Emergence of linezolid- and vancomycin-resistant Enterococcus faecium in a department for hematologic stem cell transplantation

Abstract

BackgroundPrevalence of vancomycin-resistant enterococci has increased in Germany. Here, we report the cluster of linezolid- and vancomycin-resistant Enterococcus faecium (LVRE) in a German department for hematologic stem cell transplantation (HSCT).MethodsIn this retrospective analysis we included all patients with LVRE in a university-based department for HSCT in 2014 and 2015. Patients chart reviews were used to investigate the epidemiology and clinical outcome. Available LVRE isolates underwent detailed microbiological characterization and genotyping by pulsed-field gel electrophoresis (PFGE).ResultsIn total, 20 patients with LVRE were identified within the observed time period. All except two patients underwent allogeneic HSCT. Surveillance culture results from incoming patients and chart review revealed that 10 of 20 patients were colonized at hospital admission. Eight of 10 patients with in-hospital acquired LVRE had previous linezolid treatment. Analysis of spatio-temporal patterns showed no evidence for LVRE patient-to-patient or environment-to-patient transmission within the HSCT department. In five cases (25 %) LVRE bloodstream infection occurred. Nine LVRE isolates could be saved for characterization. Eight isolates carried vanA, one isolate vanB. PFGE analysis showed that four different LVRE clones were responsible for the cluster. One single genotype was present in six LVRE isolates whereupon the corresponding patients were all referred from the same hospital to the HSCT department.ConclusionsThis is the first report demonstrating the emergence of LVRE in a German HSCT department. (L)VRE screening at patients’ admission and appropriate infection control strategies were sufficient to prevent any transmission. Further studies in this predisposed patient collective are warranted.

<p>In vitro Antibacterial Activity of Isopropoxy Benzene Guanidine Against Multidrug-Resistant <em>Enterococci</em></p>

“…[5][6][7] Concurrent with the declining discovery rate of novel antibiotics, there are some strains of Enterococci have become resistant to last-resort drugs. [8][9][10] In general, Enterococci are considered as a significant antibiotic resistance threat and pose a risk to public health as a whole.…”

Boosting nanotoxicity to combat multidrug-resistant bacteria in pathophysiological environments

“…55,57,83 Clinical isolates and cultivation of bacteria MDR bacteria were isolated and respective resistance phenotypes characterized at the University Medical Centers of Essen and Mainz using microbial methods as described. 22,32,33,81 Identity conrmation and susceptibility testing were performed by the semi-automated systems VITEK 2 (bioMérieux, Germany) and MicroScan WalkAway (Siemens, Germany) or by MALDI Biotyper® System (Bruker, Germany). 33,84 For microscopy, bacteria strains, expressing red (tdTomato) or green uorescent protein (GFP) were used.…”

“…22,32,33,81 Identity conrmation and susceptibility testing were performed by the semi-automated systems VITEK 2 (bioMérieux, Germany) and MicroScan WalkAway (Siemens, Germany) or by MALDI Biotyper® System (Bruker, Germany). 33,84 For microscopy, bacteria strains, expressing red (tdTomato) or green uorescent protein (GFP) were used. 35 Bacteria were grown in liquid cultures overnight at 37 C and 140 rpm or on agar plates in their respective media.…”

“…29 When applicable, a colony forming unit (CFU) assay was performed additionally. 33,35,81,85 Cell and cytotoxicity experiments Primary human epithelial skin cells (HEC) were purchased from Provitro AG and cultured for up to ve passages in Epithelial Cell Medium (Provitro AG) as described elsewhere. 86 For cytotoxicity studies, cells were seeded in 96-well cell culture plates.…”

“…[27][28][29] Here, hospital-acquired MDR bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA), Salmonella enterica or Pseudomonas aeruginosa, and extended-spectrum b-lactamaseproducing Escherichia coli (ESBL-EC) are problematic in the clinics even in highly developed countries. 10,27,[30][31][32][33][34][35][36] Consequently, NMs are investigated as tools for diagnosis of bacteria, as antibiotic drug carriers and/or based on their antimicrobial activity, directly tested as novel nano-antibiotics. 4,[6][7][8][9][10]27,29,35,37 Antibacterial nano-therapeutics so far mainly focused on a variety of semiconductor, metal, and metal oxide NMs.…”