VRE – The new superbug

Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics, especially vancomycin. Enterococci bacteria live in our intestines and on our skin and usually without causing problems until they cause infection.
With a total market volume of nearly $ 800m in 2012 and with no specific registered drug in the market, VRE is now considered to be one of the more interesting bacteria to target within the
Gram positive space.

These infections can occur anywhere in the body. Some common sites include the intestines, the urinary tract, and wounds. For some people, especially those who are weak or ill, these infections can become serious. VRE is associated with outbreaks of hospital-acquired (nosocomial) infections around the world and on the United States, vancomycin-resistant E. faecium was associated with 4% of healthcare-associated infections reported to the Centers for Disease Control and Prevention National Healthcare Safety Network from January 2006 to October 2007.
In clinical practice, combination therapy with a cell wall–active agent and a synergistic aminoglycoside should be considered for treating serious enterococcal infections in critically ill patients and in those with evidence of sepsis, as well as in patients with endocarditis, meningitis, osteomyelitis, or joint infections.

Vancomycin-resistant enterococci (VRE) are a worldwide problem, having spread to at least 18 countries across 6 continents, and enterococci are the second most common organism recovered from catheter-associated infections and skin and soft tissue infections in the United States.

Current drugs used to treat VRE infections are Daptomycin, Linezolid, Cilastatin sodium/Imipenem, Sulbactam sodium/Cefoperazone sodium, Clindamycin and Vancomycin. Most of these compounds have no specific clinical data for VRE indications and have poor activity against Enterococci even in in-vitro tests. The challenges faced by clinicians treating VRE are increasing resistance profiles combined with bad toxic profile of the currently used substances that is based on the long-term nature of therapy (often more than 4 weeks). Patients can remain colonized with VRE for long time periods, causing the possibility of further spread of VRE among health care facilities.