Journal article
Assessing risks for a pre-emergent pathogen: virginiamycin use and the emergence of streptogramin resistance in Enterococcus faecium
The Lancet. Infectious diseases, Vol.3(4), pp.241-249
04/2003
DOI: 10.1016/S1473-3099(03)00581-4
PMID: 12679267
Abstract
Vancomycin-resistant enterococci (VRE) are an important cause of hospital-acquired infections and an emerging infectious disease. VRE infections were resistant to standard antibiotics until quinupristin/dalfopristin (QD), a streptogramin antibiotic, was approved in 1999 for the treatment of vancomycin-resistant Enterococcus faecium infections in people. After that decision, the practice of using virginiamycin in agriculture for animal growth promotion came under intense scrutiny. Virginiamycin, another streptogramin, threatens the efficacy of QD in medicine because streptogramin resistance in enterococci associated with food animals may be transferred to E faecium in hospitalised patients. Policy makers face an unavoidable conundrum when assessing risks for pre-emergent pathogens; good policies that prevent or delay adverse outcomes may leave little evidence that they had an effect. To provide a sound basis for policy, we have reviewed the epidemiology of E faecium and streptogramin resistance and present qualitative results from mathematical models. These models are based on simple assumptions consistent with evidence, and they establish reasonable expectations about the population-genetic and population-dynamic processes underlying the emergence of streptogramin-resistant E faecium (SREF). Using the model, we have identified critical aspects of SREF emergence. We conclude that the emergence of SREF is likely to be the result of an interaction between QD use in medicine and the long-term use of virginiamycin for animal growth promotion. Virginiamycin use has created a credible threat to the efficacy of QD by increasing the mobility and frequency of high-level resistance genes. The potential effects are greatest for intermediate rates of human-to-human transmission (R0 approximately equal 1).
Details
- Title: Subtitle
- Assessing risks for a pre-emergent pathogen: virginiamycin use and the emergence of streptogramin resistance in Enterococcus faecium
- Creators
- D L Smith - Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA. dave@needles.umaryland.eduJ A JohnsonA D HarrisJ P FurunoE N PerencevichJ G Morris Jr - University of Florida
- Resource Type
- Journal article
- Publication Details
- The Lancet. Infectious diseases, Vol.3(4), pp.241-249
- Publisher
- United States
- DOI
- 10.1016/S1473-3099(03)00581-4
- PMID
- 12679267
- ISSN
- 1473-3099
- eISSN
- 1474-4457
- Language
- English
- Date published
- 04/2003
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9983779296802771
Metrics
32 Record Views