalis and E. faecium clinical isolates were first documented in Europe in the late 1980s.^[2]^[3] Since then, VRE have been associated with outbreaks of hospital-acquired (nosocomial) infections around the world. In the United States, vancomycin-resistant E. faecium was associated with 4% of healthcare-associated infections reported to the Centers for Disease Control and Prevention National Healthcare Safety Network from January 2006 to October 2007.^[4]

VRE can be carried by healthy people who have come into contact with the bacteria. The most likely place where such contact can occur is in a hospital (nosocomial infection), although it is thought that a significant percentage of intensively farmed chicken also carry VRE.^[5]^[6]

Mechanism of acquired vancomycin resistance[edit]

Six different types of vancomycin resistance are shown by enterococcus : Van-A, Van-B, Van-C, Van-D, Van-E and Van-F. Of these, only Van-A, Van-B and Van-C have been seen in general clinical practice, so far. The significance is that Van-A VRE is resistant to both vancomycin and teicoplanin, Van-B VRE is resistant to vancomycin but sensitive to teicoplanin, and Van-C is only partly resistant to vancomycin, and sensitive to teicoplanin. In the US, linezolid is commonly used to treat VRE, as teicoplanin

The mechanism of resistance to vancomycin found in enterococcus involves the alteration to the terminal amino acid residues of the NAM/NAG-peptide subunits, under normal conditions, D-alanyl-D-alanine, to which vancomycin binds. The D-alanyl-D-lactate variation results in the loss of one hydrogen-bonding interaction (four, as opposed to five for D-alanyl-D-alanine) being possible between vancomycin and the peptide. This loss of just one point of interaction results in a 1000-fold decrease in affinity. The D-alanyl-D-serine variation causes a six-fold loss of affinity between vancomycin and the peptide, likely due to steric hindrance.^[7]

Some VREs respond to the presence of vancomycin rather than just its effect on the cell wall.^[8]

Prevention and treatment of VRE infection[edit]

Cephalosporin use is a risk factor for colonization and infection by VRE, and restriction of cephalosporin usage has been associated with decreased VRE infection and transmission in hospitals.^[9]

In 2005, Lactobacillus rhamnosus GG (LGG), a strain of L. rhamnosus, was used successfully for the first time to treat gastrointestinal carriage of VRE in renal patients.^[10]

References[edit]

^ Courvalin P (January 2006). "Vancomycin resistance in gram-positive cocci". Clin. Infect. Dis. 42 Suppl 1: S25–34. doi:10.1086/491711. PMID 16323116.
^ Uttley AH, Collins CH, Naidoo J, George RC (1988). "Vancomycin-resistant enterococci". Lancet 1 (8575-6): 57–8. PMID 2891921.
^ Leclercq R, Derlot E, Duval J, Courvalin P (July 1988). "Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium". N. Engl. J. Med. 319 (3): 157–61. doi:10.1056/NEJM198807213190307. PMID 2968517.
^ Hidron AI, Edwards JR, Patel J, et al. (November 2008). "NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007". Infect Control Hosp Epidemiol 29 (11): 996–1011. doi:10.1086/591861. PMID 18947320.
^ Harwood VJ, Brownell M, Perusek W, Whitlock JE (2001). "Vancomycin-resistant Enterococcus spp. isolated from wastewater and chicken feces in the United States". Appl Environ Microbiol 67 (10): 4930–3. doi:10.1128/AEM.67.10.4930-4933.2001. PMC 93253. PMID 11571206.
^ Cox LA Jr, Popken DA (2004). "Quantifying human health risks from virginiamycin used in chickens". Risk Analysis 24 (1): 271–88. doi:10.1111/j.0272-4332.2004.00428.x. PMID 15028017.
^ Pootoolal J, Neu J, Wright GD (2002). "Glycopeptide Antibiotic Resistance". Annu Rev Pharmacol Toxicol 42: 381–408. doi:10.1146/annurev.pharmtox.42.091601.142813. PMID 11807177.
^ "Researchers Identify the Mechanism that Triggers Resistance to Vancomycin". 2010.
^ Chavers, LS.; Moser, SA.; Benjamin, WH.; Banks, SE.; Steinhauer, JR.; Smith, AM.; Johnson, CN.; Funkhouser, E. et al. (Mar 2003). "Vancomycin-resistant enterococci: 15 years and counting.". J Hosp Infect 53 (3): 159–71. PMID 12623315. |displayauthors= suggested (help)
^ Manley KJ, Fraenkel MB, Mayall BC, Power DA (2007). "Probiotic treatment of vancomycin-resistant enterococci: a randomised controlled trial". Med J Aust. 186 (9): 454–7. PMID 17484706.

External links[edit]

Vancomycin-resistant Enterococci (VRE) and the Clinical Laboratory

UpToDate Contents

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1. バンコマイシン耐性腸球菌の疫学、予防および管理 epidemiology prevention and control of vancomycin resistant enterococci
2. 腸球菌感染症の治療 treatment of enterococcal infections
3. メチシリン耐性黄色ブドウ球菌およびバンコマイシン耐性腸球菌の治療のための抗菌薬の薬理 pharmacology of antimicrobial agents for treatment of methicillin resistant staphylococcus aureus and vancomycin resistant enterococcus
4. 長期透析患者における非アクセス関連感染症 non access related infections in chronic dialysis patients
5. バンコマイシン中等度耐性およびバンコマイシン耐性黄色ブドウ球菌感染症 vancomycin intermediate and vancomycin resistant staphylococcus aureus infections

English Journal

Antibacterial activity of quinoxalines, quinazolines, and 1,5-naphthyridines.

