Outbreak of vancomycin-resistant Enterococcus spp. in an Italian general intensive care unit

Peta, Mario; Carretto, Edoardo; Barbarini, Daniela; Zamperoni, A.; Carnevale, L; Perversi, L.; Pagani, Michele; Bonora, Maria; Fontana, Roberta; Marone, Piero; Langer, Monica

doi:10.1111/j.1469-0691.2005.01331.x

Cited by 31 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…And CNS4 (4-1-1-1-1-1-1) which was never reported until now is expected to be new to MLST database. The most common form of STs in Korea is known to be ST78 [20]. But in this CNS3 CNS4 CNS5 CNS6 CNS8 CNS9 CNS10 CNS11 CNS12 CNS13 CNS14 CNS15 CNS16 CNS17 CNS18 CNS19 CNS20 CNS22 CNS23 CNS24 CNS25 CNS27 CBS2 CBS3 CBS6 CBS7 CBS8 CBS9 CBS11 CBS12 CBS14 EJS1 EJS2 EJS3 EJS4 EJS5 EJS7 78 New 192 78 192 78 78 192 192 78 192 192 192 78 192 192 78 192 192 192 192 17 17 78 78 192 192 414 192 192 78 192 192 78 78 192 …”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Resistance and Multilocus Sequence Typing of Vancomycin-ResistantEnterococcus faeciumIsolated from the Chungcheong Area

Cho

Sung

Kwon

et al. 2011

Korean J Clin Microbiol

View full text Add to dashboard Cite

Background: Enterococcus faecium has emerged as an important nosocomial pathogen worldwide, and this trend has been associated with the dissemination of a genetic lineage designated clonal complex 17 (CC17). In the present study, characterization of the glycopeptide resistance mechanism, genetic relatedness, and pathogenicity in isolates of vancomycin-resistant E. faecium in the Chungcheong area were investigated. Methods: A total of 37 consecutive, non-duplicate, vancomycin-resistant E. faecium were isolated at three university hospitals in the Chungcheong area. The mechanism of glycopeptide resistance and pathogenicity factors were studied using PCR, and the genetic relatedness was determined via multilocus sequence type and esp repeat profile analysis. Additionally, the quinolone resistance-determining regions of parC and gyrA were sequenced to identify mutations involved in ciprofloxacin resistance. Results: Two genotypes of VRE were confirmed: VanAphenotype vanA genotype VRE (25 isolates) and VanB-phenotype vanA genotype VRE (12 isolates). MLST analysis revealed five sequence types. A significant result was that ST414 and CNS4 (4-1-1-1-1-1-1) were considered as belonging to CC17. The esp and hyl genes were found in 100% and 86.4% of the isolates, respectively. A total of 37 isolates showed genetic mutations in parC and gyrA. Conclusion: All isolated strains in the present study belonged to one of the CC17 genotypes including ST414 and CNS4 (4-1-1-1-1-1-1), which were not previously detected in Korea. The combination of MLST and the esp gene repeat profiles can be useful for genetic characterization of VREF isolates with regard to the evolutionary process and epidemiology of the clones. (Korean J Clin Microbiol 2011;14:60-66)

show abstract

Section: Discussionmentioning

confidence: 99%

Antimicrobial Resistance and Multilocus Sequence Typing of Vancomycin-ResistantEnterococcus faeciumIsolated from the Chungcheong Area

Cho

Sung

Kwon

et al. 2011

Korean J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…MLST of representative MT-159 isolates (also from the three hospitals not included in the study) revealed ST-78. Nosocomial outbreaks of ST-78 have been described in Korea and Europe, including Germany and Italy (1,14,16,24).…”

