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Nopparatmaitree M, Nava M, Chumsangchotisakun V, Saenphoom P, Chotnipat S, Kitpipit W. Effect of trimmed asparagus by-products supplementation in broiler diets on performance, nutrients digestibility, gut ecology, and functional meat production. Vet World 2022; 15:147-161. [PMID: 35369594 PMCID: PMC8924397 DOI: 10.14202/vetworld.2022.147-161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim Trimmed asparagus by-products (TABP) is the resultant waste from asparagus possessing. TABP has fructans, such as inulins and fructooligosaccharide, which can be utilized as an alternative prebiotic. This study was conducted to examine the effect of TABP dietary supplementation on the productive performance, nutrient digestibility, gut microbiota, volatile fatty acid (VFA) content, small-intestine histology, and meat quality of broilers. Materials and Methods A total of 320 1-day-old broiler chicks (Ross 308®) were raised under ambient temperature and assigned through a completely randomized design to one of four dietary treatments, with four replicates per treatment. The dietary treatments comprised corn-soybean basal diet supplemented with 0 (control), 10, 30, or 50 g/kg TABP. All birds were provided drinking water and feed ad libitum to meet the standard nutritional requirements of National Research Council for broiler chickens. Results TABP supplementation to the broilers significantly increased the apparent ether extract, crude fiber, and gross energy digestibility (p<0.05). TABP supplementation significantly increased lactic bacteria and Enterococcus spp. numbers as well as acetic, propionic, butyric, and total VFA levels (p<0.01); on the other hand, it also significantly decreased Salmonella spp. and Escherichia coli contents in the cecum compared with the control group (p<0.01). Moreover, TABP supplementation increased villus height in the duodenum and jejunum (p<0.01), cryptal depth in the jejunum and ileum (p<0.01), and villus surface areas in the duodenum, jejunum, and ileum (p<0.01). Overall, 0-35 day TABP supplementation significantly increased the feed intake (p<0.01) and average daily gain of broilers (p<0.05), but not significantly affected the viability, productive index, and economic benefit return (p>0.05). The carcass characteristics, pH, color, and water holding capacity of the chicken meat between groups were not significantly different (p>0.05). All levels of TABP supplementation appeared to be a feasible means of producing broilers with the lower serum low-density lipoprotein cholesterol and triglyceride levels as well as atherogenic indices of serum compared with the control (p<0.05). Cholesterol contents and palmitic acid, oleic acid, saturated fatty acids, and Monounsaturated fatty acids levels decreased with an increase of TABP supplementation (p<0.05). Furthermore, TABP supplementation decreased atherogenic index (AI) and thrombogenicity index (TI) of meat (p<0.05). Conclusion Supplementation of 30 g/kg TABP in broiler diet could enhance broiler performance and provide chicken meat with beneficial properties, with decreased AI and TI resulted from altered cholesterol and fatty acid profiles.
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Affiliation(s)
- Manatsanun Nopparatmaitree
- Faculty of Animal Science and Agricultural Technology, Silpakorn University, Phetchaburi IT Campus, Cha-Am, Phetchaburi, 76120, Thailand
| | - Marisa Nava
- Faculty of Animal Science and Agricultural Technology, Silpakorn University, Phetchaburi IT Campus, Cha-Am, Phetchaburi, 76120, Thailand
| | - Verachai Chumsangchotisakun
- Faculty of Animal Science and Agricultural Technology, Silpakorn University, Phetchaburi IT Campus, Cha-Am, Phetchaburi, 76120, Thailand
| | - Pornpan Saenphoom
- Faculty of Animal Science and Agricultural Technology, Silpakorn University, Phetchaburi IT Campus, Cha-Am, Phetchaburi, 76120, Thailand
| | - Soranot Chotnipat
- Faculty of Animal Science and Agricultural Technology, Silpakorn University, Phetchaburi IT Campus, Cha-Am, Phetchaburi, 76120, Thailand
| | - Warangkana Kitpipit
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat, 80160, Thailand
- One Health Research Center, Walailak University, Nakhon Si Thammarat, 80160, Thailand
- Food Technology and Innovation Research Center of Excellent, Walailak University, Nakhon Si Thammarat, 80160, Thailand
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Ebeid T, Al-Homidan I, Fathi M, Al-Jamaan R, Mostafa M, Abou-Emera O, El-Razik MA, Alkhalaf A. Impact of probiotics and/or organic acids supplementation on growth performance, microbiota, antioxidative status, and immune response of broilers. ITALIAN JOURNAL OF ANIMAL SCIENCE 2021. [DOI: 10.1080/1828051x.2021.2012092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tarek Ebeid
- Department of Animal Production and Breeding, Qassim University, Buraydah, Saudi Arabia
- Department of Poultry Production, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Ibrahim Al-Homidan
- Department of Animal Production and Breeding, Qassim University, Buraydah, Saudi Arabia
| | - Moataz Fathi
- Department of Animal Production and Breeding, Qassim University, Buraydah, Saudi Arabia
- Department of Poultry Production, Ain Shams University, Cairo, Egypt
| | - Rakan Al-Jamaan
- Department of Animal Production and Breeding, Qassim University, Buraydah, Saudi Arabia
| | - Mohamed Mostafa
- Department of Animal Production and Breeding, Qassim University, Buraydah, Saudi Arabia
- Department of Poultry Production, Ain Shams University, Cairo, Egypt
| | - Osama Abou-Emera
- Department of Animal Production and Breeding, Qassim University, Buraydah, Saudi Arabia
- Agriculture Research Center, Animal Production Research Institute, Dokki, Egypt
| | - Mohamed Abd El-Razik
- Department of Food Science and Human Nutrition, Qassim University, Buraydah, Saudi Arabia
- Department of Food Science, Faculty of Agriculture, Ain Shams University, Cairo, Egypt
| | - Abdullah Alkhalaf
- Department of Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia
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Prevalence of Vancomycin-Resistant Enterococcus (VRE) in Companion Animals: The First Meta-Analysis and Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10020138. [PMID: 33572528 PMCID: PMC7911405 DOI: 10.3390/antibiotics10020138] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/26/2022] Open
Abstract
Antimicrobial resistance in companion animals is a major public health concern worldwide due to the animals’ zoonotic potential and ability to act as a reservoir for resistant genes. We report on the first use of meta-analysis and a systematic review to analyze the prevalence of vancomycin-resistant Enterococcus (VRE) in companion animals. Databases such as MedLib, PubMed, Web of Science, Scopus, and Google Scholar were searched. The information was extracted by two independent reviewers and the results were reviewed by a third. Two reviewers independently assessed the study protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence data. OpenMeta analyst and comprehensive meta-analysis (CMA) were used for the meta-analysis. The random effect model was used, and publication bias was assessed using the Eggers test and funnel plot. Between-study heterogeneity was assessed, and the sources were analyzed using the leave-one-out meta-analysis, subgroup analysis and meta-regression. Twenty-two studies met the eligibility criteria, but because some studies reported the prevalence of VRE in more than one companion animal, they were considered as individual studies, and 35 studies were therefore added to the final meta-analysis. Sampling period of the included studies was from 1995–2018. Of the 4288 isolates tested in the included studies, 1241 were VRE. The pooled prevalence of VRE in companion animals was estimated at 14.6% (95% CI; 8.7–23.5%; I2 = 97.10%; p < 0.001). Between-study variability was high (t2 = 2.859; heterogeneity I2 = 97.10% with heterogeneity chi-square (Q) = 1173.346, degrees of freedom (df) = 34, and p < 0.001). The funnel plot showed bias, which was confirmed by Eggers test (t-value = 3.97165; p = 0.00036), and estimates from the leave-one-out forest plot did not affect the pooled prevalence. Pooled prevalence of VRE in dogs and cats were 18.2% (CI = 9.4–32.5%) and 12.3%, CI = 3.8–33.1%), respectively. More studies were reported in Europe than in any other continent, with most studies using feces as the sample type and disc diffusion as the detection method. With the emergence of resistant strains, new antimicrobials are required in veterinary medicine.
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Sozcu A. Growth performance, pH value of gizzard, hepatic enzyme activity, immunologic indicators, intestinal histomorphology, and cecal microflora of broilers fed diets supplemented with processed lignocellulose. Poult Sci 2020; 98:6880-6887. [PMID: 31392325 PMCID: PMC8914004 DOI: 10.3382/ps/pez449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022] Open
Abstract
This study was performed to investigate the hypothesis that supplementation of processed lignocellulose (PL) in the diets of broilers has a positive effect on growing performance, pH value of gizzard, hepatic enzyme activity, immunologic indicators, histomorphological character of small intestine, and cecal microflora populations. A total of 720 one-day-old Ross 308 broiler chicks were allotted to 4 treatment groups and fed maize−soybean meal based diets. The basal diet was supplemented with PL with an amount of 0 kg (control), 0.5 kg, 1 kg, and 2 kg per ton feed. Growing performance parameters, were determined weekly until 35 D of age. Blood samples for enzyme activities and immunoglobulins, jejunum and cecum samples for histomorphological characters for villus growth, and microbial population were collected from 12 broilers from each group. At 35 D of age, body weight of broilers supplemented with 1 kg of PL was found to be the highest with a value of 2305.0 g, when compared to the broilers supplemented with control, 0,5 and 2 kg of PL groups (2154.0, 2201.0, and 2141.7 g, respectively, P = 0.001). An increased activity of aspartate amino transferase (AST) was observed in the control and 1 kg PL supplementation groups (633.6 and 597.4 IU/L, respectively), whereas alkaline phosphatase (ALP) activity was the highest in the control group (5404 IU/L, P < 0.05). Broilers in the control group had the lowest level of IgY and IgA (122.2 and 25.8 mg/dL, respectively, P < 0.05). Villus height increased by 22.0%, 40.7%, and 34.8% in 0.5, 1, and 2 kg PL supplementation groups, respectively, when compared to the control (P < 0.001). The processed lignocellulose supplemented as 1 kg of PL decreased the average count of Staphylococcaceae, E. coli, and Enterobacteriaceae, whereas it increased the population of Lactobacillus spp. in the cecum (P < 0.05). These data indicate that the supplementation of processed lignocellulose had positive effects for performance via changes in hepatic enzyme activities, immunoglobulin levels, villus growth in jejunum, and microflora in cecum.
