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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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抵抗力のある;(…に)抵抗する《+『to』+『名』》

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/28 05:07:42」(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 susceptible to teicoplanin, and Van-C is only partly resistant to vancomycin, and susceptible 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. Cite uses deprecated parameters (help)
^ 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. Cite uses deprecated parameters (help)
^ 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. Cite uses deprecated parameters (help)
^ 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. Cite uses deprecated parameters (help); |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 and 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. 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
5. Important sites and pathogens causing infections in long-term care facilities

English Journal

One-step syntheses of nitrofuranyl benzimidazoles that are active against multidrug-resistant bacteria.

Moraski GC, Thanassi JA, Podos SD, Pucci MJ, Miller MJ.SourceDepartment of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA.
The Journal of antibiotics.J Antibiot (Tokyo).2011 Aug 3. doi: 10.1038/ja.2011.67. [Epub ahead of print]
Nitrofuranyl benzimidazoles can be made in one synthetic step from commercially available starting materials. The compounds displayed unexpected antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci with MICs as low as 1?μg?ml(-1)
PMID 21811261

An Evaluation of the Ability of the Probiotic Strain Lactobacillus rhamnosus GG to Eliminate the Gastrointestinal Carrier State of Vancomycin-Resistant Enterococci in Colonized Children.

Szachta P, Igny? I, Cichy W.SourceFirst Department of Paediatrics, Department of Paediatric Gastroenterology and Metabolic Disorders, Poznan University of Medical Sciences, Poland.
Journal of clinical gastroenterology.J Clin Gastroenterol.2011 Aug 2. [Epub ahead of print]
GOALS: To evaluate the efficacy of Lactobacillus rhamnosus GG (LGG) supplementation in eliminating the gastrointestinal carrier state of vancomycin-resistant enterococci (VRE) in colonized children, and to evaluate the affect of the probiotic on Lactobacillus spp. counts in the gastrointestinal trac
PMID 21814146

Japanese Journal

vanA 型 Vancomycin-resistant enterococci 病棟内伝播事例への対応

鈴木高弘,伊藤章,佐々木由香,佐々木隆,篠永正道,廣井みどり,石井良和,山口惠三
日本環境感染学会誌 = Japanese journal of environmental infections 24(2), 113-118, 2009-03-25
… 棟内で伝播した可能性が高いことが示唆された．さらなる伝播を防止するために，インフェクションコントロールチーム，リンクナース，病棟職員が連携して，接触感染予防策の徹底，担当看護師の専従化，感染性廃棄物用足踏み式ゴミ箱の導入などを実施した．その結果，新規にVREが検出されることはなかった．また今回の事例から，vancomycin以外の抗菌薬の使用が，VREによる感染の一因となる可能性が示唆された． …
NAID 10024804285

Gene Cloning and Characterization of EfmA, a Multidrug Efflux Pump, from Enterococcus faecium(Microbiology)

NISHIOKA Toshihiro,OGAWA Wakano,KURODA Teruo,KATSU Takashi,TSUCHIYA Tomofusa
Biological & pharmaceutical bulletin 32(3), 483-488, 2009-03-01
… coli KAM32 harboring a recombinant plasmid (pTFM8) carrying the DNA fragment became resistant to fluoroquinolones, macrolides, ethidium bromide, 4',6-diamidino-2-phenylindole (DAPI) and tetraphenylphosphonium chloride (TPPCI). …
NAID 110007122697