Collateral sensitivity to pleuromutilins in vancomycin-resistant Enterococcus faecium
Qian Li, Shang Chen, Kui Zhu, Xiaoluo Huang, Yucheng Huang, Zhangqi Shen, Shuangyang Ding, Danxia Gu, Qiwen Yang, Hongli Sun, Fupin Hu, Hui Wang, Jiachang Cai, Bing Ma, Rong Zhang, Jianzhong Shen
Abstract
The acquisition of resistance to one antibiotic sometimes leads to collateral sensitivity to a second antibiotic. Here, we show that vancomycin resistance in Enterococcus faecium is associated with a remarkable increase in susceptibility to pleuromutilin antibiotics (such as lefamulin), which target the bacterial ribosome. The trade-off between vancomycin and pleuromutilins is mediated by epistasis between the van gene cluster and msrC, encoding an ABC-F protein that protects bacterial ribosomes from antibiotic targeting. In mouse models of vancomycin-resistant E. faecium colonization and septicemia, pleuromutilin treatment reduces colonization and improves survival more effectively than standard therapy (linezolid). Our findings suggest that pleuromutilins may be useful for the treatment of vancomycin-resistant E. faecium infections.