Section: Vol 46 2008 Emergence Of Cc17 E Faecium 217mentioning

confidence: 99%

Emergence of Clonal Complex 17 Enterococcus faecium in The Netherlands

et al. 2008

View full text Add to dashboard Cite

The global emergence of vancomycin-resistant Enterococcus faecium has been characterized as the clonal spread of clonal complex 17 (CC17) E. faecium. CC17 was defined upon multilocus sequence typing and is characterized by resistance to quinolones and ampicillin and the presence of the enterococcal surface protein (Esp) in the majority of isolates. The recently noticed increased incidence of vancomycin-susceptible CC17 E. faecium infections in our hospital initiated a nationwide study to determine ecological changes among enterococcal infections. The data and strain collections were obtained from 26 (38%) and 9 (14%) of 66 microbiology laboratories in The Netherlands. E. faecium and E. faecalis were distinguished by multiplex PCR; all E. faecium isolates were genotyped by multiple-locus variable-number tandem-repeat analysis (MLVA), and the presence of esp was identified by PCR. Average numbers of ampicillin-resistant enterococcal isolates from normally sterile body sites per hospital increased from 5 ؎ 1 in 1994 to 25 ؎ 21 in 2005. Among all enterococcal bloodstream infections, the proportions of ampicillin-resistant E. faecium (AREF) increased from 4% in 1994 to 20% in 2005 (P < 0.001). All E. faecalis isolates were susceptible to ampicillin, whereas 78% of the E. faecium isolates were resistant (49% of these contained esp). Genotyping revealed that 86% of AREF isolates belonged to CC17, including four dominant MLVA types found in >3 hospitals, accounting for 64% of the AREF isolates. Infections caused by CC17 E. faecium has increased nationwide, especially in university hospitals due to the clonal spread of four MLVA types, and seems associated with acquisition of the esp gene.The emergence of vancomycin-resistant Enterococcus faecium (VREF) in the United States in the 1990s was preceded by the emergence of ampicillin-resistant Enterococcus faecium (AREF) in the 1980s (8,11,27,28). Molecular epidemiological studies of human-and animal-derived E. faecium since then, revealed the existence of a genetic lineage, labeled clonal complex 17 (CC17), associated with nosocomial E. faecium outbreaks and infections in five continents. CC17 is characterized by ampicillin and quinolone resistance and the presence of a putative pathogenicity island, including the esp gene in the majority of isolates (2-4, 9, 12, 17-20, 31, 36). In retrospect, it seems likely that the acquisition of ampicillin resistance was an earlier step in hospital adaptation of E. faecium, facilitating the subsequent emergence of VREF (18,36).Since 2000, infection rates of VREF are rising in European hospitals (see EARSS Annual Report 2005 [www.rivm.nl /earss]), suggesting that the increase of VREF in Europe follows the American epidemiology with a 10-year delay. Little is known, though, about the molecular epidemiology of AREF.In our hospital (the University Medical Center Utrecht [UMCU]), the proportion of invasive enterococcal infections caused by AREF increased from 2% in 1994 to 32% in 2005, with partial replacement of ampicillin-susceptible (Amp ...

show abstract

“…Most cases are those with mere colonization of the gastrointestinal tract. However, VRE strains may act as etiological agents of serious urinary and respiratory infections and generalized sepses 11 .…”

Section: Discussionmentioning

confidence: 99%

Sources and Pathways of Spread of Vancomycin-Resistant Enterococci in Hemato-Oncological Patients

Vágnerová

Šauer²,

Kolář³

et al. 2006

BIOMED PAP

View full text Add to dashboard Cite

The presented study aims at analyzing an increasing prevalence of vancomycin-resistant enterococci (VRE) isolated from various kinds of clinical material obtained from patients in the Department of Hemato-oncology (DHO), University Hospital in Olomouc, Czech Republic.Between January 1 and March 31, 2005, enterococci were isolated by standard microbiological procedures using both clinical material obtained from hospitalized patients and samples from the department environment. Resistance to vancomycin and teicoplanin was determined by a standardized microdilution method. Phenotype determination of resistance to vancomycin was verified by PCR detection of vanA and vanB genes. In VanA Enterococcus faecium, macrorestriction analysis was performed by pulsed-field gel electrophoresis.During the monitored period, a total of 128 Enterococcus sp. strains were isolated, of which 38 (30 %) isolates from 22 different patients were determined as VRE. Dominating were Enterococcus faecium VanA (63 %) and Enterococcus casseliflavus VanC (16 %) strains. At the same time, one Enterococcus faecium VanA strain was acquired from a bed-side table used by a patient in whom a similar strain had been isolated repeatedly from various clinical materials including a rectal swab taken in 2004. Based on the macrorestriction analysis of genome DNA in 24 vancomycin-resistant Enterococcus faecium VanA strains isolated from the patients' clinical material, one strain from the bed-side table surface and one strain isolated from stools in 2004, 8 unique restriction profiles with similarity ranging from 90 % to 100 % were identified, which could be classified into 3 clonal types.Thus, we can assume not only the endogenous origin of the VRE in hemato-oncological patients and their potential selection caused by therapy with broad-spectrum antibiotics but also the ability of the strains to survive in a hospital setting and, subsequently, to be spread clonally by various vectors.

show abstract

Outbreak of vancomycin-resistant Enterococcus spp. in an Italian general intensive care unit

Cited by 31 publications

References 27 publications

Antimicrobial Resistance and Multilocus Sequence Typing of Vancomycin-ResistantEnterococcus faeciumIsolated from the Chungcheong Area

Antimicrobial Resistance and Multilocus Sequence Typing of Vancomycin-ResistantEnterococcus faeciumIsolated from the Chungcheong Area

Emergence of Clonal Complex 17 Enterococcus faecium in The Netherlands

Sources and Pathways of Spread of Vancomycin-Resistant Enterococci in Hemato-Oncological Patients

Contact Info

Product

Resources

About