An essential protease, FtsH, influence daptomycin resistance acquisition in Enterococcus faecalis via chaperone modulation

Enterococci are a major healthcare concern due to its association with hospital acquired infections and tendency to be resistant to a wide spectrum of antibiotics. This is especially the case for vancomycin resistant Enterococci, which are commonly treated with linezolid and daptomycin as last line drugs. However, reports of daptomycin resistance are concerning as it further limits treatment options. Existing studies have uncovered membrane remodeling and antimicrobial stress sensing as resistance mechanisms. However, the multiple peptide resistance factor (mprF) has also been found to play a role. This study investigates novel mutations that arise in the absence of mprF activity in Enterococcus faecalis during in vitro evolution to daptomycin resistance.