the intrinsically glycopeptide-resistant Enterococcus gallinarum, Enterococcus casseliflavus, and Enterococcus flavescens (VanC type) and is present in the VanE and VanG types in which E. faecalis has acquired the genes encoding vancomycin resistance. Some of the enzymes implicated in this second resistance mechanism are different from those involved in high-level resistance, indicating a second route by which resistance has evolved. The basis of resistance results from the sixfold-lower affinity of vancomycin for acyl-D-Ala-D-Ser than for acyl-D-Ala-D-Ala (13) because of the increased bulk of the hydroxymethyl group of serine relative to the methyl group of alanine.
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Reynolds et al. (2004) studied this question.
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