Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens. Invasive VRE infections are difficult to treat since common therapeutic options including ampicillin and glycopeptides often fail. In vitro, most VRE remain susceptible to last-resort antibiotics such as linezolid, tigecycline and daptomycin. However, neither tigecycline nor linezolid act in a bactericidal manner, and daptomycin has proven activity only at high dosages licensed for treating enterococcal endocarditis. Despite these pharmacological and therapeutic limitations, reports on resistance to these last-resort drugs in VRE, and enterococci in general, have increased in recent years. In this review, we briefly recapitulate the current knowledge on the mode of action as well as the known and novel mechanisms of resistance and describe surveillance data on resistance to linezolid, tigecycline and daptomycin in enterococci. In addition, we also suggest a common nomenclature for designating enterococci and VRE with resistances to these important last-resort antibiotics.

耐万古霉素的肠球菌（VRE）是重要的医院内病原体。侵袭性VRE感染很难治疗，因为包括氨苄青霉素和糖肽在内的常见治疗选择常常会失败。体外，大多数VRE仍然对最后使用的抗生素（如利奈唑胺，替加环素和达托霉素）敏感。但是，替加环素和利奈唑胺均没有杀菌作用，达托霉素仅在许可用于治疗肠球菌性心内膜炎的高剂量下才具有活性。尽管存在这些药理和治疗方面的局限性，但近年来有关VRE和一般肠球菌对这些最后治疗药物产生耐药性的报道有所增加。在这篇综述中，我们简要总结了有关作用方式的最新知识以及已知的和新颖的耐药机制，并描述了对肠球菌对利奈唑胺，替加环素和达托霉素耐药的监测数据。此外，我们还建议使用通用的命名法来指定对这些重要的终末抗生素具有耐药性的肠球菌和VRE。