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JAC Advance Access published online on February 18, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh138
© 2004 by The British Society for Antimicrobial Chemotherapy
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© 2004 The British Society for Antimicrobial Chemotherapy

Original article

Molecular and clinical epidemiology of vancomycin-resistant Enterococcus faecalis

Simona F. Oprea 1 , Najam Zaidi 1 , Susan M. Donabedian 1 , Mamtha Balasubramaniam 1 , Ellie Hershberger 1 , and Marcus J. Zervos 2 *

1 William Beaumont Hospital, Royal Oak, MI;
2 William Beaumont Hospital, Royal Oak, MI; Wayne State University School of Medicine, Detroit, MI, USA

* Corresponding author. E-mail: mzervos{at}beaumont.edu.

Received 25 November 2003 ; revised 6 January 2004 ; accepted 7 January 2004

Abstract

Objectives: With the recent emergence of vancomycin-resistant (VR) Staphylococcus aureus, subsequent to the suggested transfer of the vanA resistance gene from Enterococcus faecalis, we sought to determine risk factors for acquisition of VR E. faecalis and to evaluate the molecular epidemiology of this less-prevalent and less-studied species of VR enterococcus.

Methods: We compared clinical isolates of VR E. faecalis from 71 patients, collected over 12 years in a large community teaching hospital, with isolates from 126 patients with vancomycin-susceptible E. faecalis.

Results: Risk factors for VR E. faecalis acquisition by multivariate analysis were nursing home residence (P = 0.0005), haemodialysis (P = 0.009), decubitus ulcers (P = 0.03) and receipt of parenteral vancomycin (P = 0.0002). Twenty-one percent of VR E. faecalis demonstrated vanA and 79% vanB resistance. The number of VanA isolates increased over time. Molecular analysis showed vanA or vanB in multiple PFGE groups.

Conclusions: The results of this study suggest gene dissemination among some isolates and intra-hospital spread of other isolates. The risk factors identified clearly suggest that VR E. faecalis is a nosocomial pathogen and should be considered in infection control practices. Further surveillance of VR E. faecalis is warranted, due to the potential spread of vancomycin resistance among enterococci and staphylococci.

Keywords: risk factors, pulse-field gel electrophoresis, E. faecalis
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