Parhi AK, Zhang Y, Saionz KW, Pradhan P, Kaul M, Trivedi K, Pilch DS, Lavoie EJ.SourceDepartment of Medicinal Chemistry, Rutgers, The State University of New Jersey, Piscataway, NJ 08854-8020, USA; TAXIS Pharmaceuticals Inc., North Brunswick, NJ, USA.
Bioorganic & medicinal chemistry letters.Bioorg Med Chem Lett.2013 Sep 1;23(17):4968-74. doi: 10.1016/j.bmcl.2013.06.048. Epub 2013 Jun 26.
Several phenyl substituted naphthalenes and isoquinolines have been identified as antibacterial agents that inhibit FtsZ-Zing formation. In the present study we evaluated the antibacterial of several phenyl substituted quinoxalines, quinazolines and 1,5-naphthyridines against methicillin-sensitive a
PMID 23891185

High-level aminoglycoside resistance and virulence characteristics among Enterococci isolated from recreational beaches in Malaysia.

Dada AC, Ahmad A, Usup G, Heng LY, Hamid R.SourceFaculty of Science and Technology, School of Biosciences and Biotechnology, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia, ayokunled@yahoo.com.
Environmental monitoring and assessment.Environ Monit Assess.2013 Sep;185(9):7427-43. doi: 10.1007/s10661-013-3110-x. Epub 2013 Feb 16.
We report the first study on the occurrence of high-level aminoglycoside-resistant (HLAR) Enterococci in coastal bathing waters and beach sand in Malaysia. None of the encountered isolates were resistant to high levels of gentamicin (500 μg/mL). However, high-level resistance to kanamycin (2,000
PMID 23417753

Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan.

Tosh PK, Agolory S, Strong BL, Verlee K, Finks J, Hayakawa K, Chopra T, Kaye KS, Gilpin N, Carpenter CF, Haque NZ, Lamarato LE, Zervos MJ, Albrecht VS, McAllister SK, Limbago B, Maccannell DR, McDougal LK, Kallen AJ, Guh AY.SourceEpidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America.Infect Control Hosp Epidemiol.2013 Sep;34(9):954-60. doi: 10.1086/671735. Epub 2013 Jul 26.
Background. Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. I
PMID 23917910

Japanese Journal

Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study

BMC Infectious Diseases 15, 426, 2015-10-16
NAID 120005676327

Nosocomial infection caused by vancomycin-susceptible multidrug-resistant Enterococcus faecalis over a long period in a university hospital in Japan

Microbiology and immunology 58(11), 607-614, 2014-11
NAID 40020271456

Identification and Characterization ofVancomycin-resistant Enterococcus species Frequently Isolated from Laboratory Mice

Experimental Animals 63(3), 297-304, 2014
NAID 130004677820

Related Pictures

A medical illustration of vancomycin–resistant, Enterococci sp Drug-resistant superbugs may have just learned a new trick Vancomycin-resistant Enterococci (VRE) - ABC News (Australian CDC sounds alarm over killer superbugs Molecular characterization of vancomycin-resistant Enterococcus faecium Deadly superbug-related scopes sold without FDA's OK - CNN.com Vancomycin | Public Health | Manitoba Health, Seniors and Active Living | Province of

★リンクテーブル★

リンク元	「バンコマイシン耐性腸球菌」「VRE」
関連記事	「resistant」「vancomycin」

「バンコマイシン耐性腸球菌」

　　[★]

英: vancomycin-resistant enterococcus vancomycin-resistant Enterococcus VRE
関: バンコマイシン

腸球菌はヒト腸管や女性外陰部の常在菌であり、免疫が低下した宿主で心内膜炎、敗血症、複雑性尿路感染症、胆道感染などを引きおこしうる。
VREとはバンコマイシンに薬剤耐性を獲得した腸球菌のことであり、Enterococcus faecalis, Enterococcus faeciumのいずれにもVREが存在する。
VREは、1986年フランスでバンコマイシン高度耐性腸球菌として発見され、その後、ヨーロッパ諸国において重症院内感染原因菌として広がった。
アメリカでは1989年以降、院内感染菌として急激な広がりをみせ、現在最も治療困難な院内感染菌となっている。
基本的に、VREとは最小発育阻止濃度(MIC)が16μg/mL以上、或いはディスク法の阻止円径が14mm以下の腸球菌を指すが、vanA, vanBなどの外来性の誘導型VCM高度耐性遺伝子を保有した腸球菌も指す。

耐性遺伝子	MIC		耐性遺伝子の存在部位	耐性の発現	菌種
耐性遺伝子	VCM	TEIC	耐性遺伝子の存在部位	耐性の発現	菌種
vanA	64～1000	16～512	プラスミド,染色体	誘導耐性	E. faecalis, E. faecium
vanB	4～1000	0.5～1	プラスミド, 染色体	誘導耐性	E. faecalis, E. faecium
vanC	2～32	0.5～1	染色体	非調導型	E. gallinarum, E. casseliflavus, E. flavescens
vanD	64～128	4～64	染色体	非誘導型	E. faecalis, E. faecium, E. raffinosus
vanE	8～32	0.5	染色体	誘導耐性	E. faecalis
vanG	16	0.5	染色体	誘導耐性	E. faecalis