Using a highly selective enrichment broth, 62 isolates of vancomycin-resistant Enterococcus faecium were obtained from non-human sources; 35 isolates from raw sewage, 22 from farm animals and 5 from uncooked chickens. All strains possessed the Van A gene, conferring high-level resistance to vancomycin (MIC > or = 256 mg/L). Ribotyping of 42 of these isolates resulted in 14 distinguishable patterns. Two ribotyping patterns were found among isolates from animals and sewage and those from clinical sources. A blood and a urine isolate from separate hospital patients and porcine isolates shared the same ribotyping pattern number 6 and a stool isolate from a patient in the community and sewage isolates shared another pattern, number 10. This finding suggests that animals may serve as a reservoir of vancomycin-resistant enterococci (VRE), which may enter the human food chain. The emergence of VRE in hospital patients may reflect selection of these organisms in the hospital environment by antibiotic usage from which nosocomial spread might occur.

Eight clinical isolates of vancomycin-resistant Enterococcus faecium (VRE) were obtained from four renal and four other in-patients within an 11 week period during 1992. Characterisation of the isolates by restriction enzyme analysis with Sal I and rRNA gene restriction patterns (ribotyping) showed them to be clonally related. During the next 3 months an additional 14 VRE were isolated from hospital patients, nine of which were indistinguishable by ribotyping from the strain associated with the outbreak. An epidemiological survey was instigated in order to determine the level of carriage of this VRE. A total of 354 stool specimens was screened using a highly selective enrichment broth. VRE were detected in the stools of 11/73 (15%) of renal patients, 5/97 (5%) of other hospital patients and 3/184 (2%) of patients based in the community. Of the 25 stool isolates that were further characterised by ribotyping, 17 were indistinguishable from the outbreak strain. The remaining eight isolates gave seven different patterns. Patients harbouring the outbreak strain stayed in hospital significantly longer and had received more antibiotic treatment, for longer, than those patients from whom other VRE had been isolated. There was no significant difference in vancomycin or cephalosporin usage between the two groups of patients. Ribotyping showed there to be a number of clones of VRE carried by patients and that one of these clones was especially prevalent and has been responsible for the outbreak of infection in the renal unit. The technique also showed the presence of different VRE in general practice patients suggesting they are not just a hospital phenomenon.

No abstract

No abstract