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Affiliation(s)
- A Sozcu
- Ödemiş Vocational High School, Ege University, 35750 Ödemiş, İzmir, Turkey
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Ebeid TA, Fathi MM, Al-Homidan I, Ibrahim ZH, Al-Sagan AA. Effect of dietary probiotics and stocking density on carcass traits, meat quality, microbial populations and ileal histomorphology in broilers under hot-climate conditions. ANIMAL PRODUCTION SCIENCE 2019. [DOI: 10.1071/an18353] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of the present study was to investigate the potential effects associated with dietary probiotic inclusion and the stocking density on carcass traits, meat chemical composition, meat sensory quality, microbial populations and ileal histomorphology in broiler chickens raised under hot climate conditions. In total, 1800 1-day-old unsexed broiler chicks (Ross 308) were randomly allocated in a completely randomised design according to a 3 × 2 factorial arrangement, with three concentrations of a dietary probiotic (0, 200 and 400 mg/kg) containing 4 × 109 cfu/g of Bacillus subtilis and two stocking densities (12 or 18 birds/m2), forming six treatments, with three pens (replicates) each. The probiotic concentration had no significant (P > 0.05) effect on bodyweight gain, feed consumption, feed conversion ratio, carcass percentage and meat chemical composition. Dietary probiotic inclusion significantly (P = 0.02) increased the scores of meat colour and odour. The acceptability score was significantly (P < 0.03) affected by the stocking density. Dietary supplementation of the probiotic at both 200 and 400 mg/kg significantly (P = 0.05) reduced the counts of Escherichia coli and Salmonella in the gut and litter. In meat, dietary supplementation of the probiotic at 200 and 400 mg/kg significantly (P = 0.03) reduced the counts of E. coli, compared with those of the control group. Moreover, Salmonella was not detected in meat. Regarding the ileal villi and crypt morphology, dietary probiotic supplementation significantly (P = 0.05) increased the height of the villus. There were no significant probiotic concentration × stocking density interactions for any of the investigated parameters, except for the gizzard percentage. Thus, dietary probiotic supplementation in broilers raised under a high ambient temperature had a significantly positive effect on the ileal villus height and a significantly negative effect on the counts of E. coli and Salmonella in the gut and litter. No negative effects on growth performance, carcass parts and meat quality were detected.
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Hosseini SM, Farhangfar H, Nourmohammadi R. Effects of a blend of essential oils and overcrowding stress on the growth performance, meat quality and heat shock protein gene expression of broilers. Br Poult Sci 2018; 59:92-99. [PMID: 28990804 DOI: 10.1080/00071668.2017.1390209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Overcrowding stress is common in the poultry industry. Chickens exposed to long-term stressful situations are characterised by welfare impairment and immunosuppression. 1. The present study evaluated the effects of a blend of essential oils (EOB; cinnamaldehyde and thymol) and stocking density on the performance, gut microflora, meat quality and physiological stress markers of broilers. 2. One-day-old Ross 308 male broiler chickens (n = 360) were allocated to 4 experimental groups from d 22 to 42. Each treatment had 6 replicates of 15 chicks. Two groups were subjected to a high stocking density (HSD) of 20 birds/m2 and the other two groups were kept at a low stocking density (LSD) of 10 birds/m2. 3. The results of this study indicate that overcrowding stress decreased growth performance parameters, blood immunoglobulin (Ig)G and heterophil:lymphocyte (H:L) ratio but increased IgA and IgM levels. HSD reduced water-loss rate and pH decline at 45 min post mortem in the breast muscle. 4. Essential oils supplementation elevated H:L ratio but decreased breast meat redness and pH24. 5. Significant interactions between EOB and stocking density were observed for corticosterone (CS) level and mRNA levels of heat shock protein 70 (HSP70) in brain and heart. Although HSD increased CS and HSP70 when compared to LSD, the effects of the former were inconsistent with EOB supplemented diets. 6. In conclusion, dietary EOB supplementation could improve some of the biomarkers associated with overcrowding stress in broiler chickens.
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Affiliation(s)
- S M Hosseini
- a Department of Animal Sciences, College of Agriculture , University of Birjand , Birjand , Iran
| | - H Farhangfar
- a Department of Animal Sciences, College of Agriculture , University of Birjand , Birjand , Iran
| | - R Nourmohammadi
- b Young Researchers and Elites Club, Birjand Branch , Islamic Azad University , Birjand , Iran
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Cengiz Ö, Köksal BH, Tatlı O, Sevim Ö, Ahsan U, Üner AG, Ulutaş PA, Beyaz D, Büyükyörük S, Yakan A, Önol AG. Effect of dietary probiotic and high stocking density on the performance, carcass yield, gut microflora, and stress indicators of broilers. Poult Sci 2015; 94:2395-403. [PMID: 26240393 DOI: 10.3382/ps/pev194] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/09/2015] [Indexed: 01/09/2023] Open
Abstract
A study was carried out to evaluate the effect of dietary probiotic supplementation and stocking density on the performance, relative carcass yield, gut microflora, and stress markers of broilers. One-day-old Ross 308 male broiler chickens (n = 480) were allocated to 4 experimental groups for 42 d. Each treatment had 8 replicates of 15 chicks each. Two groups were subjected to a high stocking density (HSD) of 20 birds/m² and the other 2 groups were kept at low stocking density (LSD) of 10 birds/m². A basal diet supplemented with probiotic 1 and 0.5 g/kg of diet (in starter and finisher diets, respectively) was fed to 2 treatments, one with HSD and the other with LSD, thereby making a 2 × 2 factorial arrangement. There was no interaction between stocking density (LSD and HSD) and dietary probiotic (supplemented and unsupplemented) for all the variables. Feed intake and weight gain were significantly low and feed conversion ratio was poor in broilers at HSD. Dietary probiotic significantly enhanced the feed intake and weight gain in starter phase only. Dietary probiotic supplementation had no effect (P > 0.05) on total aerobs, Salmonella sp., and Lactobacilli populations in the intestines of broilers. However, HSD reduced the Lactobacilli population only (P < 0.05). Relative breast yields were significantly higher in broilers reared at LSD than HSD. Thigh meat yield was higher in broilers in HSD group compared to LSD. Dietary probiotic did not affect the relative carcass yield and weight of lymphoid organs. Serum malondialdehyde, corticosterone, nitric oxide, and plasma heterophil:lymphocyte ratio were not affected either by stocking density or dietary probiotic supplementation. In conclusion, HSD negatively affected the performance and intestinal Lactobacilli population of broilers only, whereas probiotic supplementation enhanced the performance of broilers during the starter phase only. Total aerobes, Salmonella, Lactobacilli carcass yield, and stress indicators of broilers were not affected by the dietary supplementation of probiotic under the conditions of the present study.
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Affiliation(s)
- Özcan Cengiz
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Bekir H Köksal
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Onur Tatlı
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Ömer Sevim
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Umair Ahsan
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Aykut G Üner
- Department of Physiology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Pınar A Ulutaş
- Department of Biochemistry, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Devrim Beyaz
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Sadık Büyükyörük
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
| | - Akın Yakan
- Department of Animal Husbandry, Faculty of Veterinary Medicine, Mustafa Kemal University, Hatay 31000, Turkey
| | - Ahmet G Önol
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Adnan Menderes University, Aydın 09016, Turkey
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Corduk M, Sarica S, Yarim G. Effects of oregano or red pepper essential oil supplementation to diets for broiler chicks with delayed feeding after hatching. 1. Performance and microbial population. J APPL POULTRY RES 2013. [DOI: 10.3382/japr.2012-00672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Daşkıran M, Önol A, Cengiz Ö, Ünsal H, Türkyılmaz S, Tatlı O, Sevim Ö. Influence of dietary probiotic inclusion on growth performance, blood parameters, and intestinal microflora of male broiler chickens exposed to posthatch holding time. J APPL POULTRY RES 2012. [DOI: 10.3382/japr.2011-00512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Evaluation of a PCR assay to detect enterococcusfaecalis in blood and determine glycopeptides resistance genes: van a and van B. IRANIAN JOURNAL OF MEDICAL SCIENCES 2012; 37:194-9. [PMID: 23115452 PMCID: PMC3470089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/17/2011] [Accepted: 12/04/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bacteremia due to Enterococcus faecalis is usually caused by strains resistant to most antibiotics. Effective management of the disease is dependent on rapid detection and characterization of the bacteria, and determination its sensitivity pattern to antimicrobial drugs. The aim of this study was to investigate a more rapid and reliable assay for simultaneous diagnosis of enterococcal bacteremia and its sensitivity pattern to antimicrobial drugs. METHODS Several bacterial suspensions with different content of two standard strains of Enterococcus faecalis resistant to vancomycin were used for inoculation to defibrinated sheep blood samples. PCR and routine assay was performed on all blood samples with different bacterial content. RESULTS Routine assay and PCR for all inoculated blood samples with ≥5 cfu/ml was positive. Mean time for PCR and routine assays was 10 hours and 5 days, respectively. CONCLUSION PCR is a more rapid and sensitive assay for simultaneous detection and characterization for Enterococcus faecalis, and determination of its sensitivity pattern to vancomycin.
