Characterization of vancomycin resistant Enterococcus faecium from clinical and chicken sources

Agarose Gel Electrophoresis-Based RAPD-PCR-An Optimization of the Conditions to Rapidly Detect Similarity of the Alert Pathogens for the Purpose of Epidemiological Studies

Agarose gel electrophoresis is a well-known tool to detect DNA fragments amplified in polymerase chain reaction (PCR). Its usefulness has also been confirmed for epidemiological studies based on restriction fragments length polymorphism (RFLP), usually performed using pulsed-field gel electrophoresis (PFGE). Little is known on the effectiveness for alert-pathogen epidemiological studies of another less time-consuming and costly technique called randomly amplified polymorphic DNA-PCR (RAPD-PCR). Meanwhile, its usefulness is believed to be comparable to RFLP-PFGE. Therefore, the aim of the study was to establish and optimize the conditions of agarose gel electrophoresis following RAPD-PCR for 19 Enterococcus faecium strains derived from epidemic outbreaks at intensive care units. An application of different PCR primers, primer combinations, and, in particular, agarose gel concentrations and electrophoresis conditions revealed the usefulness of this relatively fast and inexpensive method based on RAPD-PCR for epidemiological studies without a compulsion to use the specialized equipment necessary for RFLP-PFGE.

Vancomycin-resistant enterococci carriage in an acute Irish hospital

BACKGROUND

Ireland has been shown to have the highest rate of vancomycin-resistant enterococci (VRE) in cases of bacteraemia in Europe, according to a report in 2014 from the European Antimicrobial Resistance Surveillance System Network.

AIM

To investigate the prevalence of VRE gut colonization in a cohort of patients in 2014 at Cork University Hospital (CUH) by performing a cross-sectional study using faecal samples submitted to the microbiology laboratory for routine investigation from both hospital inpatients and community-based patients.

METHODS

Faeces were examined for VRE colonization using selective cultivation, antimicrobial susceptibility testing, and speciation using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. All VRE isolates were evaluated by molecular means for resistance determinants, type, and Insertion Sequence 16 as an indicator of Clonal Complex 17 (CC17).

FINDINGS

From the 350 specimens investigated, 67 (19.1%) specimens were positive for VRE [95% confidence interval (CI): 15.0-23.2]. The prevalence of VRE colonization among CUH patients tested in this study (N = 194) was 31.4% (95% CI: 24.7-38.1). By contrast, the general practitioner patient samples (N=29) showed a prevalence of 0%, whereas 22.2% of samples from other hospitals (N=27) were positive for VRE. All isolates were Enterococcus faecium (VREfm) and were indicated to contain CC17, though with considerable heterogeneity among the isolates.

CONCLUSION

This high prevalence goes some way towards providing an explanation for the current high rates of VRE bacteraemia in Ireland, as well as highlighting the benefits of screening and enhanced infection control practices by all hospitals to control the high rates of VRE observed.