JAC Advance Access originally published online on June 12, 2003
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Journal of Antimicrobial Chemotherapy (2003) 52, 113-115
© 2003 The British Society for Antimicrobial Chemotherapy
Intra-hospital dissemination of quinupristin/dalfopristin- and vancomycin-resistant Enterococcus faecium in a paediatric ward of a German hospital
1 Robert Koch Institute, Wernigerode Branch, Burgstr. 37, 38855 Wernigerode; 2 Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Leipzig, Liebigstraße 24, 04103 Leipzig, Germany
Received 20 February 2003; returned 2 April 2003; revised 28 April 2003; accepted 28 April 2003
Objectives: To demonstrate nosocomial transmission of Enterococcus faecium resistant to quinupristin/dalfopristin and vancomycin/teicoplanin among paediatric patients in a German hospital ward.
Materials and methods: Multiply-resistant E. faecium were isolated from three female patients aged 9 months, 2 and 15 years during a 10 day time span. Antibiotic susceptibilities were determined by microbroth dilution. Clonal relatedness among the isolates was investigated via SmaI-macrorestriction analysis by PFGE, multilocus sequence typing (MLST), and plasmid profiling. Presence of virulence and resistance determinants was tested by polymerase chain reaction (PCR). Selected resistance genes were localized by Southern hybridizations.
Results: A single E. faecium isolate per patient was investigated. All exhibited resistances to quinupristin/dalfopristin, vancomycin/teicoplanin, streptomycin (high-level), penicillin/ampicillin, erythromycin, oxytetracycline, chloramphenicol, rifampicin and fusidic acid. The isolates were susceptible to linezolid only and intermediately resistant to fluoroquinolones including moxifloxacin. PFGE revealed identical patterns for all three isolates. PCRs for virulence determinants hyaluronidase and enterococcal surface protein, esp, were negative, whereas PCR for the enterocin A gene was positive. MLST identified clonal type [8-5-1-1-1-1-1] belonging to a clonal subgroup C1 of hospital- and outbreak-related E. faecium. Southern hybridizations located several resistance genes (erm(B), vat(D), vanA) on a large plasmid, which was transferable in mating experiments with an E. faecium recipient.
Conclusions: These data show routes of dissemination of resistance to multiple antibiotics including streptogramins and glycopeptides in E. faecium via vertical and/or horizontal gene transfer. The isolates spread in the absence of a direct selective pressure, as none of the patients had received earlier streptogramin or glycopeptide therapy.
Keywords: quinupristin/dalfopristin, vancomycin, vanA, vat(D), VRE
* Corresponding author. Tel: +49-3943-679-210; Fax: +49-3943-679-207; E-mail: wernerg{at}rki.de
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Abele-Horn, U. Vogel, I. Klare, C. Konstabel, R. Trabold, R. Kurihara, W. Witte, W. Kreth, P.-G. Schlegel, and H. Claus Molecular Epidemiology of Hospital-Acquired Vancomycin-Resistant Enterococci J. Clin. Microbiol., November 1, 2006; 44(11): 4009 - 4013. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Stampone, M. Del Grosso, D. Boccia, and A. Pantosti Clonal Spread of a Vancomycin-Resistant Enterococcus faecium Strain among Bloodstream-Infecting Isolates in Italy J. Clin. Microbiol., April 1, 2005; 43(4): 1575 - 1580. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Bersos, M. Maniati, F. Kontos, E. Petinaki, and A. N. Maniatis First report of a linezolid-resistant vancomycin-resistant Enterococcus faecium strain in Greece J. Antimicrob. Chemother., April 1, 2004; 53(4): 685 - 686. [Full Text] [PDF]
|
|