Vancomycin tolerance in Gram-positive cocci
Article first published online: 20 APR 2011
© 2011 Society for Applied Microbiology and Blackwell Publishing Ltd
Environmental Microbiology Reports
Volume 3, Issue 6, pages 640–650, December 2011
How to Cite
Moscoso, M., Domenech, M. and García, E. (2011), Vancomycin tolerance in Gram-positive cocci. Environmental Microbiology Reports, 3: 640–650. doi: 10.1111/j.1758-2229.2011.00254.x
- Issue published online: 14 NOV 2011
- Article first published online: 20 APR 2011
- Received 9 December, 2010; accepted 26 February, 2011.
Vancomycin, a glycopeptide antimicrobial agent, represents the last line of defence against a wide range of multi-resistant Gram-positive pathogens such as enterococci, staphylococci and streptococci. However, vancomycin-resistant enterococci and staphylococci, along with vancomycin-tolerant clinical isolates, are compromising the therapeutic efficacy of vancomycin. It is conceivable that tolerance may emerge during prolonged vancomycin use. It has not been until recently, however, that the molecular basis of this tolerance began to be understood. Superoxide anions might be involved in the bactericidal activity of vancomycin in enterococci, and recent evidence suggests that the stringent response is partly responsible for vancomycin tolerance in Enterococcus faecalis. The mechanism of vancomycin tolerance in Staphylococcus aureus and Streptococcus pneumoniae is sometimes associated with a reduction of autolysin activity. Vancomycin tolerance in S. aureus and S. pneumoniae also appears to be somehow related with the two-component regulatory systems linked to cell envelope stress, although the precise molecular regulatory pathways remain poorly defined.