Rifaximin prophylaxis causes resistance to the last-resort antibiotic daptomycin.

ABSTRACT: Multidrug-resistant bacterial pathogens like vancomycin-resistant Enterococcus faecium (VREfm) are a critical threat to human health¹. Daptomycin is a last-resort antibiotic for VREfm infections with a novel mode of action², but for which resistance has been widely reported but is unexplained. Here we show that rifaximin, an unrelated antibiotic used prophylactically to prevent hepatic encephalopathy in patients with liver disease³, causes cross-resistance to daptomycin in VREfm. Amino acid changes arising within the bacterial RNA polymerase in response to rifaximin exposure cause upregulation of a previously uncharacterized operon (prdRAB) that leads to cell membrane remodelling and cross-resistance to daptomycin through reduced binding of the antibiotic.

SUBMITTER: Turner AM 

PROVIDER: S-EPMC11602712 | biostudies-literature | 2024 Nov

REPOSITORIES: biostudies-literature