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Jahansepas A, Ahangarzadeh Rezaee M, Hasani A, Sharifi Y, Rahnamaye Farzami M, Dolatyar A, Aghazadeh M. Molecular Epidemiology of Vancomycin-Resistant Enterococcus faecalis and Enterococcus faecium Isolated from Clinical Specimens in the Northwest of Iran. Microb Drug Resist 2018; 24:1165-1173. [PMID: 29708837 DOI: 10.1089/mdr.2017.0380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study was conducted to investigate the phenotypic and genotypic characteristics of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium. Antibiotic resistance and virulence genes in the aforementioned resistant isolates were studied using the epsilometer (E)-test and polymerase chain reaction (PCR). These isolates were subjected to typing by pulsed-field gel electrophoresis (PFGE). Thirty vancomycin-resistant enterococci (VRE; 18.75%) were isolated from a total of 160 various clinical specimens cultured for any bacterial growth. Of these, 11 (36.7%) isolates were identified as E. faecalis and 19 (63.3%) as E. faecium. Minimum inhibitory concentrations (MICs) of vancomycin, teicoplanin, and three alternative therapeutic options (linezolid, daptomycin, and quinupristin/dalfopristin) were determined using the E-test. Multiplex PCR was done for confirming species, identification of the resistant genotypes, and the detection of the virulence genes. Finally, the clonal relationship of all VRE strains was studied by PFGE. All VRE strains showed vancomycin MIC ≥256 μg/mL, and 27 (90%) isolates carried the vanA gene, whereas none of the isolates carried vanB. The most common resistance antibiotic pattern observed was toward rifampicin (n = 30 [100%]). Among all virulence genes studied, gelE (n = 28 [93.33%]) was found as the most prevalent virulent gene. VRE isolates exhibited 90%, 46.67%, 100%, and 66.67% resistance to teicoplanin, linezolid, quinupristin/dalfopristin, and daptomycin, respectively. Molecular typing demonstrated 16 PFGE types of VRE isolates (A-P). Although vanA was carried by most of the isolates, PFGE displayed small clonal dissemination among VR E. faecium and VR E. faecalis species.
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Affiliation(s)
- Ali Jahansepas
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Mohammad Ahangarzadeh Rezaee
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Alka Hasani
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Yaeghob Sharifi
- 3 Department of Clinical Microbiology, Faculty of Medicine, Urmia University of Medical Sciences , Urmia, Iran
| | - Marjan Rahnamaye Farzami
- 4 Reference Health Laboratories Research Centre, Ministry of Health and Medical Education , Tehran, Iran
| | - Alireza Dolatyar
- 4 Reference Health Laboratories Research Centre, Ministry of Health and Medical Education , Tehran, Iran
| | - Mohammad Aghazadeh
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
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van Bunnik BAD, Ciccolini M, Gibbons CL, Edwards G, Fitzgerald R, McAdam PR, Ward MJ, Laurenson IF, Woolhouse MEJ. Efficient national surveillance for health-care-associated infections. BMC Public Health 2015; 15:832. [PMID: 26316148 PMCID: PMC4552460 DOI: 10.1186/s12889-015-2172-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/21/2015] [Indexed: 12/16/2022] Open
Abstract
Background Detecting novel healthcare-associated infections (HCAI) as early as possible is an important public health priority. However, there is currently no evidence base to guide the design of efficient and reliable surveillance systems. Here we address this issue in the context of a novel pathogen spreading primarily between hospitals through the movement of patients. Methods Using a mathematical modelling approach we compare the current surveillance system for a HCAI that spreads primarily between hospitals due to patient movements as it is implemented in Scotland with a gold standard to determine if the current system is maximally efficient or whether it would be beneficial to alter the number and choice of hospitals in which to concentrate surveillance effort. Results We validated our model by demonstrating that it accurately predicts the risk of meticillin-resistant Staphylococcus aureus bacteraemia cases in Scotland. Using the 29 (out of 182) sentinel hospitals that currently contribute most of the national surveillance effort results in an average detection time of 117 days. A reduction in detection time to 87 days is possible by optimal selection of 29 hospitals. Alternatively, the same detection time (117 days) can be achieved using just 22 optimally selected hospitals. Increasing the number of sentinel hospitals to 38 (teaching and general hospitals) reduces detection time by 43 days; however decreasing the number to seven sentinel hospitals (teaching hospitals) increases detection time substantially to 268 days. Conclusions Our results show that the current surveillance system as it is used in Scotland is not optimal in detecting novel pathogens when compared to a gold standard. However, efficiency gains are possible by better choice of sentinel hospitals, or by increasing the number of hospitals involved in surveillance. Similar studies could be used elsewhere to inform the design and implementation of efficient national, hospital-based surveillance systems that achieve rapid detection of novel HCAIs for minimal effort. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2172-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B A D van Bunnik
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK.