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Kim DH, Kim HK, Kim KM, Kim CK, Jeong MH, Ko CY, Moon KH, Kang JS. Antibacterial activities of macrolactin A and 7-O-succinyl macrolactin A from Bacillus polyfermenticus KJS-2 against vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. Arch Pharm Res 2011; 34:147-52. [PMID: 21468926 DOI: 10.1007/s12272-011-0117-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 10/15/2010] [Accepted: 10/18/2010] [Indexed: 11/25/2022]
Abstract
The principal objective of this study was to evaluate the antibacterial activities of macrolactin A (MA) and 7-O-succinyl macrolactin A (SMA) generated from Bacillus polyfermenticus KJS-2 against vancomycin-resistant enterococci (VREs) and methicillin-resistant Staphylococcus aureus. The minimal inhibitory concentrations (MICs) of MA and SMA against VREs were 16 and 2∼1 μg/mL, respectively, and the MICs of MA and SMA against methicillin-resistant Staphylococcus aureus were 2 and < 0.25 μg/mL, respectively. Their MIC values were comparable or superior to those of teicoplanin. In evaluating the inhibitory effects of intestinal VRE colonization in mice, the oral MA and SMA effected a rapid inhibition of intestinal VRE colonization in mice, and the intraperitoneal SMA also inhibited VRE colonization, whereas intraperitoneal MA did not.
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Affiliation(s)
- Dong Hee Kim
- Research and Development Center, Daewoo Pharm. Co. Ltd., Gimhae, Korea
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Vancomycin-resistant enterococci in fecal samples from hospitalized patients and non-hospitalized individuals in Gaza City. J Public Health (Oxf) 2009. [DOI: 10.1007/s10389-008-0242-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Production, isolation and biological activity of nargenicin from Nocardia sp. CS682. Arch Pharm Res 2008; 31:1339-45. [PMID: 18958426 DOI: 10.1007/s12272-001-2115-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 10/01/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
Culture broth of an actinomycete isolate, Nocardia sp. CS682 showed specifically higher antibacterial activity against methicillin resistant Staphylococcus aureus (MRSA). Purified substance from the organism, CS-682, which is active against MRSA and Micrococcus leuteus, is a C(28)H(37)NO(8) (M+H(+), observed: 516.83) and identified as an unusual macrolide antibiotic, nargenicin. The chemical structure of CS-682 was identified by FT-IR, (1)H-NMR, (13)C-NMR, and ((1)H-(1)H and (1)H-(13)H) COSY. The anti-MRSA activity of CS-682 was stronger than that of oxacillin, vancomycin, monensin, erythromycin, and spiramycin. Phylogenetic analysis showed that strain CS682 is closely related to Nocardia tenerifensis DSM 44704(T) (98.7% sequence similarity), followed by N. brasiliensis ATCC 19296(T) (98.4% sequence similarity). The ability of Nocardia sp. CS682 to produce nargenicin was unique.
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Fortineau N, Leclercq R, Maugat S, Robert J. Entérocoques résistants à la vancomycine : données des réseaux de l’ONERBA et résultats de l’enquête nationale trans-réseaux 2006 sur le portage digestif. Med Mal Infect 2008; 38 Suppl 2:S65-7. [DOI: 10.1016/s0399-077x(08)72995-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Delmas J, Robin F, Schweitzer C, Lesens O, Bonnet R. Evaluation of a new chromogenic medium, ChromID VRE, for detection of vancomycin-resistant Enterococci in stool samples and rectal swabs. J Clin Microbiol 2007; 45:2731-3. [PMID: 17553971 PMCID: PMC1951253 DOI: 10.1128/jcm.00448-07] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 05/04/2007] [Accepted: 05/25/2007] [Indexed: 11/20/2022] Open
Abstract
We compared ChromID VRE medium with Enterococcosel containing vancomycin for the detection of vancomycin-resistant Enterococcus in 1,007 specimens. ChromID VRE in combination with Gram straining provided a higher specificity than Enterococcosel, irrespective of the incubation time and enrichment.
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Affiliation(s)
- Julien Delmas
- Laboratoire de Bactériologie Clinique, Centre de Biologie, CHU Clermont-Ferrand, Clermont-Ferrand F-63003, France.
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Mascini EM, Bonten MJM. Vancomycin-resistant enterococci: consequences for therapy and infection control. Clin Microbiol Infect 2005; 11 Suppl 4:43-56. [PMID: 15953021 DOI: 10.1111/j.1469-0691.2005.01164.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens, initially in the USA, but now also in Europe, where hospital outbreaks are being reported with increasing frequency, although the incidence of VRE infections remains extremely low in most European countries. The recently demonstrated in-human transmission of vancomycin resistance from VRE to methicillin-resistant Staphylococcus aureus (MRSA) in two American patients underscores the potential danger of a coexisting reservoir of both pathogens. As MRSA is already endemic in many European hospital settings, prevention of endemicity with VRE seems relevant, but should be balanced against the costs associated with the implementation of effective strategies. The presence of a large community reservoir of VRE in Europe could hamper the feasibility of infection control strategies. Although the prevalence of colonisation amongst healthy subjects has apparently decreased after the ban on avoparcin use in the agricultural industry, a large proportion of admitted patients are still potential sources of VRE transmission. With no risk profile available to identify these carriers, effective screening, followed by barrier precautions for carriers, seems to be impossible. Recent studies, however, have suggested that hospital outbreaks are almost exclusively caused by specific genogroups of VRE that can be characterised phenotypically and genotypically (e.g., co-resistance to ampicillin and the presence of the variant esp gene). Based on our own experience, we propose that VRE infection control programmes should be restricted to patients colonised with these VRE strains. If such a strain is cultured from a clinical sample, surveillance amongst contact patients is recommended and barrier precautions should be implemented in the case of documented spread.
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Affiliation(s)
- E M Mascini
- Eijkman-Winkler Institute for Medical Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Moore DF, Harwood VJ, Ferguson DM, Lukasik J, Hannah P, Getrich M, Brownell M. Evaluation of antibiotic resistance analysis and ribotyping for identification of faecal pollution sources in an urban watershed. J Appl Microbiol 2005; 99:618-28. [PMID: 16108804 DOI: 10.1111/j.1365-2672.2005.02612.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The accuracy of ribotyping and antibiotic resistance analysis (ARA) for prediction of sources of faecal bacterial pollution in an urban southern California watershed was determined using blinded proficiency samples. METHODS AND RESULTS Antibiotic resistance patterns and HindIII ribotypes of Escherichia coli (n = 997), and antibiotic resistance patterns of Enterococcus spp. (n = 3657) were used to construct libraries from sewage samples and from faeces of seagulls, dogs, cats, horses and humans within the watershed. The three libraries were analysed to determine the accuracy of host source prediction. The internal accuracy of the libraries (average rate of correct classification, ARCC) with six source categories was 44% for E. coli ARA, 69% for E. coli ribotyping and 48% for Enterococcus ARA. Each library's predictive ability towards isolates that were not part of the library was determined using a blinded proficiency panel of 97 E. coli and 99 Enterococcus isolates. Twenty-eight per cent (by ARA) and 27% (by ribotyping) of the E. coli proficiency isolates were assigned to the correct source category. Sixteen per cent were assigned to the same source category by both methods, and 6% were assigned to the correct category. Addition of 2480 E. coli isolates to the ARA library did not improve the ARCC or proficiency accuracy. In contrast, 45% of Enterococcus proficiency isolates were correctly identified by ARA. CONCLUSIONS None of the methods performed well enough on the proficiency panel to be judged ready for application to environmental samples. SIGNIFICANCE AND IMPACT OF THE STUDY Most microbial source tracking (MST) studies published have demonstrated library accuracy solely by the internal ARCC measurement. Low rates of correct classification for E. coli proficiency isolates compared with the ARCCs of the libraries indicate that testing of bacteria from samples that are not represented in the library, such as blinded proficiency samples, is necessary to accurately measure predictive ability. The library-based MST methods used in this study may not be suited for determination of the source(s) of faecal pollution in large, urban watersheds.
