Glycopeptide-resistant enterococci (GRE): epidemiological situation, current control measures, and future challenges.

Enterococci (Enterococcus faecalis and E. faecium) are commensal bacteria of the gastrointestinal flora responsible for rare and generally mild hospital-acquired infections. Their resistance to glycopeptides (ERG) first emerged in the United States and more recently in Europe. The situation in France has been marked by the occurrence of local or regional hospital outbreaks over the past four years. ERG first emerged under selection pressure from glycopeptides. Cross-transmission via hands then allowed the spread of the most adapted strains, as antibiotics facilitated their establishment and colonization in a carrier patient. Unlike other multidrug-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, which are already widespread, the challenge in France is controlling an emerging phenomenon, where the risk of transferring the resistance gene from ERG to MRSA is offset by the low virulence of the strains and a perceived low risk. Recommendations for controlling ERG are technically similar to those for other multidrug-resistant (MDR) bacteria transmitted by hands, but differ in terms of the speed of response, active investigation of secondary cases, sectorization of cases and contacts, and reporting to health authorities. In the event of a prolonged outbreak, these measures may impact hospital operations and the quality of patient care. The rapidly evolving epidemiological situation warrants regular adaptation of control measures. (R.A.)

Author(s): Lucet JC, Andremont A, Coignard B

Publishing year: 2008

Pages: 386-90

Weekly Epidemiological Bulletin, 2008, n° 41-42, p. 386-90

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