Vancomycin-Resistant Enterococcus: Issues in Human Health, Animal Health, Resistant Mechanisms and the Malaysian Paradox

Enterococcus is a major constituent of the intestinal flora and environment. They are a hardy organism and can survive harsh prevailing environmental factors and hosts. Over time, the constant and heavy usage of antibiotics like vancomycin in treating infection caused by them has resulted in their development of resistance and virulent characteristics. VRE infections in animals are uncommon, and even so in pets. The reverse is, however, the case with human VRE infection. VRE are of great importance in public health, animal and medical health. The adaptability and complexity of the VRE genes have resulted in the appearance of resistant species in a wide range of environment and hosts which will invariably allow the host and environment to act as a reservoir. This article, therefore, discusses and reviews VRE, its phenotypic and genotypic characteristics, antimicrobial resistance, virulence factors and zoonotic potential. Finally, it sheds light on the situation of VRE in Malaysia. This would be the first review to look at VRE in Malaysia. Continuous surveillance is required as these VRE could evolve into a multidrug-resistant strain.