Vancomycin-resistente Enterokokken (VRE) nehmen auch in Europa in besorgniserregender Weise zu. Obwohl Enterokokken nicht besonders virulent sind, können Enterokokken-Infektionen zu erheblichen Problemen führen, vor allem wegen einer meist schweren Grunderkrankung der Patienten und der damit assoziierten Abwehrschwäche. Klinisch bedeutsam sind zwei Enterokokkenarten: Enterococcus faecalis und Enterococcus faecium. E. faecalis ist die häufigste Art (ca. 85 % der klinischen Isolate) und gilt als virulenter im Vergleich zu E. faecium. Vancomycinresistenz ist bei E. faecalis ungewöhnlich. Bei den meisten VRE handelt es sich um E. faecium. Im Zeitraum 2000 - 2002 waren in Deutschland 4,8 % der E. faecium-Isolate resistent oder intermediär empfindlich gegen Vancomycin, dagegen nur 0,3 % der E. faecalis-Isolate [24].
Die Vancomycinresistenz bei Enterokokken ist häufig verbunden mit Mehrfachresistenz, die auch Ampicillin und andere Penicilline einschließt. In den meisten Fällen besteht eine Kreuzresistenz gegenüber Teicoplanin, dem zweiten in Deutschland zugelassenen Glykopeptidantibiotikum. Durch die Mehrfachresistenz sind die therapeutischen Möglichkeiten eingeschränkt. Vereinzelt entstehen Situationen, in denen keine relevante therapeutische Option mehr verfügbar ist. Die Einführung von zwei neuen Präparaten (Quinupristin-Dalfopristin und Linezolid) mit Aktivität gegenüber VRE hat hier zwar in den letzten Jahren einen gewissen Fortschritt erbracht. Resistenzen gegenüber diesen Substanzen sind allerdings bereits in der kurzen Zeit ihrer Verfügbarkeit aufgetreten.
Die folgende Übersicht soll die Problematik ins Blickfeld rücken, wobei die Kenntnisnahme, vor allem aber auch die Diskussion darüber notwendig ist, um eine weitere epidemiologische Entwicklung wie in den USA zu verhindern.
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