Radford-Smith Daniel E, Anthony Daniel C
Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK.
Antibiotics (Basel). 2025 May 19;14(5):522. doi: 10.3390/antibiotics14050522.
Antimicrobial resistance (AMR) poses a profound threat to modern healthcare, with vancomycin-resistant (VREfm) emerging as a particularly resilient and clinically significant pathogen. This mini-review examines the biological mechanisms underpinning VREfm resistance, including biofilm formation, stress tolerance, and the acquisition of resistance genes such as and . It also explores the behavioural, social, and healthcare system factors that facilitate VREfm transmission, highlighting disparities in burden across vulnerable populations and low-resource settings. Prevention strategies are mapped across the disease pathway, spanning primary, secondary, and tertiary levels, with a particular focus on the role and evolving challenges of antimicrobial stewardship programmes (ASP). We highlight emerging threats, such as rifaximin-induced cross-resistance to daptomycin, which challenge conventional stewardship paradigms. Finally, we propose future directions to enhance global surveillance, promote equitable stewardship interventions, and accelerate the development of innovative therapies. Addressing VREfm requires a coordinated, multidisciplinary effort to safeguard the efficacy of existing antimicrobials and protect at-risk patient populations.
抗菌药物耐药性（AMR）对现代医疗保健构成了严重威胁，耐万古霉素肠球菌（VREfm）已成为一种特别具有韧性且在临床上具有重要意义的病原体。本综述探讨了VREfm耐药性的生物学机制，包括生物膜形成、应激耐受性以及耐药基因的获得，如[此处原文缺失具体基因名称]。它还探讨了促进VREfm传播的行为、社会和医疗系统因素，强调了弱势群体和资源匮乏地区在负担方面的差异。预防策略涵盖疾病的整个路径，包括一级、二级和三级预防，特别关注抗菌药物管理计划（ASP）的作用和不断演变的挑战。我们强调了新出现的威胁，如利福昔明诱导的对达托霉素的交叉耐药性，这对传统的管理模式提出了挑战。最后，我们提出了未来的方向，以加强全球监测、促进公平的管理干预措施，并加速创新疗法的开发。应对VREfm需要协调一致的多学科努力，以保障现有抗菌药物的疗效，并保护高危患者群体。
