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Clinical, genomic, and functional characterization of vancomycin-resistant Enterococci from immunocompromised patients: insights into epithelial dysfunction and bloodstream infections
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Clinical, genomic, and functional characterization of vancomycin-resistant Enterococci from immunocompromised patients: insights into epithelial dysfunction and bloodstream infections
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Journal Article
Clinical, genomic, and functional characterization of vancomycin-resistant Enterococci from immunocompromised patients: insights into epithelial dysfunction and bloodstream infections
2025
Overview
Vancomycin-resistant
and
(VRE) are increasingly recognized as major opportunistic pathogens in immunocompromised patients, where they may cause bloodstream infections (BSIs). The present study aimed to characterize a cohort of immunocompromised patients colonized or infected with VRE, performing genomic analysis of these isolates. Additionally, we investigated the impact of bacterial culture supernatants on Caco-2 epithelial cells, focusing on adhesion and cytotoxicity to elucidate mechanisms related to epithelial dysfunction and bacterial translocation.
We conducted a retrospective study including 46 VRE from two Italian hospitals. Clinical and epidemiological data were collected, and isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing. Four representative isolates (
ST80,
ST117,
ST28, and
ST179) and two reference strains (ATCC 29212™ and ATCC 51299™) were selected for
analyses. Adhesion to Caco-2 monolayers was quantified, while cytotoxicity was assessed using MTT assays with bacterial cell-free supernatants (CS). Hydrogen peroxide (H
O
) production was measured using the Amplex
Red Hydrogen Peroxide/Peroxidase Assay Kit.
The majority of isolates were
(78.3%), predominantly ST80 and ST117, possessed multiple resistance determinants.
isolates displayed greater sequence type diversity with a ST28 predominance, carrying virulence genes as
,
, and
.
, bloodstream-derived isolates (
51,
52) and reference strain ATCC 29212™ adhered more strongly to Caco-2 cells than other isolates. CS from invasive isolates and ATCC 51299™ significantly reduced epithelial cell viability at 24 h (p < 0.01). In these isolates, H
O
higher quantification was documented in a cellular model.
Our findings highlighted the convergence of antimicrobial resistance and virulence traits in VRE, alongside functional evidence of strain-dependent adhesion and secretion of cytotoxic metabolites. Elevated H
O
production provides a possible path between enterococcal secretomes and epithelial injury, suggesting oxidative stress as a contributor to epithelial dysfunction and potential translocation. These insights expand current understanding of VRE pathogenesis and point to novel therapeutic approaches aimed at preserving epithelial integrity and mitigating oxidative damage in high-risk patients.
Publisher
Frontiers Media SA,Frontiers Media S.A
Subject
/ Aged
/ Anti-Bacterial Agents - pharmacology
/ Diabetes
/ Enterococcus faecalis - drug effects
/ Enterococcus faecalis - genetics
/ Enterococcus faecalis - isolation & purification
/ Enterococcus faecium - drug effects
/ Enterococcus faecium - genetics
/ Enterococcus faecium - isolation & purification
/ Epithelial Cells - microbiology
/ Female
/ Genes
/ Genomics
/ Gram-Positive Bacterial Infections - microbiology
/ Humans
/ Hydrogen Peroxide - metabolism
/ Italy
/ Male
/ Oncology
/ Patients
/ Vancomycin-Resistant Enterococci - classification
/ Vancomycin-Resistant Enterococci - drug effects
/ Vancomycin-Resistant Enterococci - genetics
/ Vancomycin-Resistant Enterococci - isolation & purification
/ Vancomycin-Resistant Enterococci - pathogenicity