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Affiliation(s)
- D F Moore
- Orange County Public Health Laboratory, Santa Ana, CA, USA
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19
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Delmas J, Robin F, Romaszko JP, Baraduc R, Lesens O, Sirot J, Bonnet R. [VCA agar (bioMérieux) for selective isolation of vancomycin-resistant Enterococci (VRE) from fecal specimens]. ACTA ACUST UNITED AC 2005; 53:485-9. [PMID: 16084029 DOI: 10.1016/j.patbio.2005.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 06/30/2005] [Indexed: 10/25/2022]
Abstract
Screening for Vancomycin Resistant Enterococci (VRE) is recommended for preventing nosocomial infections with VRE. The aim of this study was to assess the performance of VCA3 agar (bioMérieux) in VRE isolation from fecal specimens. 220 specimens were cultured on VCA3 agar, which contains vancomycin and in parallel, on CAP agar (Oxoid), which is vancomycin-free. 36 vancomycin resistant enterococci were isolated: 24 isolates of Enterococcus faecium expressed a high-level resistance to vancomycin and 12 isolates of E. gallinarum/casseliflavus exhibited resistance at low-level. The sensitivity of VCA3 appeared greater than that of CAP for VRE isolation: 92% (22/24) vs 79% (19/24) for E. faecium (NS, P>0.05) ; 83% (10/12) vs 50% (6/12) for E. gallinarum/casselliflavus (NS, P>0.05). As expected, initial cultures of multiple gram positive organisms were far more frequent on CAP agar than on VCA3 agar. The isolation rate of vancomycin susceptible gram positive strains was impressively lower on VCA3 medium than on CAP medium. VCA3 agar avoided therefore additional subcultures, useless identification and susceptibility tests. In conclusion, VCA3 medium could be useful for the direct, rapid and selective isolation of VRE from fecal specimens.
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Affiliation(s)
- J Delmas
- Service de bactériologie, faculté de médecine, CHU Clermont-Ferrand, 28 place H.-Dunant, 63001 Clermont-Ferrand, France.
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20
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Stephan J, Mailaender C, Etienne G, Daffé M, Niederweis M. Multidrug resistance of a porin deletion mutant of Mycobacterium smegmatis. Antimicrob Agents Chemother 2004; 48:4163-70. [PMID: 15504836 PMCID: PMC525411 DOI: 10.1128/aac.48.11.4163-4170.2004] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacteria contain an outer membrane of unusually low permeability which contributes to their intrinsic resistance to many agents. It is assumed that small and hydrophilic antibiotics cross the outer membrane via porins, whereas hydrophobic antibiotics may diffuse through the membrane directly. A mutant of Mycobacterium smegmatis lacking the major porin MspA was used to examine the role of the porin pathway in antibiotic sensitivity. Deletion of the mspA gene caused high-level resistance of M. smegmatis to 256 microg of ampicillin/ml by increasing the MIC 16-fold. The permeation of cephaloridine in the mspA mutant was reduced ninefold, and the resistance increased eightfold. This established a clear relationship between the activity and the outer membrane permeation of cephaloridine. Surprisingly, the MICs of the large and/or hydrophobic antibiotics vancomycin, erythromycin, and rifampin for the mspA mutant were increased 2- to 10-fold. This is in contrast to those for Escherichia coli, whose sensitivity to these agents was not affected by deletion of porin genes. Uptake of the very hydrophobic steroid chenodeoxycholate by the mspA mutant was retarded threefold, which supports the hypothesis that loss of MspA indirectly reduces the permeability by the lipid pathway. The multidrug resistance of the mspA mutant highlights the prominent role of outer membrane permeability for the sensitivity of M. smegmatis to antibiotics. An understanding of the pathways across the outer membrane is essential to the successful design of chemotherapeutic agents with activities against mycobacteria.
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Affiliation(s)
- Joachim Stephan
- Department of Microbiology, University of Alabama at Birmingham, 609 Bevill Biomedical Research Building, 845 19th St. South, Birmingham, AL 35294, USA
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21
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Seong CN, Shim ES, Kim SM, Yoo JC. Prevalence and characterization of vancomycin-resistant enterococci in chicken intestines and humans of korea. Arch Pharm Res 2004; 27:246-53. [PMID: 15022729 DOI: 10.1007/bf02980113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence, genotype for antibiotic resistance and antibiotic susceptibility of vancomycin resistant enterococci (VRE) were determined. And molecular typings of the Enterococcus faecium isolates were analyzed. Prevalence of VRE in chickens, healthy children and intensive care unit (ICU) patients was 41.6%, 7.9%, and 20.4%, respectively. Forty out of 54 isolates from chicken intestines, and 9 out of 11 from ICU patients were identified as Enterococcus faecium. Eleven out of 13 isolates from non-hospitalized young children were E. gallinarium. Twelve strains of E. faecalis were isolated from chicken intestines. The gene for the antibiotic resistance in E. faecium, and E. faecalis was vanA, while that in E. gallinarium was vanC1. E. faecium isolates were resistant to most of antibiotics except ampicillin and gentamicin. Molecular typing of the E. faecium strains obtained by pulse field gel electrophoresis and repetitive sequence-based PCR suggest that VRE transmit horizontally from poultry to humans, especially young children, via the food chains in Korea.
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Affiliation(s)
- Chi Nam Seong
- Department of Biological Science, Sunchon National University, Suncheon 540-742, Korea
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22
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Mondino SSB, Castro ACD, Mondino PJJ, Carvalho MDGS, Silva KMF, Teixeira LM. Phenotypic and genotypic characterization of clinical and intestinal enterococci isolated from inpatients and outpatients in two Brazilian hospitals. Microb Drug Resist 2004; 9:167-74. [PMID: 12820802 DOI: 10.1089/107662903765826769] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The phenotypic and genotypic characteristics of clinical and intestinal enterococcal isolates recovered from inpatients and outpatients of two Brazilian hospitals, located in Niterói city, Rio de Janeiro, Brazil, were compared. A total of 601 strains were studied, including 253 isolated from different clinical sources and 348 intestinal strains (205 isolated from inpatients and 143 from outpatients) recovered from fecal specimens. Isolates were identified by using conventional physiological tests and evaluated for high-level resistance to aminoglycosides (HLR-A) and resistance to vancomycin and ampicillin by the agar screening technique. Susceptibility to several antimicrobial agents was evaluated by the disk diffusion method. The genetic diversity of Enterococcus faecalis strains presenting HLR-A was assessed by pulsed-field gel electrophoresis of chromosomal DNA after SmaI digestion. E. faecalis was the most frequent species among clinical isolates (90.1%) and intestinal strains from inpatients (53.6%). E. casseliflavus was the prevalent species among intestinal isolates from outpatients (35.0%). Clinical isolates were shown to be resistant to erythromycin (53.0%), tetracycline (52.2%), ciprofloxacin (36.4%), gentamicin (36.4%), streptomycin (30.4%), chloramphenicol (34.4%), norfloxacin (32.0%), imipenem (3.2%), and ampicillin (2.8%). Vancomycin resistance was only detected in intrinsic vancomycin-resistant enterococcal species. The overall prevalence of HLR-A was 52.2% among clinical isolates and 40.5% among intestinal strains. However, HLR-A was significantly more frequent among intestinal strains obtained from inpatients (56.6%) than among strains from outpatients (17.5%). Three major clonal groups were found among E. faecalis strains exhibiting HLR-GE or HLR-GE/ST (clonal groups GE-A and GE-B), and strains exhibiting HLR-ST (clonal group ST-A). HLR-A, particularly HLR-GE, was most frequently associated with enterococcal strains of nosocomial origin. Isolates included in the major clonal groups were recovered from clinical and intestinal sources from patients in both hospitals, indicating both intrahospital and interhospital spread of strains.
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Affiliation(s)
- Silvia S B Mondino
- Departamento de Microbiologia Médica, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-590, Brazil
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23
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Choi SH, Lee SO, Kim TH, Chung JW, Choo EJ, Kwak YG, Kim MN, Kim YS, Woo JH, Ryu J, Kim NJ. Clinical features and outcomes of bacteremia caused by Enterococcus casseliflavus and Enterococcus gallinarum: analysis of 56 cases. Clin Infect Dis 2003; 38:53-61. [PMID: 14679448 DOI: 10.1086/380452] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Accepted: 08/21/2003] [Indexed: 11/03/2022] Open
Abstract
The clinical significance and virulence potential of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum are still uncertain. We retrospectively analyzed 56 cases of significant bacteremia caused by E. casseliflavus or E. gallinarum. Of these cases, 25 (44.6%) were associated with polymicrobial bacteremia, and 43 (76.8%) were associated with entry via the biliary tract. Resistance to vancomycin was observed in 17 (30.4%) of these 56 patients, and this resistance was significantly associated with E. gallinarum bacteremia (adjusted odds ratio [AOR], 10.56; 95% confidence interval [CI], 2.41-46.27) and bacteremia without biliary tract origin (AOR, 6.74; 95% CI, 1.44-31.67). The crude mortality rate was 13%, and the bacteremia-related mortality rate was 1.9%. In conclusion, bacteremia due to E. casseliflavus and E. gallinarum is commonly associated with biliary tract disease and may be associated with a low risk of mortality.
