Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci

Boyle, J F; Soumakis, S. A.; Rendo, Angela; Herrington, Janet; Gianarkis, Dean; Thurberg, B. E.; Painter, Barbara G.

doi:10.1128/jcm.31.5.1280-1285.1993

Cited by 207 publications

(74 citation statements)

References 30 publications

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“…During the last decade, multiple drugresistant enterococci have become significantly important from a clinical point of view (Murray 1990;Gray and Pedler 1992;Korten and Murray 1993;Tailor et al 1993), with E. faecium considered the second most clinically important species accounting for about 5-10% of all encountered clinical isolates of Enterococcus. Many attempts have been made to show the ability of enterococci to transfer genes encoding for antibiotic resistance with the same or different entero- coccal species, as well as to other members of other bacteria genera (Leclercq et al 1989;Nicas et al 1989;Noble et al 1992;Boyle et al 1993) Transferable drug-resistant represent a major threat to the treatment of infectious diseases in both humans and animals. Hence the findings in this study are worth taking into consideration, since the contamination of the beef with Enterococcus showing multiple resistance to antimicrobial agents would be a threat not only as a source of disease, but also as a source from which antibiotic resistance can easily spread to other pathogens.…”

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confidence: 99%

Isolation and molecular characterization of vancomycin-resistant Enterococcus faecium in Malaysia

Radu¹,

Nimita

Rusul

et al. 1999

Lett Appl Microbiol

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Enterococcus faecium isolated from 10 of 75 (13·3%) tenderloin beef samples were examined for resistance to selected antibiotics, presence of plasmids, and genetic diversity by random amplification of polymorphic DNA analysis. All strains showed multiple resistant to the antibiotics tested. Multiple antibiotic indexing of the vancomycin-resistant E. faecium strains showed that all (100%) originated from high risk contamination environments where antibiotics were often used. Plasmids ranging in size from 1·5 to 36 megadalton were detected in 15 of 19 (79%) strains. Thus, three plasmid profiles and eight antibiotypes were observed among the E. faecium strains. A high degree of polymorphism was obtained by combining the results of the two primers used; with the 19 E. faecium strains being differentiated into 19 RAPD-types. These preliminary results suggest that RAPD-PCR has application for epidemiologic studies and that resistance patterns and plasmid profiling could be used as an adjunct to RAPD for the typing of E. faecium in the study area.

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confidence: 99%

Isolation and molecular characterization of vancomycin-resistant Enterococcus faecium in Malaysia

Radu¹,

Nimita

Rusul

et al. 1999

Lett Appl Microbiol

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“…Staphylococcus aureus and streptococci (Leclercq et al 1989;Norrby 1995). Enterococcus faecium seems to be an organism with an outstanding ability for gene transfer, which can occur within the same species as well as between different enterococcal species (Nicas et al 1989;Boyle et al 1993). Transfer has also been shown to occur between enterococci and members of other bacterial genera, e.g.…”

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confidence: 99%

Antibiotic-resistant strains of Enterococcus isolated from Swedish and Danish retailed chicken and pork

et al. 1998

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Two hundred and seventy‐seven Enterococcus isolates representing the predominating enterococcal flora of retailed chicken and pork were identified by phenotypical features, and by random amplified polymorphic DNA. The resistance to nine different antibiotics was determined. Enterococcus faecium was the most frequently occurring species in both Swedish and Danish chicken. Enterococcus faecalis and unidentified groups of Enterococcus dominated in pork. Seventy‐three per cent of the Enterococcus isolates from Swedish chicken were resistant to one or more of the tested antibiotics. The corresponding values for Swedish pork, Danish chicken and Danish pork were 9%, 55% and 14%, respectively. Tetracycline resistance was most frequent in isolates from Danish pork and Swedish chicken, while erythromycin resistance was most frequent in Danish chicken. Strains with acquired vancomycin resistance, mainly Ent. faecium, were found only on Danish chicken, except for one isolate from Danish pork. All vancomycin‐resistant isolates contained the vanA gene. Vancomycin resistance could be transferred to a vancomycin‐sensitive Ent. faecium strain from four of nine tested donor strains.

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“…With the emergence of resistance to glycopeptides, enterococci have rapidly become important nosocomial pathogens (Murray, 2000). Over the past decade, vancomycin‐resistant enterococci (VRE) have been reported with increasing frequency as the cause of nosocomial outbreaks, usually involving high‐risk patient populations, such as haemato‐oncology patients, organ transplant recipients and patients in intensive care units (Boyle et al , 1993; Boyce et al , 1994; Edmond et al , 1995; Nourse et al , 1998; Loeb et al , 1999; Falk et al , 2000; McCarthy et al , 2000). In general, such outbreaks have a serious impact on the daily care and treatment of patients on the ward or in the hospital involved.…”

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confidence: 99%

Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic

Timmers¹,

Zwet

Simoons-Smit

et al. 2002

Br J Haematol

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Summary. We describe an outbreak of vancomycin-resistant Enterococcus faecium (VRE) on the haematology ward of a Dutch university hospital. After the occurrence of three consecutive cases of bacteraemia with VRE, strains were genotyped and found to be identical. During the next 4 months an intensive surveillance programme identified 21 additional patients to be colonized with VRE, while two more patients developed bacteraemia. A case-control study was carried out to identify risk factors for VRE acquisition. In comparison with VRE-negative control patients (n ¼ 49), cases (n ¼ 24) had a longer stay on the ward during the year preceding the outbreak (25AE8 versus 10AE1 d, P ¼ 0AE02), more cases with acute myeloid leukaemia [11 versus 4, odds ratio (OR) 9AE5, 95% confidence interval (CI 95 ) 2AE4-32AE2] and higher grades of mucositis (P ¼ 0AE03).Logistic regression analysis identified antibiotic use within 1 month before admission (OR 13AE0, CI 95 2AE1-80AE5, P ¼ 0AE006) and low albumin levels at baseline (OR 1AE2, CI 95 1AE1-1AE3, P ¼ 0AE02) to be independent risk factors. Four patients with VRE-bacteraemia were successfully treated with quinupristin/dalfopristin (Synercid Ò ). Control of the outbreak was achieved by step-wise implementation of intensive infection control measures, which included the cohorting of patients, allocation of nurses and reinforcement of hand hygiene.

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Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci

Cited by 207 publications

References 30 publications

Isolation and molecular characterization of vancomycin-resistant Enterococcus faecium in Malaysia

Isolation and molecular characterization of vancomycin-resistant Enterococcus faecium in Malaysia

Antibiotic-resistant strains of Enterococcus isolated from Swedish and Danish retailed chicken and pork

Outbreak of vancomycin‐resistant Enterococcus faecium in a haematology unit: risk factor assessment and successful control of the epidemic

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