vanA- positive multi-drug-resistant Enterococcus spp. isolated from surfaces of a US hospital laundry facility

Michael, Karen; No, David; Roberts, Marilyn C.

doi:10.1016/j.jhin.2016.10.017

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…We found that 37.7% of the isolates carried vanA gene, whereas vanB and vanC 1 genes were not detected in any of the strains. Similarly, previous researches had indicated that the vanA gene was the only glycopeptide resistance determinant found in E. faecalis isolates [2,9,44,45]. According to these studies, vanA gene was the predominant glycopeptide resistance gene among E. faecalis strains.…”

Section: Discussionmentioning

confidence: 74%

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High prevalence of vancomycin and high-level gentamicin resistance in Enterococcus faecalis isolates

Taji

Heidari

Ebrahim‐Saraie

et al. 2018

AMicr

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Multiple drug-resistant enterococci are major cause of healthcare-associated infections due to their antibiotic resistance traits. Among them, Enterococcus faecalis is an important opportunistic pathogen causing various hospital-acquired infections. A total of 53 E. faecalis isolates were obtained from various infections. They were identified by phenotypic and genotypic methods. Determination of antimicrobial resistance patterns was done according to CLSI guidelines. The isolates that were non-susceptible to at least one agent in ≥3 antimicrobial categories were defined as multidrug-resistant (MDR). Detection of antimicrobial resistance genes was performed using standard procedures. According to MDR definition, all of the isolates were MDR (100%). High-level gentamicin resistance was observed among 50.9% of them (MIC ≥ 500 μg/ml). The distributions of aac(6′)-Ie-aph(2′′)-Ia and aph(3′)-IIIa genes were 47.2% and 69.8%, respectively. The aph(2′′)-Ib, aph(2′′)-Ic, aph(2′′)-Id, and ant(4′)-Ia genes were not detected. Vancomycin resistance was found in 45.3% of strains. The vanA gene was detected in 37.7% of isolates, whereas vanB and vanC 1 genes were not observed in any strain. Erythromycin resistance rate was 79.2% and the frequencies of ermB and ermC genes were 88.6% and 69.8%, respectively. The ermA and msrA genes were not present in any of the isolates. Our data indicate a high rate of MDR E. faecalis strains. All of high-level gentamicin-resistant isolates carried at least one of aac(6′)-Ie-aph(2′′)-Ia or aph(3′)-IIIa genes. Distribution of vanA was notable among the isolates. In addition, ermB and ermC were accountable for resistance to erythromycin.

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Section: Discussionmentioning

confidence: 74%

“…Vancomycin-resistant enterococci (VRE)-associated infections are more severe than infections with vancomycin-susceptible enterococci [9]. Resistance to vancomycin is mediated by van gene clusters.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of vancomycin and high-level gentamicin resistance in Enterococcus faecalis isolates

Taji

Heidari

Ebrahim‐Saraie

et al. 2018

AMicr

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“…Of the 2 predominant strains during the carbapenem period, ST967 is novel and ST664 has rarely been reported elsewhere. 17 Of the 2 more recent strains, ST186 appears to be novel, and ST896 has been uncommonly detected in the Western Hemisphere. 18 The factors that allow a strain to dominate are largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Decrease in vancomycin-resistantEnterococcuscolonization associated with a reduction in carbapenem use as empiric therapy for febrile neutropenia in patients with acute leukemia

