Enterococcus faecium: evolution, adaptation, pathogenesis and emerging therapeutics Original paper
Researched by:
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Divine Aleru
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Divine Aleru
Read MoreI am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
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Microbes
Microbes
Microbes are microscopic organisms living in and on the human body, shaping health through digestion, vitamin production, and immune protection. When microbial balance is disrupted, disease can occur. This guide explains key microbe types—bacteria, viruses, fungi, protozoa, and archaea—plus major pathogenic and beneficial examples.
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Divine Aleru
Read More
Researched by:
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Divine Aleru
ID
Divine Aleru
Read More
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was reviewed?
This review explored the evolutionary history, environmental adaptation, and pathogenic mechanisms of Enterococcus faecium, with a focus on its role in human infections, particularly vancomycin-resistant Enterococcus faecium (VREfm). The authors highlighted the genetic evolution of E. faecium through horizontal gene transfer (HGT), its resistance to multiple antibiotics, and its ability to adapt to various hospital and animal environments. The review also examined novel therapeutics under development to combat VREfm infections and its growing clinical threat.
Who was reviewed?
The review evaluated clinical and commensal isolates of Enterococcus faecium, including vancomycin-resistant strains from hospital environments, patients, and animals. It compared the genomic features and resistance profiles of clinical isolates, especially the clade A1 strains associated with hospital infections, and clade B strains, typically from healthy human microbiomes. These strains were analyzed for their virulence factors, antibiotic resistance genes, and the potential mechanisms of dissemination in the environment and host tissues.
What were the most important findings?
The review found that Enterococcus faecium has evolved significant genetic diversity, particularly through HGT, allowing it to acquire antibiotic resistance genes such as vanA and vanB. This adaptation has facilitated the emergence of VREfm, with clade A1 strains being particularly problematic in hospital settings due to their high resistance to last-resort antibiotics like vancomycin. VREfm strains showed increased survival in harsh environments, including hospital surfaces and the human gut microbiome, where they persist and spread through horizontal gene transfer. The study revealed that VREfm’s ability to adapt to different stresses, including antibiotic exposure, is crucial to its survival. Moreover, these strains exhibit high genome plasticity, with mobile genetic elements contributing to the rapid spread of resistance and virulence genes. This plasticity is associated with the increasing prevalence of VREfm infections globally, particularly in immunocompromised patients.
What are the greatest implications of this review?
This review underscores the critical need for surveillance of VREfm in both clinical and environmental settings due to its adaptability, genetic exchange, and antibiotic resistance. The findings emphasize the importance of developing new therapeutic strategies, including microbiota-based treatments, phage therapy, and novel antibiotics, to address the growing threat of VREfm. The study also highlights the role of environmental and animal reservoirs in the spread of resistance, stressing the need for a One Health approach to control its transmission across human, animal, and environmental interfaces.
Enterococcus faecalis
Enterococcus faecalis is a gut‑adapted, Gram‑positive, non‑spore‑forming facultative anaerobe that becomes an important opportunistic pathogen in healthcare when host barriers are breached or antibiotics select for enterococcal overgrowth. Its clinical impact is driven more by persistence, adhesion, and biofilm biology, quorum‑regulated secreted effectors (fsr‑controlled gelatinase GelE), and high genome plasticity than by a broad repertoire of classical tissue‑destroying toxins. Antimicrobial decision‑making must account for the intrinsic poor activity of cephalosporins, the potential for transferable glycopeptide resistance mediated by van gene clusters, and the need for regimen selection in endocarditis that respects synergy/tolerance and local high‑level aminoglycoside resistance patterns.