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Enterococcus faecium: evolution, adaptation, pathogenesis and emerging therapeutics

Nature Reviews Microbiology (2024)Cite this article

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Abstract

The opportunistic pathogen Enterococcus faecium colonizes humans and a wide range of animals, endures numerous stresses, resists antibiotic treatment and stubbornly persists in clinical environments. The widespread application of antibiotics in hospitals and agriculture has contributed to the emergence of vancomycin-resistant E. faecium, which causes many hospital-acquired infections. In this Review, we explore recent discoveries about the evolutionary history, the environmental adaptation and the colonization and dissemination mechanisms of E. faecium and vancomycin-resistant E. faecium. These studies provide critical insights necessary for developing novel preventive and therapeutic approaches against vancomycin-resistant E. faecium and also reveal the intricate interrelationships between the environment, the microorganism and the host, providing knowledge that is broadly relevant to how antibiotic-resistant pathogens emerge and endure.

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Fig. 1: VREfm transmission and evolution.
Fig. 2: Roles of plasmids in antimicrobial resistance spread in E. faecium.
Fig. 3: Adaptive strategies of VREfm that promote survival and resistance to antimicrobials.
Fig. 4: Colonization and pathogenicity of E. faecium.

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Acknowledgements

The authors thank the National Institutes of Health for their funding support through grants R56AI139105 and R01AI148366 to K.L.P.

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Authors and Affiliations

  1. School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, USA

    Yahan Wei

  2. Department of Biological Sciences, The University of Texas at Dallas, Richardson, TX, USA

    Dennise Palacios Araya & Kelli L. Palmer

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  1. Yahan Wei
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Contributions

Y.W. and K.L.P. researched data for the article. Y.W. and K.L.P. contributed substantially to the discussion of the content. Y.W. and K.L.P. wrote the article. D.P.A. contributed to the editing to the first draft of the manuscript. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Kelli L. Palmer.

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Glossary

Biofilms

Microbial communities resulting from adherence of planktonic organisms to a surface followed by growth.

Complement proteins

Part of innate immunity, a group of proteins circulating in serum that are activated by the presence of pathogens, which leads to either destruction of pathogens by inducing cell lysis or recognition and clearance of pathogens by immune cells.

Core genome multilocus sequence typing

(cgMLST). A method that compares the sequences of the core genes among a certain set of genomes for discrimination of strains of different sequence types.

Persister cells

A small population of cells that are killed more slowly than the majority of the population during the exposure to bactericidal factors, such as antibiotics.

Phosphotransferase system

(PTS). An active sugar-transport system that phosphorylates the imported sugar using phosphoenolpyruvate as the phosphoryl group donor.

Resuscitation

A process for viable but nonculturable cells to regain the ability to perform cell division (that is, culturability) under favourable conditions.

Sequence type

A unique combination of variations in the sequences of seven E. faecium housekeeping genes, atpA, ddl, gdh, purK, gyd, pstS and adk.

Viable but nonculturable

(VBNC). A small population of cells that are unable to grow on culture media but are functionally viable.

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Wei, Y., Palacios Araya, D. & Palmer, K.L. Enterococcus faecium: evolution, adaptation, pathogenesis and emerging therapeutics. Nat Rev Microbiol (2024). https://doi.org/10.1038/s41579-024-01058-6

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