JAC Advance Access published online on July 29, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg352
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Medical
Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg;
Departments of Medicine
and Clinical Microbiology,
Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba,
Canada R3A 1R9
* Corresponding author. E-mail: ggzhanel{at}pcs.mb.ca.
Received 9 December 2002
; revised 2 April 2003
; accepted 30 May 2003
Background: The purpose of this study
was to assess the prevalence of vancomycin-resistant enterococci (VRE)
in urinary isolates in North America, and the activity of various
antibiotics against VRE. Materials and methods: Twenty-eight medical
centres in the United States and 10 centres in Canada assessed the
prevalence of VRE in urinary isolates in 2002. Each study site was
asked to collect up to a maximum of 50 consecutive VRE (Enterococcus
faecium, Enterococcus faecalis only) urinary isolates. Susceptibility
was determined by NCCLS broth microdilution. The prevalence of vanA and vanB resistance genotypes
was determined by multiplex PCR. Results: From the 28 US medical centres, a total
of 697 VRE (616 [88.4%] E.
faecium and 81 [11.6%] E.
faecalis) were received. Approximately 75% of all
VRE (E. faecium and E. faecalis)
isolates demonstrated a VanA phenotype (resistance to both vancomycin
and teicoplanin). PCR detection of vanA and vanB resistance
determinants showed that the vanA genotype
was present in 584 of 697 (83.8%) VRE isolates, whereas 113
(16.2%) isolates possessed the vanB gene.
The most active agents were linezolid, nitrofurantoin and chloramphenicol,
with 0.3%, 0.6% and 2.4% resistance,
respectively. The majority (77.8%) of vancomycin-resistant E. faecium isolates displayed the VanA phenotype,
and 538 of these 616 (87.3%) isolates were PCR-positive
for vanA; the vanB genotype
was detected in 78 (12.7%) isolates. Resistance was lowest
with linezolid, chloramphenicol and nitrofurantoin at 0.3%,
0.3% and 0.5%, respectively. Only three genetically indistinguishable vanA-positive E. faecium were
isolated from the 10 Canadian medical centres. Conclusion: VRE urinary isolates are common
in the United States, are primarily of the vanA genotype and are very susceptible to linezolid,
nitrofurantoin and chloramphenicol. In Canada, VRE urinary isolates remain
uncommon.
Keywords: glycopeptide resistance, urinary isolates, Enterococcus faecium
Antibiotic activity against urinary tract infection
(UTI) isolates
of vancomycin-resistant enterococci (VRE): results from the 2002 North American Vancomycin Resistant Enterococci Susceptibility Study (NAVRESS)
2 Department of Medical
Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg
3 Department of Clinical Microbiology,
Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba,
Canada R3A 1R9
4 International
Health Management Associates (IHMA), Chicago, IL, USA
5 Department of Medical
Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg;
Department of Clinical Microbiology,
Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba,
Canada R3A 1R9; International
Health Management Associates (IHMA), Chicago, IL, USA
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