| | - M Ciccolini
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - C L Gibbons
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK.
| | - G Edwards
- Microbiology Department, Scottish MRSA Reference Laboratory, Glasgow, UK.
| | - R Fitzgerald
- The Roslin Institute and Edinburgh Infectious Diseases, University of Edinburgh, Edinburgh, UK.
| | - P R McAdam
- The Roslin Institute and Edinburgh Infectious Diseases, University of Edinburgh, Edinburgh, UK.
| | - M J Ward
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK.
| | - I F Laurenson
- Scottish Mycobacteria Reference Laboratory, Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - M E J Woolhouse
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK.
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Ciccolini M, Donker T, Grundmann H, Bonten MJM, Woolhouse MEJ. Efficient surveillance for healthcare-associated infections spreading between hospitals. Proc Natl Acad Sci U S A 2014; 111:2271-6. [PMID: 24469791 PMCID: PMC3926017 DOI: 10.1073/pnas.1308062111] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Early detection of new or novel variants of nosocomial pathogens is a public health priority. We show that, for healthcare-associated infections that spread between hospitals as a result of patient movements, it is possible to design an effective surveillance system based on a relatively small number of sentinel hospitals. We apply recently developed mathematical models to patient admission data from the national healthcare systems of England and The Netherlands. Relatively short detection times are achieved once 10-20% hospitals are recruited as sentinels and only modest reductions are seen as more hospitals are recruited thereafter. Using a heuristic optimization approach to sentinel selection, the same expected time to detection can be achieved by recruiting approximately half as many hospitals. Our study provides a robust evidence base to underpin the design of an efficient sentinel hospital surveillance system for novel nosocomial pathogens, delivering early detection times for reduced expenditure and effort.
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Affiliation(s)
- Mariano Ciccolini
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh EH9 3JT, United Kingdom
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
| | - Tjibbe Donker
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, 3721 MA, The Netherlands, and
| | - Hajo Grundmann
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, 3721 MA, The Netherlands, and
| | - Marc J. M. Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Mark E. J. Woolhouse
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh EH9 3JT, United Kingdom
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Borhani K, Ahmadi A, Rahimi F, Pourshafie MR, Talebi M. Determination of Vancomycin Resistant Enterococcus faecium Diversity in Tehran Sewage Using Plasmid Profile, Biochemical Fingerprinting and Antibiotic Resistance. Jundishapur J Microbiol 2014; 7:e8951. [PMID: 25147674 PMCID: PMC4138691 DOI: 10.5812/jjm.8951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/23/2013] [Accepted: 02/19/2013] [Indexed: 12/17/2022] Open
Abstract
Background: Sewage treatment plants are considered to be the hotspots for antibiotic resistance transfer among bacterial species. Many fecal bacteria including Enterococci circulate and are exposed to antibiotic residues in this environment. Being as one of the most common cause of nosocomial infections, special concerns have risen worldwide about the rate and characteristics of Enterococci (especially, isolates with high resistance against glycopeptides) which are available in raw sewages. Objectives: Study on the vancomycin Resistant E. faecium diversity in Tehran sewage by plasmid profile, biochemical fingerprinting and antibiotic resistance Materials and Methods: Forty isolates recovered from an urban sewage treatment plant were studied during 2009- 2010. The antibiotic resistance of isolates against 7 antibiotics was examined by disk diffusion method. Extraction of plasmid DNA was performed and identification of van genotype (vanA and vanB) was done by PCR. Biochemical fingerprinting was done by the use of Phene-Plate system (PhP). Results: All isolates were found to be resistant to erythromycin, ampicillin and ciprofloxacin. The PCR analyses showed that all E. faecium isolates harbored vanA gene and 5 (13%) isolates harbored vanA and vanB concomitantly. By plasmid profiling the VRE isolates differentiated into 11 types. PhP showed that VRE isolates were grouped into 23 biochemical types. Conclusions: The combination of plasmid profiling and PhP techniques revealed the presence of diverse population of VRE in sewage treatment plant in Tehran. Furthermore, the results showed that the PhP technique is a reliable method in determining the VRE clonal diversity.
