scholarly journals Genomic Insights to Control the Emergence of Vancomycin-Resistant Enterococci

mBio ◽  
2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Benjamin P. Howden ◽  
Kathryn E. Holt ◽  
Margaret M. C. Lam ◽  
Torsten Seemann ◽  
Susan Ballard ◽  
...  
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Enterococcus Faecium ◽  
De Novo ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Content Type ◽  
New Findings ◽  
Cross Transmission ◽  
Vancomycin Resistant

ABSTRACTNosocomial outbreaks of vancomycin-resistantEnterococcus faecium(VREfm) are thought to occur by transmission of VREfm between patients, predicting that infection control interventions will limit cross-transmission. Despite implementation of such strategies, the incidence of VREfm infections continues to rise. We aimed to use genomics to better understand the epidemiology ofE. faeciumwithin a large hospital and investigate the reasons for failure of infection control strategies. Whole-genome sequencing was performed on 61E. faecium(36 VREfm) isolates, predominately from blood cultures collected at a single hospital between 1998 and 2009, and on fivevanB-positive anaerobic commensal bacteria isolated from human feces. Phylogenomic analysis and precise mapping of thevanBgene, which contains the Tn1549transposon, showed that at least 18 of the 36 VREfm isolates had acquired the transposon via independent insertion events, indicatingde novogeneration of VREfm rather than cross-transmission. Furthermore, Tn1549sequences found in 15 of the 36 VREfm isolates were the same as the Tn1549sequence from one of the gut anaerobes. National and international comparatorE. faeciumisolates were phylogenetically interspersed with isolates from our hospital, suggesting that our findings might be globally representative. These data demonstrate that VREfm generation within a patient is common, presumably occurring in the human bowel during antibiotic therapy, and help explain our inability to reduce VREfm infections. A recommendation from our findings is that infection control practices should include screening patients for specific hospital clones of vancomycin-susceptibleE. faeciumrather than just VREfm.IMPORTANCEEnterococcus faeciumis an increasingly important human pathogen causing predominantly antibiotic-resistant infections in hospitalized patients. Large amounts of health care funding are spent trying to control antibiotic-resistant bacteria in hospitals globally, yet in many institutions around the world, vancomycin-resistantE. faecium(VREfm) infections continue to rise. The new findings from this study help explain the failures of our current approaches to controllingvanBVREfm in health care institutions. Given the importance of this bacterium as a cause of hospital-acquired infections and the difficulties faced by infection control units in trying to prevent colonization in their institutions, the novel findings from this study provide evidence that a new approach to controlling VREfm in hospitals is required. In particular, more attention should be given to understanding the epidemiology of hospital-adapted vancomycin-susceptibleE. faecium, and patients at higher risk forde novogeneration of VREfm need to be identified and optimally managed.

scholarly journals Chloride-Inducible Expression Vector for Delivery of Antimicrobial Peptides Targeting Antibiotic-Resistant Enterococcus faecium

2015 ◽  
Vol 81 (11) ◽  
pp. 3889-3897 ◽  
Author(s):  
Kathryn Geldart ◽  
Juan Borrero ◽  
Yiannis N. Kaznessis
Keyword(s):  
Antimicrobial Peptides ◽  
Protein Expression ◽  
Enterococcus Faecium ◽  
Inducible Promoter ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Content Type ◽  
Vancomycin Resistant ◽  
Enterococcal Infections