Ford

Coombs

Stofer

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:To compare the effects of empiric carbapenems versus cycling cefepime and piperacillin/tazobactam on the rates of vancomycin-resistant Enterococcus (VRE) colonization, bloodstream infections, and outcomes of patients admitted with acute leukemia.Design:Retrospective clinical study with VRE molecular strain typing and gastrointestinal microbiome comparison.Setting:A regional referral center for acute leukemia.Patients:342 consecutive patients admitted with newly diagnosed acute leukemia.Methods:In September 2015, we changed our empiric antibiotic of choice for neutropenic fever from a carbapenem to the cycling regimen. We studied 214 consecutive patients during the carbapenem period and 128 during the cycling period. Surveillance for VRE stool colonization was conducted weekly. Representative stool samples were analyzed for VRE MLST types and changes in the composition and diversity of the fecal microbiota.Results:The change in empiric antibiotics was associated with a significant decrease in VRE colonization (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.27–0.66), a switch in the dominant VRE MLST types on the unit, and some modifications in the gastrointestinal microbiome. There were no differences in total gram-positive or gram-negative BSIs. During the carbapenem period, we observed higher absolute numbers of Candida spp and fewer ESBL BSIs, but these did not reach statistical significance. Patients during the carbapenem period had longer lengths of stay and durations of severe neutropenia and 10% higher hospital cost.Conclusions:Carbapenem-sparing empiric antibiotic regimens may have advantages related to VRE ecology, gastrointestinal dysbiosis, duration of neutropenia, cost and length of stay.

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“…While ST412 and ST584 have been prevalent, especially in the Western Hemisphere, ST967 is novel and ST664 is rarely reported. 16 Outbreaks of these strains on our unit suggest compliance problems with isolation and sterilization procedures, which we have documented elsewhere. 8 They also suggest the possibility that other outbreaks before or after the study period may have gone undetected.…”

Section: Discussionmentioning

confidence: 62%

“…ST664 and ST967 were not identified prior to or during our renovation, and our data are consistent with the hypothesis that these types were introduced to our unit by patients admitted after the renovation. While ST412 and ST584 have been prevalent, especially in the Western Hemisphere, ST967 is novel and ST664 is rarely reported 16 . Outbreaks of these strains on our unit suggest compliance problems with isolation and sterilization procedures, which we have documented elsewhere 8 .…”

Section: Discussionmentioning

confidence: 67%

Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the Treatment of Hematologic Malignancies and Hematopoietic Stem-Cell Transplantation

Ford

Stofer

Coombs

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE While a direct relation between hospital construction and concomitant infection rates has been clearly established, few data are available regarding the environmental decontamination effects of renovation in which surfaces are replaced and regarding subsequent infection incidence. DESIGN Retrospective clinical study with vancomycin-resistant Enterococcus (VRE) molecular strain typing and environmental cultures. SETTING A regional referral center for acute leukemia and hematopoietic stem-cell transplantation. PATIENTS Overall, 536 consecutive hospital admissions for newly diagnosed acute leukemia or a first autologous or allogeneic stem-cell transplantation were reviewed. INTERVENTION During 2009-2010, our unit underwent complete remodeling including replacement of all surfaces. We assessed the effects of this construction on the incidence of hospital-acquired VRE colonization before, during, and after the renovation. RESULTS We observed a sharp decrease in VRE colonization rates (hazard ratio, <0.23; 95% confidence interval, 0.18-0.44; P<.0001) during the first year after the renovation, with a return to near baseline rates thereafter. The known risk factors for VRE colonization appeared to be stable over the study interval. Environmental cultures outside of patient rooms revealed several contaminated areas that are commonly touched by unit personnel. Multilocus sequence typing of VRE isolates that were cryopreserved over the study interval showed that dominant strains prior to construction disappeared and were replaced by other strains after the renovation. CONCLUSIONS Unit reconstruction interrupted endemic transmission of VRE, which resumed with novel strains upon reopening. Contamination of environmental surfaces and shared equipment may play an important role in endemic transmission of VRE. Infect Control Hosp Epidemiol 2017;38:1055-1061.

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vanA- positive multi-drug-resistant Enterococcus spp. isolated from surfaces of a US hospital laundry facility

Cited by 14 publications

References 18 publications

High prevalence of vancomycin and high-level gentamicin resistance in Enterococcus faecalis isolates

High prevalence of vancomycin and high-level gentamicin resistance in Enterococcus faecalis isolates

Decrease in vancomycin-resistantEnterococcuscolonization associated with a reduction in carbapenem use as empiric therapy for febrile neutropenia in patients with acute leukemia

Decrease in Vancomycin-Resistant Enterococcus Colonization After Extensive Renovation of a Unit Dedicated to the Treatment of Hematologic Malignancies and Hematopoietic Stem-Cell Transplantation

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