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Affiliation(s)
- Katayoun Borhani
- Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran
| | - Ali Ahmadi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Fateh Rahimi
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, IR Iran
| | - Mohammad Reza Pourshafie
- Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran
- Corresponding authors: Mohammad Reza Pourshafie, Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran, E-mail: ; Malihe Talebi, Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. Tel+98-2186703193, Fax: +98-88058649, E-mail:
| | - Malihe Talebi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding authors: Mohammad Reza Pourshafie, Department of Microbiology, Pasteur Institute of Iran, Tehran, IR Iran, E-mail: ; Malihe Talebi, Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. Tel+98-2186703193, Fax: +98-88058649, E-mail:
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Ciccolini M, Donker T, Köck R, Mielke M, Hendrix R, Jurke A, Rahamat-Langendoen J, Becker K, Niesters HGM, Grundmann H, Friedrich AW. Infection prevention in a connected world: the case for a regional approach. Int J Med Microbiol 2013; 303:380-7. [PMID: 23499307 DOI: 10.1016/j.ijmm.2013.02.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Results from microbiological and epidemiological investigations, as well as mathematical modelling, show that the transmission dynamics of nosocomial pathogens, especially of multiple antibiotic-resistant bacteria, is not exclusively amenable to single-hospital infection prevention measures. Crucially, their extent of spread depends on the structure of an underlying "healthcare network", as determined by inter-institutional referrals of patients. The current trend towards centralized healthcare systems favours the spread of hospital-associated pathogens, and must be addressed by coordinated regional or national approaches to infection prevention in order to maintain patient safety. Here we review recent advances that support this hypothesis, and propose a "next-generation" network-approach to hospital infection prevention and control.
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Affiliation(s)
- Mariano Ciccolini
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lesosky M, McGeer A, Simor A, Green K, Low DE, Raboud J. Effect of patterns of transferring patients among healthcare institutions on rates of nosocomial methicillin-resistant Staphylococcus aureus transmission: a Monte Carlo simulation. Infect Control Hosp Epidemiol 2011; 32:136-47. [PMID: 21460468 DOI: 10.1086/657945] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the effect of the rate and pattern of patient transfers among institutions within a single metropolitan area on the rates of methicillin-resistant Staphylococcus aureus (MRSA) transmission among patients in hospitals and nursing homes. METHODS A stochastic, discrete-time, Monte Carlo simulation was used to model the rate and spread of MRSA transmission among patients in medical institutions within a single metropolitan area. Admission, discharges, transfers, and nosocomial transmission were simulated with respect to different interinstitutional transfer strategies and various situational scenarios, such as outlier institutions with high transmission rates. RESULTS The simulation results indicated that transfer patterns and transfer rate changes do not affect nosocomial MRSA transmission. Outlier institutions with high transmission rates affect the system wide rate of nosocomial infections differently, depending on institution type. CONCLUSION It is worth effort to understanding disease-transmission dynamics and interinstitutional transfer patterns for the management of recently introduced diseases or strains. Once endemic in a system, other strategies for transmission control need to be implemented.
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Conceição N, Oliveira CDCHBD, Silva PRD, Avila BGM, Oliveira AGD. Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study. Rev Soc Bras Med Trop 2011; 44:177-81. [PMID: 21468473 DOI: 10.1590/s0037-86822011005000009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 11/17/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. METHODS Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). RESULTS A total of 324 non-repetitive enterococcal isolates were recovered, of which 87% were E. faecalis and 10.8% E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5% to 15.5% (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >256 µg/ mL) and harbored vanA genes. The majority (89.5%) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5% to 21.4% from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. CONCLUSIONS The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.
