Vancomycin Clinically important resistance to vancomycin was first described among enterococci in France in 1988. Vancomycin-resistant enterococci (VRE) have subsequently become disseminated worldwide. The genes encoding resistance are carried on plasmids that can transfer themselves from cell to cell and on transposons that can jump from plasmids to chromosomes. Resistance is mediated by enzymes that substitute D-lactate for D-alanine on the peptidoglycan stem peptide so that there is no longer an appropriate target for vancomycin binding. This alteration does not appear to affect cell-wall integrity, however. This type of acquired vancomycin resistance was confined for 14 years to enterococci—more specifically,.
