JAC Advance Access published online on June 12, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg305
© 2003 by The British Society for Antimicrobial Chemotherapy
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Brief report
1 Robert Koch Institute,
Wernigerode Branch, Burgstr. 37, 38855 Wernigerode
* Corresponding author. E-mail: wernerg{at}rki.de.
Received 20 February 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
Intra-hospital dissemination of quinupristin/dalfopristin-
and vancomycin-resistant Enterococcus faecium in
a paediatric ward of a German hospital
2 Institute of Medical Microbiology and
Epidemiology of Infectious Diseases, University Leipzig, Liebigstraße
24, 04103 Leipzig, Germany
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