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Affiliation(s)
- Natália Conceição
- Departamento de Ciências Biológicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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d'Azevedo PA, Furtado GH, Medeiros EA, Santiago KA, Silbert S, Pignatari AC. Molecular characterization of vancomycin-resistant Enterococci strains eight years apart from its first isolation in São Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2008; 50:195-8. [DOI: 10.1590/s0036-46652008000400001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 06/30/2008] [Indexed: 11/21/2022] Open
Abstract
E. faecium was the first reported VRE species, carrying the vanA gene in Brazil. In spite of this, vancomycin-resistant E. faecalis has become the predominant species in Brazilian hospitals. The aim of this study was to evaluate the genetic relatedness of VREs isolated in a Brazilian teaching hospital eight years apart from its first isolation. We analyzed 38 VRE strains obtained from 81 surveillance cultures of patients admitted to the four largest intensive care units in Hospital São Paulo in February, 2006. Presence of the vanA gene was assayed by PCR and PFGE analysis was used for molecular characterization. All VRE strains carried the vanA gene. Two distinct clonal groups were observed among vancomycin-resistant E. faecalis. Vancomycin-resistant E. faecium belonged to five distinct clones were demonstrated by molecular typing. All of these clones were different from the first vancomycin-resistant enterococci clone isolated eight years ago in our hospital.
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Affiliation(s)
- Pedro Alves d'Azevedo
- Universidade Federal de São Paulo, Brasil; Fundação Faculdade Federal de Porto Alegre, Brasil
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Camargo ILBC, Zanella RC, Gilmore MS, Darini ALC. Virulence factors in vancomycin-resistant and vancomycin- susceptible Enterococcus faecalis from Brazil. Braz J Microbiol 2008; 39:273-8. [PMID: 24031215 PMCID: PMC3768389 DOI: 10.1590/s1517-838220080002000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 12/10/2007] [Accepted: 02/21/2008] [Indexed: 11/21/2022] Open
Abstract
Enterococci are members of commensal flora of animals and insects, but are also important opportunistic pathogens. Our objective was to observe if there was any difference of virulence in several groups of E. faecalis, mainly between vancomycin-resistant E. faecalis (VREFS) of colonization and infection. VREFS and vancomycin-sensitive E. faecalis from Brazil were screened for the presence of virulence factor genes. Phenotypic assays were used to assess in vitro expression, to understand the pathogenic potential of these isolates and to determine whether a correlation exists between virulence and antibiotic resistance. Different virulence profiles were found suggesting that the disseminating clone may have generated several variations. However, our study showed that one constellation of traits appeared most commonly: gelatinase, aggregation substance and esp (GEA). These factors are important because they have been implicated in cell aggregation and biofilm formation. Biofilm formation may promote the conjugation of plasmids harboring resistance and virulence genes, enhancing the probability of entry of new resistance genes into species. Curiously, the profile GEA was not exclusive to VREFS, it was the second most observed in VSEFS isolates from colonization and infection in hospitalized patients and also from rectal swabs of healthy volunteers. Such strains appear to represent the entry gateway to new resistance genes into E. faecalis and may contribute to the spreading of E. faecalis mainly in hospitals.
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Affiliation(s)
- I L B C Camargo
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto, SP , Brasil
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Corso AC, Gagetti PS, Rodríguez MM, Melano RG, Ceriana PG, Faccone DF, Galas MF. Molecular epidemiology of vancomycin-resistant Enterococcus faecium in Argentina. Int J Infect Dis 2007; 11:69-75. [PMID: 16793306 DOI: 10.1016/j.ijid.2006.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 01/30/2006] [Accepted: 02/01/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To characterize the mechanism of glycopeptide resistance and to determine the genetic relatedness among strains by pulsed-field gel electrophoresis (PFGE) in vancomycin-resistant Enterococcus faecium from Argentina. MATERIALS AND METHODS A total of 189 vancomycin-resistant single-patient isolates of Enterococcus faecium recovered between January 1997 and December 2000 from 30 hospitals in Argentina were studied. Minimum inhibitory concentrations were determined by the agar dilution method and van genes were detected by PCR. PFGE was used for molecular typing. RESULTS All isolates except three (vanB) were of genotype vanA. For 189 vancomycin-resistant Enterococcus faecium, SmaI-PFGE indicated 35 clonal types. Most of the isolates (56%) belonged to the same clonal type 1, which was present in 19 hospitals and dominant in 17. CONCLUSIONS The emergence of vancomycin-resistant Enterococcus faecium in Argentina seems to be related to the intra- and inter-hospital dissemination of an epidemic clone carrying the vanA element.
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Affiliation(s)
- Alejandra C Corso
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas - ANLIS Dr. Carlos G. Malbrán, Av. Velez Sarsfield 563 (1281), Buenos Aires, Argentina.
