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JAC Advance Access originally published online on January 29, 2008
Journal of Antimicrobial Chemotherapy 2008 61(4):838-844; doi:10.1093/jac/dkn025
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype

Jae-Hoon Song1,2,*,{dagger}, Kwan Soo Ko2,3,{dagger}, Ji Yoeun Suh2,{dagger}, Won Sup Oh1, Cheol-In Kang1, Doo Ryeon Chung1, Kyong Ran Peck1, Nam Yong Lee4 and Wee Gyo Lee5

1 Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 Asian-Pacific Research Foundation for Infectious Diseases (ARFID), Seoul, Korea 3 Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea 4 Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 5 Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Korea

Received 14 September 2007; returned 5 November 2007; revised 3 January 2008; accepted 4 January 2008

* Corresponding author. Tel: +82-2-3410-0320; Fax: +82-2-3410-0328; E-mail: jhsong{at}ansorp.org

Objectives: To investigate the clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype (VanD-vanA VRE).

Methods: We tested in vitro and in vivo efficacies of teicoplanin against VanD-vanA VRE strains. Change in teicoplanin MICs was monitored during incubation with teicoplanin. In vitro and in vivo time–kill assay and survival analysis using a mouse peritonitis model were performed.

Results: Teicoplanin MICs of VanD-vanA VRE strains increased to 128 mg/L within 48 h when they were cultured with 120 mg/L teicoplanin. In vitro and in vivo time–kill assay showed that VanD-vanA VRE strains were not eliminated by 120 mg/L teicoplanin in contrast to vancomycin-susceptible E. faecium and VanD-vanB strains. The survival rate of mice infected with VanD-vanA VRE strains treated with teicoplanin was comparable with that of untreated mice.

Conclusion: Data suggest that teicoplanin would fail in the treatment of VanD type VRE infections if the strains contained the vanA gene, which cannot be detected in the clinical microbiology laboratory.

Keywords: vancomycin-resistant enterococci , teicoplanin , VanD-vanA

{dagger} J.-H. Song, K. S. Ko and J. Y. Suh contributed to this study equally.


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