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Affiliation(s)
- Sang-Ho Choi
- Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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24
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Harbarth S, Cosgrove S, Carmeli Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci. Antimicrob Agents Chemother 2002; 46:1619-28. [PMID: 12019066 PMCID: PMC127216 DOI: 10.1128/aac.46.6.1619-1628.2002] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Stephan Harbarth
- Division of Infectious Diseases, Children's Hospital, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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25
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Baden LR, Critchley IA, Sahm DF, So W, Gedde M, Porter S, Moellering RC, Eliopoulos G. Molecular characterization of vancomycin-resistant Enterococci repopulating the gastrointestinal tract following treatment with a novel glycolipodepsipeptide, ramoplanin. J Clin Microbiol 2002; 40:1160-3. [PMID: 11923325 PMCID: PMC140377 DOI: 10.1128/jcm.40.4.1160-1163.2002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We characterized baseline and repopulating stool isolates recovered during a phase II trial of ramoplanin for the treatment of patients with stool carriage of vancomycin-resistant enterococci (VRE). Repopulation with a strain with a related genotype was found in 74, 60, and 53% of individuals in groups treated with placebo, 100 mg of ramoplanin, and 400 mg of ramoplanin, respectively. All ramoplanin-treated patients with a culture positive for VRE at day 7 had a relapse caused by a genotypically related isolate. In ramoplanin-treated patients, antibiotics with activities against anaerobic organisms were associated with positive cultures on day 7 (relative risk [RR] = 8.8; P = 0.004), and the avoidance of such antibiotics was significantly associated with culture negativity through day 21 (RR = 0.16; P = 0.02).
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Affiliation(s)
- L R Baden
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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26
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Chadwick PR, Brown DFJ, Wilcox MH, Collyns TA, Walpole E, Dillon J, Smith R, Gopal Rao G, Oppenheim BA. Comparison of agar-based media for primary isolation of glycopeptide-resistant enterococci. Clin Microbiol Infect 2002; 3:559-563. [PMID: 11864182 DOI: 10.1111/j.1469-0691.1997.tb00308.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE: To compare four vancomycin-containing agar media for the isolation of glycopeptide-resistant enterococci (GRE) from clinical fecal specimens: kanamycin---aesculin---azide (KAA) agar; bile---aesculin---polymixin (BAP) agar; aztreonam---amphotericin blood (CBAA) agar; and neomycin blood (CBN) agar. METHODS: Fecal specimens from 125 patients were inoculated onto each medium. Media were examined for enterococci after incubation for up to 48 h. Enterococci were identified to species level, and glycopeptide phenotypes were determined by measuring minimum inhibitory concentrations of vancomycin and teicoplanin. RESULTS: GRE were isolated from 44/125 samples. Enterococcus faecalis and Enterococcus faecium isolates, expressing glycopeptide resistance of the VanA or VanB phenotypes, were recovered from 27/33 (82%) specimens on BAP medium, 26/33 (79%) on KAA medium, and 21/33 (64%) on CBN and CBAA media. Enterococcus gallinarum and Enterococcus casseliflavus isolates expressing low-level glycopeptide resistance (VanC phenotype) were recovered from 14/15 (93%) specimens on CBAA medium, 7/15 (47%) on KAA and CBN media, and 6/15 (40%) on BAP medium. CONCLUSIONS: The media tested in this study, with the exception of CBN medium, detected at least 75% of patients colonized by GRE. Further development of BAP, CBAA and KAA media is warranted to improve growth and selectivity.
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Affiliation(s)
- P. R. Chadwick
- Public Health Laboratory, Withington Hospital, Manchester
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27
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Page B, Petrich A, Stevens D, Luinstra K, Callery S, Gafni A, Mahony J, Chernesky M, Groves D. Training costs and investment payback of implementing molecular diagnostics for identification of vancomycin resistant enterococci in a clinical microbiology laboratory. Diagn Microbiol Infect Dis 2002; 42:91-7. [PMID: 11858903 DOI: 10.1016/s0732-8893(01)00340-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Molecular diagnostics may be a more efficient method to manage resources; but most Microbiology laboratories have not introduced them into routine use due to the specialized training required. Using vancomycin resistant enterococci (VRE) screening during a comparison of a multiplex PCR (MPCR) and conventional biochemical testing (CBT) we studied 3 objectives: 1) to develop a molecular diagnostics in-house training program, 2) to assess the training program outcomes for competency and confidence, and 3) to determine laboratory payback. A training program for 14 technologists using multiple adult learning methods was implemented. Methods to minimize technical errors were introduced and included: use of a calibrated loop to deliver sample; prealiquotting reagents; increasing volume of specimen; addition of gel loading dye directly into reaction tubes; and establishment of an equivocal zone. In our laboratory MPCR costs $7.06 less than CBT, therefore the payback period for training and implementation would be approximately 3 years.
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Affiliation(s)
- Bonnie Page
- Hamilton Regional Laboratory Medicine Progam, St. Joseph's Hospital, Hamilton, Ontario, Canada
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28
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D'Agata EMC, Gautam S, Green WK, Tang YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002; 34:167-72. [PMID: 11740703 DOI: 10.1086/338234] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2001] [Revised: 08/22/2001] [Indexed: 11/03/2022] Open
Abstract
The diagnostic accuracy of the rectal swab (RS) culture method in identifying gastrointestinal colonization with vancomycin-resistant enterococci (VRE) is not known. Serial quantitative stool cultures, skin cultures, and RS cultures were performed for patients with VRE infections to assess the false-negative rate of the RS and the prevalence of skin colonization, a prerequisite for cross-transmission, at varying VRE stool densities. A total of 35 stool samples were obtained from 13 patients. The sensitivity of the RS culture was 58%; it ranged from 100%, at VRE densities of > or =7.5 log10 colony forming units (cfu) per gram of stool, to 0%, at densities of < or =4.5 log10 cfu per gram of stool. Skin colonization was detected at these low VRE stool densities, but it was more common at higher VRE densities (P<.001). Antibiotic exposure was significantly associated with higher VRE stool densities (P<.001). The high false-negative rate of the RS may be contributing to the continued increase in the prevalence of VRE.
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Affiliation(s)
- Erika M C D'Agata
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
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29
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Petrich A, Luinstra K, Page B, Callery S, Stevens D, Gafni A, Groves D, Chernesky M, Mahony JB. Effect of routine use of a multiplex PCR for detection of vanA- and vanB- mediated enterococcal resistance on accuracy, costs and earlier reporting. Diagn Microbiol Infect Dis 2001; 41:215-20. [PMID: 11777663 DOI: 10.1016/s0732-8893(01)00305-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A multiplex PCR (MPCR) for detection of vanA-and vanB-mediated resistance to vancomycin was optimized and adapted for use in the routine microbiology laboratory. Consecutive specimens (1196) submitted for vancomycin resistant Enterococci (VRE) surveillance were processed by clinical technologists on Bile Esculin Azide Agar containing 6 mg/L vancomycin (BEAA/Vanco6) plates and 466 showing black colony growth were processed by conventional biochemical testing (CBT) and by MPCR. CBT identified 208 VRE positives. MPCR detected 205 of the CBT- positives plus an additional 10. Analysis of the discordant specimens determined that 5 CBT- negative/MPCR-positive specimens also contained Enterococci with vanC resistance, 3 CBT-positive/MPCR-negative specimens were true positives, and 5 CBT-negative/MPCR-positive specimens occurred due to technical error. The sensitivity and specificity of MPCR were 98.4% and 96.1%. MPCR identifications of VRE were achieved approximately 48 h earlier than CBT and at 60% of the costs.
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Affiliation(s)
- A Petrich
- Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, ON, Canada.
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Baden LR, Thiemke W, Skolnik A, Chambers R, Strymish J, Gold HS, Moellering RC, Eliopoulos GM. Prolonged colonization with vancomycin-resistant Enterococcus faecium in long-term care patients and the significance of "clearance". Clin Infect Dis 2001; 33:1654-60. [PMID: 11595985 DOI: 10.1086/323762] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2001] [Revised: 05/29/2001] [Indexed: 12/17/2022] Open
Abstract
Little is known about the persistence of colonization with vancomycin-resistant Enterococcus faecium (VRE) in the nononcologic, non-intensive care unit patient. We studied all patients who had VRE isolated on > or =2 occasions of > 1 year apart (Study A) and those who had been "cleared" of VRE colonization after 3 negative stool cultures (Study B). Twelve patients had stored VRE isolates recovered > 1 year apart (Study A), and 58% of paired isolates were genotypically related according to pulsed field gel electrophoresis patterns. In Study B, stool samples were obtained weekly from 21 "cleared" patients for 5 weeks, which revealed that 24% were VRE positive. For these culture-positive patients, 72% of the cultures failed to detect VRE. Recent antibiotic use was significantly more common in the culture-positive patients, as compared with culture-negative patients (P=.003). Colonization with VRE may persist for years, even if the results of intercurrent surveillance stool and index site cultures are negative. Cultures for detection of VRE in stool samples obtained from patients declared "cleared" are insensitive.