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Camargo ILBC, Gilmore MS, Darini ALC. Multilocus sequence typing and analysis of putative virulence factors in vancomycin-resistant and vancomycin-sensitive Enterococcus faecium isolates from Brazil. Clin Microbiol Infect 2006; 12:1123-30. [PMID: 17002613 DOI: 10.1111/j.1469-0691.2006.01496.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Enterococci are leading causes of hospital-acquired infections that are often difficult to treat because of high-level aminoglycoside and glycopeptide resistance. Vancomycin-resistant enterococci are a global problem, and have been isolated with increasing frequency in hospitals in Brazil. The objective of this study was to determine the genetic relatedness of vancomycin-resistant Enterococcus faecium (VREFM) and vancomycin-sensitive E. faecium (VSEFM) isolated from human infections and faecal sources in Brazil, and to compare these isolates with those from domesticated animals. Isolates (n = 56) were classified by multilocus sequence typing (MLST) and assessed for putative virulence traits. The acm gene was detected in 98% of all isolates. The 56 isolates studied comprised 26 different MLST types. VSEFM isolates from the faeces of pigs were found to be distinct from all human isolates characterised previously by MLST, and were assigned new sequence type (ST) numbers. VREFM isolates were represented by four different STs (ST-114, ST-17, ST-281, ST-50). Among the 26 STs identified in this study, eBURST detected three groups of STs with related allelic profiles, and 19 unrelated STs. Among E. faecium isolates from Brazil, the esp gene was restricted to vancomycin-resistant isolates. Furthermore, isolates classified as ST-17 by MLST, an epidemic strain type isolated internationally with the purK-1 gene, were found among VREFM isolates from Brazil that also harboured the esp and hyl genes.
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Affiliation(s)
- I L B C Camargo
- Faculdade de Ciencias Farmaceuticas de Ribeirao Preto, Universidade de São Paulo, São Paulo, Brazil
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Camargo ILBC, Dalla Costa LM, Woodford N, Gilmore MS, Darini ALC. Sequence analysis of Enterococcus faecium strain 10/96A (VanD4), the original vancomycin-resistant E. faecium strain in Brazil. J Clin Microbiol 2006; 44:2635-7. [PMID: 16825401 PMCID: PMC1489496 DOI: 10.1128/jcm.00509-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enterococcus faecium strain 10/96A (VanD4) was the first vancomycin-resistant enterococcus (VRE) isolated in Brazil. Subsequent Brazilian VRE strains have all had the VanA phenotype. Multilocus sequence typing showed that strain 10/96A was isolated sporadically, has a unique sequence type (ST 281), and was not the progenitor of the VRE strains isolated from hospital outbreaks in Brazil.
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Affiliation(s)
- Ilana L B C Camargo
- Faculdade de Ciencias Farmaceuticas de Ribeirao Preto, Universidade de São Paulo, and Hospital de Clinicas, Curitiba, Brazil 14040-903
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Titze-de-Almeida R, Van Belkum A, Felipe MSS, Zanella RC, Top J, Willems RJL. Multilocus Sequence Typing of Hospital-Associated Enterococcus faecium from Brazil Reveals Their Unique Evolutionary History. Microb Drug Resist 2006; 12:121. [PMID: 16922628 DOI: 10.1089/mdr.2006.12.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We studied the genetic relationships between vancomycin-susceptible (n = 11) and -resistant Enterococcus faecium (VRE, n = 20) recovered from Brazil using a multilocus sequence typing (MLST) scheme. Grouping of allelic profiles revealed six clusters of related sequence types (STs) that differ in no more than two of the seven alleles. Of these, one cluster harbored 16 of the 20 isolates recovered during the first VRE outbreak in Brazil. The ampicillin and gentamicin resistance profiles were stable in the isolates that clustered within the groups I-III. Comparison with the allelic profiles of 139 E. faecium from different geographical regions and origins found in the international database http://www.mlst.net revealed that the Brazilian outbreak clone did not cluster in the previously named complex-17. This genetic complex contains hospital epidemic and clinical isolates recovered from different countries and continents. Twenty two of the 31 Brazilian isolates, including the VRE outbreak clone, clustered apart from the E. faecium isolates from the database, suggesting that these Brazilian isolates have a distinct evolutionary history.
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Decelis S, Borg MA, Cuschieri P. Absence of carriage of glycopeptide-resistant enterococci by at-risk hospitalised patients in Malta. Clin Microbiol Infect 2004; 10:861-2. [PMID: 15355423 DOI: 10.1111/j.1198-743x.2004.00971.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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