ABSTRACTAntibiotic-resistant enterococcal infections are a major concern in hospitals where patients with compromised immunity are readily infected.Enterococcus faeciumbacteria are of particular interest as these pathogens account for over 80% of vancomycin-resistant enterococcal infections. Antimicrobial peptides (AMPs) produced at the site of infection by engineered bacteria may offer a potential alternative to traditional antibiotics for the treatment of resistant bacteria such asE. faecium. For this mode of delivery to be effective, it is essential to identify a suitable protein expression system that can be used in the desired delivery bacterium. In this study, we describe a promising chloride-inducible promoter and its application in the bacterial delivery of AMPs fromLactococcus lactisto reduce counts ofE. faeciumbacteriain vitro. Reporter gene studies show that at chloride concentrations found within the human intestines, the chloride-inducible promoter exhibits high levels of protein expression compared to those of the commonly used nisin-inducible promoter. These results indicate that this system is powerful and would not require the exogenous administration of an inducer molecule. In its application for AMP production againstE. faeciumin vitro,L. lactisproducing AMPs under the chloride promoter rapidly decreasedE. faeciumcounts by nearly 10,000-fold. As an extension of this application, we also demonstrate the potential in using this type of delivery system in combination with traditional antibiotics to slow the development of resistance. Collectively, this study shows the promise of using a chloride-inducible promoter for the bacterial delivery of AMPs in the body for the treatment of vancomycin-resistant enterococci (VRE) and other antibiotic-resistant bacteria.

scholarly journals Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

2016 ◽  
Vol 54 (10) ◽  
pp. 2436-2447 ◽  
Author(s):  
Matthew L. Faron ◽  
Nathan A. Ledeboer ◽  
Blake W. Buchan
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Control Strategies ◽  
Resistance Mechanisms ◽  
Clinical Microbiology Laboratory ◽  
Laboratory Methods ◽  
Content Type ◽  
Important Health ◽  
Vancomycin Resistant ◽  
Hospital Acquired

Infections attributable to vancomycin-resistantEnterococcus(VRE) strains have become increasingly prevalent over the past decade. Prompt identification of colonized patients combined with effective multifaceted infection control practices can reduce the transmission of VRE and aid in the prevention of hospital-acquired infections (HAIs). Increasingly, the clinical microbiology laboratory is being asked to support infection control efforts through the early identification of potential patient or environmental reservoirs. This review discusses the factors that contribute to the rise of VRE as an important health care-associated pathogen, the utility of laboratory screening and various infection control strategies, and the available laboratory methods to identify VRE in clinical specimens.

scholarly journals Systematic Review of Measurement and Adjustment for Colonization Pressure in Studies of Methicillin-ResistantStaphylococcus aureus, Vancomycin-Resistant Enterococci, andClostridium difficileAcquisition

2011 ◽  
Vol 32 (5) ◽  
pp. 481-489 ◽  
Author(s):  
Adebola O. Ajao ◽  
Anthony D. Harris ◽  
Mary-Claire Roghmann ◽  
J. Kristie Johnson ◽  
Min Zhan ◽  
...  
Keyword(s):  
Clinical Care ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Medline Search ◽  
Colonization Pressure ◽  
Vancomycin Resistant Enterococci ◽  
Control Metric ◽  
Cross Transmission ◽  
Vancomycin Resistant ◽  
Definition Of

Objective.Colonization pressure is an important infection control metric. The aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistantStaphylococcus aureus(MRSA), vancomycin-resistant enterococci (VRE), andClostridium difficile.Methods.We performed a computerized search of studies of nosocomial MRSA, VRE, andC. difficileacquisition published before July 1, 2009, through MEDLINE. Studies were included if a study outcome was MRSA, VRE, orC. difficileacquisition; the authors identified risk factors associated with MRSA, VRE, orC. difficileacquisition; and the study measured colonization pressure.Results.The initial MEDLINE search yielded 505 articles. Sixty-six of these were identified as studies of nosocomial MRSA, VRE, orC. difficileacquisition; of these, 18 (27%) measured colonization pressure and were included in the final review. The definition of colonization pressure varied considerably between studies: the proportion of MRSA- or VRE-positive patients (5 studies), the proportion of MRSA- or VRE-positive patient-days (6 studies), or the total or mean number of MRSA-, VRE-, orC. difficile-positive patients or patient-days (7 studies) in the unit over periods of varying length. In 10 of 13 studies, colonization pressure was independently associated with MRSA, VRE, orC. difficileacquisition.Conclusion.There is a need for a simple and consistent method to quantify colonization pressure in both research and routine clinical care to accurately assess the effect of colonization pressure on cross-transmission of antibiotic-resistant bacteria.