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Affiliation(s)
- L R Baden
- Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
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31
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Reisner BS, Shaw S, Huber ME, Woodmansee CE, Costa S, Falk PS, Mayhall CG. Comparison of three methods to recover vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during a hospital outbreak of VRE. Infect Control Hosp Epidemiol 2000; 21:775-9. [PMID: 11140913 DOI: 10.1086/501734] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To establish an efficient and sensitive technique for recovering vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during implementation of control measures for an outbreak of VRE. DESIGN Perianal and environmental samples were collected in triplicate on sterile swabs. One swab was used to inoculate a selective broth medium containing 6 pg of vancomycin and 8 pg of ciprofloxacin per mL, one to inoculate Campylobacter agar containing 10 microg/mL of vancomycin, and one to inoculate Enterococcosel agar containing 8 microg/mL of vancomycin. SETTING Samples were collected in the intensive care units of a 600-bed university hospital over a period of 2 months. SAMPLE SELECTION: Patients and their immediate environment were sampled if they resided in a ward with a patient known to be colonized or infected with VRE. RESULTS Of the 88 perianal samples obtained from 63 patients, 37 were positive for VRE by broth culture, with 36 also recovered on both types of solid media (sensitivity, 97.3%; negative predictive value, 98.1%). Of the initial samples collected from each of the 63 patients, 20 were positive for VRE by all methods. Of the 500 environmental samples cultured, 139 were positive for VRE in broth, with only 33 recovered on Campylobacter agar (sensitivity, 23.7%; negative predictive value, 77.2%) and 22 on Enterococcosel agar (sensitivity, 15.8%; negative predictive value, 75.2%). CONCLUSIONS Our data indicate that, when performing surveillance cultures during an outbreak of VRE, use of an enrichment broth medium is required to recover VRE contaminating environmental surfaces; however, direct inoculation to selective solid medium is adequate to recover VRE in patient perianal specimens.
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Affiliation(s)
- B S Reisner
- Department of Pathology, University of Texas Medical Branch at Galveston, USA
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Butaye P, Devriese LA, Haesebrouck F. Comparison of direct and enrichment methods for the selective isolation of vancomycin-resistant enterococci from feces of pigs and poultry. Microb Drug Resist 2000; 5:131-4. [PMID: 10432273 DOI: 10.1089/mdr.1999.5.131] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Isolation results of vancomycin-resistant enterococci (VRE) of fecal samples from pigs and broiler and layer chickens obtained with two vancomycin-supplemented enrichment media, kanamycin aesculin azide (KAA) broth and Enterococcosel (ECC) broth, and three isolation media, KAA agar, ECC agar, and Slanetz and Bartley (SL) agar, were compared. Direct isolation on vancomycin-containing agar plates was not efficient in swine and layer chickens, which had only low numbers of VRE. In broilers chickens, the VRE content of the samples was high, and SL as well as ECC were found to perform better than KAA agar. The same three agar media were used as selective plating media after 1 and 2 days incubation of the samples in KAA and ECC enrichment broths. Sensitivities of the 12 different enrichment-plate combinations tested ranged from 0 to 81% in layer chickens and from 5 to 44% in samples from pigs. In the high prevalence type of samples from broilers, sensitivities still varied substantially from 52 to 78%. Incubating vancomycin-containing enrichment broths for 2 days compared with 1 day was favorable for the isolation of vancomycin-resistant Enterococcus faecalis, E. gallinarum, and E. casseliflavus but not for E. faecium and E. hirae/E. durans. ECC broth and ECC plates yielded the highest number of E. gallinarum and E. casseliflavus. In layer as well as in broiler chickens, ECC broth incubated for 2 days and plated on ECC agar was the most sensitive method. In pigs, however, KAA broth incubated for 2 days and plated on ECC medium yielded the highest number of VRE.
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Affiliation(s)
- P Butaye
- Faculty of Veterinary Medicine, Department of Pathology, Bacteriology and Poultry Disease, University of Ghent, Merelbeke, Belgium
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33
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Gambarotto K, Ploy MC, Turlure P, Grélaud C, Martin C, Bordessoule D, Denis F. Prevalence of vancomycin-resistant enterococci in fecal samples from hospitalized patients and nonhospitalized controls in a cattle-rearing area of France. J Clin Microbiol 2000; 38:620-4. [PMID: 10655356 PMCID: PMC86160 DOI: 10.1128/jcm.38.2.620-624.2000] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens over the last decade, but little is known about their epidemiology. We report on the prevalence of VRE fecal colonization on the basis of a prospective study among patients hospitalized in a hematology intensive care unit and among nonhospitalized subjects living in the local community. A total of 243 rectal swabs from hematology patients and 169 stool samples from the control group were inoculated onto bile-esculin agar plates with and without 6 mg of vancomycin per liter and into an enrichment bile-esculin broth supplemented with 4 mg of vancomycin per liter. A total of 37% of the hospitalized patients and 11.8% of the subjects from the community were found to be VRE carriers. A total of 65 VRE strains were isolated: 12 (18.5%) E. faecium, 46 (70.7%) E. gallinarum, and 7 (10.8%) E. casseliflavus strains. No E. faecalis strains were detected. All the E. faecium strains were of the vanA genotype. Molecular typing by pulsed-field gel electrophoresis revealed a different pattern for each vanA VRE strain that originated from an individual subject. To our knowledge, this is the first study to be carried out in a cattle-rearing region of France. It reports a higher VRE prevalence than that reported in previous European or U.S. studies. A partial explanation is the use of an enrichment broth step which enabled detection of strains which would otherwise have been missed, but the fact that subjects and patients were recruited from a predominantly agricultural area where vancomycin-related antibiotics have recently been used in animal husbandry could also contribute to the high levels of VRE in patients and subjects alike.
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Affiliation(s)
- K Gambarotto
- Department of Microbiology and Virology, EP CNRS 118, Limoges University Teaching Hospital, France
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34
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Roger M, Faucher MC, Forest P, St-Antoine P, Coutlée F. Evaluation of a vanA-specific PCR assay for detection of vancomycin-resistant Enterococcus faecium during a hospital outbreak. J Clin Microbiol 1999; 37:3348-9. [PMID: 10488203 PMCID: PMC85562 DOI: 10.1128/jcm.37.10.3348-3349.1999] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We investigated the use of PCR as an alternative to culture of fecal samples for detection of vanA-containing Enterococcus faecium during a recent hospital outbreak. Rectal swabs collected consecutively from 223 patients were analyzed by culture with and without enrichment broth and by vanA-specific PCR of enrichment broth samples. Fifty-five specimens were positive for vanA-containing E. faecium by at least one method. The sensitivities of the vanA-specific PCR assay and agar culture with and without enrichment broth were 94.5, 98, and 89%, respectively. All three methods were 100% specific. Final results were obtained much more rapidly by PCR (within 24 to 30 h of specimen submission) than by the culture methods (4 to 5 days). Thus, PCR is an accurate and rapid alternative to culture for detection of vancomycin-resistant enterococci during hospital outbreaks.
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Affiliation(s)
- M Roger
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Département de Microbiologie Médicale et Infectiologie, Hôpital Notre-Dame du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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35
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Taylor ME, Oppenheim BA, Chadwick PR, Weston D, Palepou MF, Woodford N, Bellis M. Detection of glycopeptide-resistant enterococci in routine diagnostic faeces specimens. J Hosp Infect 1999; 43:25-32. [PMID: 10462636 DOI: 10.1053/jhin.1999.0630] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Faeces received in a diagnostic laboratory were screened for glycopeptide-resistant enterococci (GRE) on modified Lewisham medium, with and without enrichment in Enterococcosel broth. Colonization by GRE was detected in 102/838 patients (12.2%). In 74 (73%) of colonized patients GRE were detected by both methods and in 28 (27%) they were detected only after enrichment. The carriage rate in hospitalized patients was 32% (93/289) compared with 2.3% (11/425) in the community (GP patients and food-handlers). Carriage of GRE increased with age. Clostridium difficile isolation was associated with GRE colonization, odds ratio 6.76 (P<0.001). Fifty-nine percent (60/102) of the GRE had the VanA phenotype and 41% (42/102) had the VanB phenotype. In the community VanA predominated (91%), whereas 64% (57/89) of the isolates from hospitalised patients were of the VanB phenotype.
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Affiliation(s)
- M E Taylor
- Manchester PHL, Withington Hospital, West Didsbury, Manchester, M20 2LR
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36
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Montecalvo MA, Jarvis WR, Uman J, Shay DK, Petrullo C, Rodney K, Gedris C, Horowitz HW, Wormser GP. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med 1999; 131:269-72. [PMID: 10454948 DOI: 10.7326/0003-4819-131-4-199908170-00006] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals. OBJECTIVE To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting. DESIGN Prospective cohort study. SETTING Adult oncology inpatient unit. PATIENTS 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices. INTERVENTIONS Patient surveillance cultures were taken, patients were assigned to geographic cohorts, nurses were assigned to patient cohorts, gowns and gloves were worn on room entry, compliance with infection-control procedures was monitored, patients were educated about VRE transmission, patients taking antimicrobial agents were evaluated by an infectious disease specialist, and environmental surveillance was performed. MEASUREMENTS VRE infection rates, VRE colonization rates, and changes in antimicrobial use. RESULTS During use of enhanced infection-control strategies, incidence of VRE bloodstream infections decreased significantly (0.45 patients per 1000 patient-days compared with 2.1 patients per 1000 patient-days; relative rate ratio, 0.22 [95% CI, 0.05 to 0.92]; P = 0.04), as did VRE colonization (10.3 patients per 1000 patient-days compared with 20.7 patients per 1000 patient-days; relative rate ratio, 0.5 [CI, 0.33 to 0.75]; P < 0.001). Use of all antimicrobial agents except clindamycin and amikacin was significantly reduced. CONCLUSION Enhanced infection-control strategies reduced VRE transmission in an oncology unit in which VRE were endemic.
