First Report of Vancomycin‐Resistant Enterococcus faecium Isolated in Argentina

Abstract

as vanC1 and vanC2 probes [8, 9]. DNA from the clinical faecium Isolated in Argentina isolate hybridized to the vanA probe but not to vanB, vanC1, or vanC2 intragenic probes. Vancomycin-resistant enterococci (VRE) have been re-The patient was treated with piperacillin/tazobactam, ciported increasingly since 1988 [1]. Most of the early isolates profloxacin, chloramphenicol, and gentamicin. He underwent of VRE were from Europe, but the prevalence of VRE associbrain surgery, and two of the three abscesses were drained. ated with nosocomial infections in the United States increased Gram staining of the abscesses revealed gram-positive cocci, from 0. 3% in 1989 to 7.9% in 1993 [2]. A MEDLINE search and cultures subsequently yielded vancomycin-resistant E. faeof the English-language literature (1984 through 1996) did not cium. The patient was treated for 2 months with piperacillin/ reveal any reports of isolates of VRE in Latin America. We tazobactam, ciprofloxacin, and chloramphenicol, and he comreport the first clinical strain of a vanA-containing Enterococpleted a 2-month course of oral therapy with chloramphenicol cus faecium isolated in Argentina; this is also the first such and ciprofloxacin. isolate reported from Latin America.The patient had no prior history of travel outside of the A 7-year-old male with a history of acute lymphoblastic country. Thus, this appears to represent a true indigenous case, leukemia, diagnosed in September 1993, was admitted to a although the possibility of intrahospital spread from another hospital in Mendoza, Argentina, in September 1996 because patient who may have traveled outside of the country cannot of fever and neutropenia secondary to chemotherapy. He had be excluded. Risk factors associated with the development of previously received multiple courses of antibiotics, including the VRE infection identified in this patient include prolonged vancomycin, for the treatment of three episodes of neutropenia hospitalization, hospital transfer between floors, and prior use and fever. Physical examination revealed no abnormalities of antimicrobials such as vancomycin and third-generation other than oral thrush and multiple extensive ecchymotic lecephalosporins [10]. Because of the potential for nosocomial sions on both forearms, both legs, and the abdomen. Results spread of VRE and because of the limited therapeutic options of laboratory tests revealed the following values: hematocrit, for treatment of VRE, we consider it important to report this 23%; hemoglobin, 7.72 g/dL; WBC count, 450/mm 3 (without isolate. neutrophils); and platelet count, 18,000 1 mm 3 . He was treated initially with iv ceftriaxone and iv amikacin. Acyclovir was added to his treatment regimen because of the presence of oral herpetic lesions. The patient became afebrile, and after 9 days Marcelo E. MarıB n, Jorge R. Mera, Roberto C. Arduino, of antibiotic therapy, he was discharged to continue receiving Adriana P. Correa, Teresa M. Coque, Daniel Stamboulian, iv therapy at home. He was readmitted to the hospital ...

Molecular Epidemiology of Vancomycin-Resistant Enterococcus faecium : a Prospective, Multicenter Study in South American Hospitals

“…In South America (Brazil and Argentina), vancomycin-resistant (VR) enterococcal infections have been described since 1998 (9,20). In a prospective multicenter surveillance study conducted in 2003, the prevalence of VR among enterococci in Colombia was found to be lower (9.7%) than that in the United States (1), and the isolation of similar percentages of VR enterococci has been described more recently (21).…”

Characterization of a Divergent vanD -Type Resistance Element from the First Glycopeptide-Resistant Strain of Enterococcus faecium Isolated in Brazil

“…faecium 10/96A was isolated in August 1996 from the blood of a 9-year-old girl with aplastic anemia (6). It was the first glycopeptide-resistant enterococcus isolated in Brazil and probably the first isolated in South America, predating by 1 month a VanA strain reported from Argentina (10). Susceptibility to glycopeptides was determined with E-tests (Cambridge Diagnostics Ltd., Cambridge, United Kingdom) on Diagnostic Sensitivity Test agar (Oxoid, Basingstoke, United Kingdom) containing 5% lysed horse blood.…”

Detection of Carriage of Vancomycin-Resistant Enterococci in an Intensive Care Unit in Buenos Aires

“…The prevalence of vancomycin-resistant enterococci (VRE) associated with nosocomial infections in the United States increased from 0.3% in 1989 to 7.9% in 1993. J In Argentina, the first infection produced by vancomycinresistant Enterococcus faecium was documented by Marin et al in 1996, 2 and even though other strains of VRE continue to be isolated, they have not been reported in the literature (MEDLINE, 1996(MEDLINE, -2000. The real prevalence of the intestinal carriage of VRE in Argentina is still unknown.…”

“…1 The expanded regimen of three antiretroviral medications, including a protease inhibitor, is indicated after a high-risk exposure. 1,2 Because of good oral absorption and low reported side effects, nelfinavir is one of the recommended protease inhibitors. Commonly reported side effects involve mild abdominal cramps and diarrhea, which usually can be relieved by over-the-counter remedies.…”