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Affiliation(s)
- M A Montecalvo
- Division of Infectious Diseases, New York Medical College and Westchester Medical Center, Valhalla 10595, USA
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37
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Petrich AK, Luinstra KE, Groves D, Chernesky MA, Mahony JB. Direct detection of vanA and vanB genes in clinical specimens for rapid identification of vancomycin resistant enterococci (VRE) using multiplex PCR. Mol Cell Probes 1999; 13:275-81. [PMID: 10441200 DOI: 10.1006/mcpr.1999.0250] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Surveillance for vancomycin resistant enterococci (VRE) by culture can be labour intensive and time consuming. We have developed a multiplex polymerase chain reaction (MPCR) which can be performed directly on the clinical specimen. The assay allows sensitive detection of enterococci with vanA - and vanB -mediated resistance to vancomycin. DNA was purified from stool and rectal specimens using the XTRAX(TM)DNA Extraction Kit (Gull Labs). Multiplex PCR amplified vanA and vanB targets were detected using a microtiter plate EIA. Two-hundred specimens were tested by routine culture and MPCR. Culture identified 44 VRE isolates and MPCR detected 38 of the 44 culture positives. Multiplex PCR detected three additional positive VRE specimens missed by culture for a sensitivity and specificity of 86.4 and 98.1%, respectively. When the presence of PCR inhibitors was addressed in the six culture positive/MPCR negative specimens, four additional VRE positive specimens were detected. Performing MPCR on the original specimens and on a 1:10 dilution of all specimens to minimize the effect of inhibitors gave a sensitivity and specificity of 95.5 and 98.1%, respectively. Multiplex PCR with confirmation by microtiter plate hybridization could be completed in 8 h compared with 24-48 h required for culture.
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Affiliation(s)
- A K Petrich
- Regional Virology and Chlamydiology Laboratory.
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38
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Nelson RR. Intrinsically vancomycin-resistant gram-positive organisms: clinical relevance and implications for infection control. J Hosp Infect 1999; 42:275-82. [PMID: 10467540 DOI: 10.1053/jhin.1998.0605] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intrinsic resistance to vancomycin in gram-positive bacteria presumably predates acquired vancomycin resistance in enterococci but it has only recently generated interest. Intrinsically resistant enterococci possessing the vanC gene and the non-enterococcal genera Leuconostoc, Lactobacillus, Pediococcus and Erysipelothrix are known to cause human infection. This review examines the available data on their identification, resistance mechanisms, epidemiology, clinical infections and antimicrobial susceptibility. Intrinsically vancomycin-resistant gram-positives are usually opportunistic pathogens. Although serious infections may occur, treatment options remain available. No additional infection control measures for the intrinsically resistant genera appear justified with currently available evidence, although vigilance should be maintained to detect future changes in susceptibility patterns.
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Affiliation(s)
- R R Nelson
- Department of Clinical Microbiology, Western Infirmary, Glasgow
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39
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Ieven M, Vercauteren E, Descheemaeker P, van Laer F, Goossens H. Comparison of direct plating and broth enrichment culture for the detection of intestinal colonization by glycopeptide-resistant enterococci among hospitalized patients. J Clin Microbiol 1999; 37:1436-40. [PMID: 10203501 PMCID: PMC84795 DOI: 10.1128/jcm.37.5.1436-1440.1999] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The results of prevalence studies on glycopeptide-resistant enterococci (GRE) in the intestine may be influenced by the detection methods applied. In most studies different media, different concentrations of antibiotics, and different methods are used, and these differences result in differences in recovery rates. In this cross-sectional study on the carrier state of GRE among patients at the University Hospital Antwerp, Antwerp, Belgium, performed on 21 May 1996, direct plating and broth enrichment were compared by using the same media. Stool samples (n = 213) or rectal swabs (n = 122) were plated directly on Enterococcosel agar (bioMérieux) and after enrichment in Enterococcosel broth. The prevalence of GRE was 12.8%. Direct plating recovered 53.4% of the GRE isolates, and broth enrichment recovered an additional 46.5% of them; in the latter test the isolates were thus present at less than 10(3) CFU per g of feces. The prevalence of GRE among dialysis patients was higher than among the other patients, but the difference was not significant (P = 0.06), possibly as a result of the small numbers of dialysis patients examined. The GRE species isolated included 19 E. gallinarum (44.2%), 13 E. faecium (30.2%), 6 E. faecalis (13.9%), and 5 E. casseliflavus (11.6%) isolates. All E. faecalis and E. faecium strains isolated carried the vanA gene, and E. gallinarum and E. casseliflavus carried the vanC1 and vanC2 gene, respectively. The majority of isolates were polyclonal. Our data indicate that the rate of detection of GRE from both stool samples and rectal swabs is significantly increased with enrichment cultures.
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Affiliation(s)
- M Ieven
- Laboratory for Microbiology, University Hospital Antwerp, B-2650 Edegem, Belgium.
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40
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Patel R, Piper KE, Rouse MS, Steckelberg JM, Uhl JR, Kohner P, Hopkins MK, Cockerill FR, Kline BC. Determination of 16S rRNA sequences of enterococci and application to species identification of nonmotile Enterococcus gallinarum isolates. J Clin Microbiol 1998; 36:3399-407. [PMID: 9774606 PMCID: PMC105342 DOI: 10.1128/jcm.36.11.3399-3407.1998] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 16S rRNA sequences of enterococcal species E. faecium, E. faecalis, E. gallinarum, E. casseliflavus/flavescens, E. dispar, E. pseudoavium, E. sulfureus, E. malodoratus, E. raffinosus, E. cecorum, E. hirae, E. saccharolyticus, E. seriolicida, E. mundtii, E. avium, E. durans, E. columbae, and E. solitarius are presented herein. These data were utilized to confirm the species identification of two nonmotile E. gallinarum isolates which had been previously phenotypically identified as E. faecium. The implications of this finding are discussed.
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Affiliation(s)
- R Patel
- Division of Infectious Diseases and Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55902, USA.
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41
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Van Horn KG, Rodney KM. Colonization and microbiology of the motile enterococci in a patient population. Diagn Microbiol Infect Dis 1998; 31:525-30. [PMID: 9764390 DOI: 10.1016/s0732-8893(98)00052-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The motile enterococci with the vanC gene have intrinsic low-level resistance to vancomycin, but have not been implicated in a nosocomial outbreak. We determined the colonization rate of motile enterococci in hospitalized and nonhospitalized patients. Perianal or stool specimens were cultured in Enterococcosel broth supplemented with 6 micrograms of vancomycin per mL. Rapid motility and pigment tests were performed on all enterococci isolated. A total of 82 motile and/or pigmented enterococci were isolated from 679 patients for a colonization rate of 12.1%. There were 43 Enterococcus gallinarum, 32 Enterococcus casseliflavus, 4 Enterococcus flavescens, and 3 Enterococcus mundtii identified. The E. gallinarum vancomycin MIC90 was 32 micrograms/mL and the E. casseliflavus vancomycin MIC90 was 8 micrograms/mL.
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Affiliation(s)
- K G Van Horn
- Westchester County Medical Center, Valhalla, New York 10595, USA
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42
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van den Braak N, van Belkum A, van Keulen M, Vliegenthart J, Verbrugh HA, Endtz HP. Molecular characterization of vancomycin-resistant enterococci from hospitalized patients and poultry products in The Netherlands. J Clin Microbiol 1998; 36:1927-32. [PMID: 9650938 PMCID: PMC104954 DOI: 10.1128/jcm.36.7.1927-1932.1998] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Vancomycin-resistant enterococci (VRE) pose an emerging health risk, but little is known about the precise epidemiology of the genes coding for vancomycin resistance. To determine whether the bacterial flora of consumer poultry serves as a gene reservoir, the level of contamination of poultry products with VRE was determined. VRE were genotyped by pulsed-field gel electrophoresis (PFGE), and transposon structure mapping was done by PCR. The vanX-vanY intergenic regions of several strains were further analyzed by sequencing. A total of 242 of 305 (79%) poultry products were found to be contaminated with VRE. Of these VRE, 142 (59%) were high-level-vancomycin-resistant Enterococcus faecium strains (VREF). PFGE revealed extensive VREF heterogeneity. Two genotypes were found nationwide on multiple occasions: type A (22 of 142 VREF [15%]) and type B (14 of 142 VREF [10%]). No PFGE-deduced genetic overlap was found when VREF from humans were compared with VREF from poultry. Two vanA transposon types were identified among poultry strains. In 59 of 142 (42%) of the poultry VREF, the size of the intergenic region between vanX and vanY was approximately 1,300 bp. This transposon type was not found in human VREF. In contrast, all human strains and 83 of 142 (58%) of the poultry VREF contained an intergenic region 543 bp in size. Sequencing of this 543-bp intergenic vanX-vanY region demonstrated full sequence conservation. Though preliminary, these data suggest that dissemination of the resistance genes carried on transposable elements may be of greater importance than clonal dissemination of resistant strains. This observation is important for developing strategies to control the spread of glycopeptide resistance.
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Affiliation(s)
- N van den Braak
- Department of Medical Microbiology & Infectious Diseases, Erasmus Medical Center Rotterdam, The Netherlands
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43
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Domaracki BE, Evans A, Preston KE, Fraimow H, Venezia RA. Increased oxacillin activity associated with glycopeptides in coagulase-negative staphylococci. Eur J Clin Microbiol Infect Dis 1998; 17:143-50. [PMID: 9665294 DOI: 10.1007/bf01691109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Vancomycin resistance in methicillin-resistant staphylococci presents a potential therapeutic problem. In order to understand the impact of low-level vancomycin resistance in coagulase-negative staphylococci, stepwise selection of vancomycin resistance was accomplished by growing Staphylococcus haemolyticus in culture media with increasing concentrations of vancomycin. A >40-fold increase in susceptibility to beta-lactam antibiotics was observed. No obvious alterations in the growth curve, the presence of the mecA gene, total DNA restriction fragment length polymorphism (RFLP), beta-lactamase production, or the crude protein fraction were detected in the Staphylococcus haemolyticus-derived clones when compared to the original isolate. The proportion of the oxacillin-heteroresistant population also remained similar. A comparable phenomenon occurred with the selection of Staphylococcus epidermidis exhibiting low-level resistance to vancomycin. Additionally, it was observed that clinical isolates of coagulase-negative staphylococci grown in the presence of sub-minimum inhibitory concentrations of either vancomycin or teicoplanin lost their high-level resistance to oxacillin. Checkerboard tests showed that the combination of vancomycin and oxacillin was synergistic for two isolates of Staphylococcus haemolyticus, two of four isolates of Staphylococcus epidermidis, and one isolate of Staphylococcus hominis.
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Affiliation(s)
- B E Domaracki
- Department of Pathology and Laboratory Medicine, Albany Medical Center, New York 12208, USA
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44
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Toye B, Shymanski J, Bobrowska M, Woods W, Ramotar K. Clinical and epidemiological significance of enterococci intrinsically resistant to vancomycin (possessing the vanC genotype). J Clin Microbiol 1997; 35:3166-70. [PMID: 9399514 PMCID: PMC230142 DOI: 10.1128/jcm.35.12.3166-3170.1997] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Constitutive low-level vancomycin resistance is found intrinsically in certain enterococcal species and is encoded by vanC ligase genes. These intrinsically vancomycin-resistant enterococci (VRE) will be referred to as VANC VRE. A prospective study to determine the clinical and epidemiologic significance of VANC VRE was conducted. VANC VRE were recovered from the stools of 34 of 601 (5.7%) patients, a rate similar to that obtained for the stools of 100 outpatients in the community (5%). VANC VRE were also isolated from the nonstool specimens of 9 of 538 patients (1.7%), including two patients with bacteremia. No VRE of the vanA or vanB genotypes were detected in nonstool specimens. Eighty-two hospital contacts of the first 23 patients found to be colonized or infected with VANC VRE were screened, and 6 contacts were found to be gastrointestinal carriers of VANC VRE. However, typing of isolates from these 6 contacts by pulsed-field gel electrophoresis with SmaI showed the isolates to be unique and different from those recovered from the index patients. In fact, all VANC VRE isolates from different patients in this study were unique. A case-control study with patients who were negative when screened for VANC VRE as controls failed to identify any risk factor associated with colonization or infection with this organism. VANC VRE were infrequently recovered from clinical specimens but were occasionally found as part of the normal stool flora. Since no transmission between patients was documented, additional isolation procedures may not be necessary for patients colonized or infected with VANC VRE.
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Affiliation(s)
- B Toye
- Department of Pathology and Laboratory Medicine, Ottawa General Hospital, University of Ottawa, Ontario, Canada.
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45
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Satake S, Clark N, Rimland D, Nolte FS, Tenover FC. Detection of vancomycin-resistant enterococci in fecal samples by PCR. J Clin Microbiol 1997; 35:2325-30. [PMID: 9276411 PMCID: PMC229963 DOI: 10.1128/jcm.35.9.2325-2330.1997] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Surveillance cultures for vancomycin-resistant enterococci (VRE) are time-consuming and expensive for the laboratory to perform. Therefore, we investigated the use of PCR as an alternative method of detecting and identifying VRE directly in fecal samples. PCR primers directed to vanA, vanB, vanC1, vanC2, and enterococcal ligase genes were used to detect and identify VRE in fecal material obtained by rectal or perirectal swabbing. Although PCR-inhibitory substances were present in DNA prepared directly from the swabs, the inhibitory substances could be reduced by processing the nucleic acid with two commercially available DNA preparation columns. Fecal material from 333 swabs was cultured on several selective agar media before and after broth enrichment. DNA was extracted from the fecal material and was analyzed by PCR. By using all four primer sets, only 59 (67.8%) of the samples were positive for vanA. However, after retesting the negative samples with only the vanA primer set, 77 (88.5%) of 87 specimens that were culture positive for Enterococcus faecium containing vanA were positive by PCR. One specimen was PCR positive for the vanA gene but culture negative for enterococci. The specificity of the vanA assay was 99.6%. PCR analysis of enrichment broth samples with all four primers sets after 15 to 18 h of incubation detected 74 (85.1%) of the 87 culture-positive specimens. The specificity of the vanA assay after the enrichment step was 100%. No vanB-containing enterococci were recovered by culture. Since 16 samples can be tested by PCR in 4 h (including electrophoresis), identification of VRE is possible within 8 h of specimen submission at a cost of approximately $10.12/assay. Thus, PCR may be a cost-effective alternative to culture for surveillance of VRE in some hospitals.
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Affiliation(s)
- S Satake
- Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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46
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Nelson RR. Screening for vancomycin-resistant gram-positive cocci. J Hosp Infect 1997; 37:71-3. [PMID: 9321731 DOI: 10.1016/s0195-6701(97)90075-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: 02/05/2023]
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47
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Sahm DF, Free L, Smith C, Eveland M, Mundy LM. Rapid characterization schemes for surveillance isolates of vancomycin-resistant enterococci. J Clin Microbiol 1997; 35:2026-30. [PMID: 9230375 PMCID: PMC229896 DOI: 10.1128/jcm.35.8.2026-2030.1997] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Surveillance cultures for vancomycin-resistant enterococci (VRE) and subsequent characterization of the isolates can be extremely burdensome and difficult. Therefore, efficient and reliable schemes for the characterization of surveillance isolates are needed. In this study, a commercial agar (bile esculin azide agar with 6 microg of vancomycin per ml [BEAA]; Remel, Lenexa, Kans.) was used in the initial screening step to establish relatively rapid (i.e., in < or = 24 h from the time of isolation) phenotype-based and PCR-based schemes for the detection and characterization of VRE. The phenotype-based scheme included Gram staining of growth on BEAA and subculture of cocci on sheep blood agar plates for vancomycin disk diffusion and pyrazinamidase (PYR) testing. For the PCR scheme, inocula for van gene detection were taken directly from the BEAA plates. The phenotypic approach was applied to 378 surveillance cultures that yielded growth on BEAA. Gram staining quickly eliminated gram-positive bacilli from further testing, and a negative PYR test classified 25 additional isolates as probable pediococci. A positive PYR test reliably identified 121 single-patient VRE isolates that included 83 Enterococcus faecium, 33 E. gallinarum, and 5 E. casseliflavus strains. The vancomycin inhibition zone size clearly distinguished VanA and VanB strains from VanC strains within 24 h of BEAA isolation. All VanA and VanB strains failed to produce zones of >6 mm, while only one VanC strain produced a zone of < 15 mm. Challenging this phenotypic scheme with 47 stock VRE isolates produced similar findings. In direct PCR analyses, false-negative vanA and vanB results occurred with 12% of the specimens. Many of the false-negative reactions also failed to produce an internal control product, which underscores the need for including control primers when a PCR scheme is used. In summary, the phenotype- and the PCR-based schemes provide efficient methods for characterizing VRE within 24 h of isolation.
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Affiliation(s)
- D F Sahm
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Anderson M, Davey R, Bell J. Increasing vancomycin resistance in Enterococcus spp. in Australia: facing the challenge in the laboratory. Pathology 1997; 29:303-4. [PMID: 9271023 DOI: 10.1080/00313029700169145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
High level vancomycin resistance in enterococci (VRE) is increasing in Australia. If the spread of VRE is to be checked, then it is vital for laboratories to be able to detect it promptly and accurately. We have established a rapid and accurate screening method using Enterococcosel agar supplemented with 6 mg/l vancomycin. It can recover VRE from spiked feces, it may be used to screen feces for carriage of VRE and it is not subject to the confounding effects which feces introduce to broth enrichment culture.
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Affiliation(s)
- M Anderson
- Pathology Division, Western Hospital, Footscray, Vic, Australia
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Boyce JM. Vancomycin-resistant enterococcus. Detection, epidemiology, and control measures. Infect Dis Clin North Am 1997; 11:367-84. [PMID: 9187952 DOI: 10.1016/s0891-5520(05)70361-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
VRE have spread rapidly since their initial description in 1988. Although much has been learned about the epidemiology of VRE, further studies are needed to establish the reservoirs of the organism and the relative importance of various modes of transmission. There is considerable anecdotal evidence that nosocomial transmission of VRE can be thwarted by using measures such as those recommended by HICPAC, especially if they are implemented promptly after VRE have been introduced into hospitals.
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Affiliation(s)
- J M Boyce
- Division of Infectious Diseases, Brown University, Providence, Rhode Island, USA
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