scholarly journals Intestinal Microbiota Containing Barnesiella Species Cures Vancomycin-Resistant Enterococcus faecium Colonization

2013 ◽  
Vol 81 (3) ◽  
pp. 965-973 ◽  
Author(s):  
Carles Ubeda ◽  
Vanni Bucci ◽  
Silvia Caballero ◽  
Ana Djukovic ◽  
Nora C. Toussaint ◽  
...  
Keyword(s):  
Intestinal Microbiota ◽  
Resistant Bacteria ◽  
Rrna Gene ◽  
Intestinal Colonization ◽  
Antibiotic Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Hematopoietic Stem ◽  
Content Type ◽  
Obligate Anaerobic ◽  
Vancomycin Resistant

ABSTRACTBacteria causing infections in hospitalized patients are increasingly antibiotic resistant. Classical infection control practices are only partially effective at preventing spread of antibiotic-resistant bacteria within hospitals. Because the density of intestinal colonization by the highly antibiotic-resistant bacterium vancomycin-resistantEnterococcus(VRE) can exceed 109organisms per gram of feces, even optimally implemented hygiene protocols often fail. Decreasing the density of intestinal colonization, therefore, represents an important approach to limit VRE transmission. We demonstrate that reintroduction of a diverse intestinal microbiota to densely VRE-colonized mice eliminates VRE from the intestinal tract. While oxygen-tolerant members of the microbiota are ineffective at eliminating VRE, administration of obligate anaerobic commensal bacteria to mice results in a billionfold reduction in the density of intestinal VRE colonization. 16S rRNA gene sequence analysis of intestinal bacterial populations isolated from mice that cleared VRE following microbiota reconstitution revealed that recolonization with a microbiota that containsBarnesiellacorrelates with VRE elimination. Characterization of the fecal microbiota of patients undergoing allogeneic hematopoietic stem cell transplantation demonstrated that intestinal colonization withBarnesiellaconfers resistance to intestinal domination and bloodstream infection with VRE. Our studies indicate that obligate anaerobic bacteria belonging to theBarnesiellagenus enable clearance of intestinal VRE colonization and may provide novel approaches to prevent the spread of highly antibiotic-resistant bacteria.

scholarly journals Complete Genome Sequences of Four Isolates of Vancomycin-Resistant Enterococcus faecium with the vanA Gene and Two Daptomycin Resistance Mutations, Obtained from Two Inpatients with Prolonged Bacteremia

2020 ◽  
Vol 9 (6) ◽  
Author(s):  
Piroon Jenjaroenpun ◽  
Thidathip Wongsurawat ◽  
Zulema Udaondo ◽  
Courtney Anderson ◽  
James Lopez ◽  
...  
Keyword(s):  
Enterococcus Faecium ◽  
Complete Genome ◽  
De Novo ◽  
Sequence Data ◽  
Resistance Mutations ◽  
Genome Sequences ◽  
Content Type ◽  
Vana Gene ◽  
Illumina Sequence ◽  
Vancomycin Resistant

Here, we present complete genome sequences of four Enterococcus faecium isolates, obtained from two patients with apparent vancomycin-resistant Enterococcus faecium bacteremia; these isolates also carried two mutations known to be associated with daptomycin resistance. Sequences were obtained using de novo and hybrid assembly of Oxford Nanopore and Illumina sequence data.

scholarly journals Multiresistant Bacteria Isolated from Intestinal Faeces of Farm Animals in Austria

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 466
Author(s):  
Herbert Galler ◽  
Josefa Luxner ◽  
Christian Petternel ◽  
Franz F. Reinthaler ◽  
Juliana Habib ◽  
...  
Keyword(s):  
Meat Products ◽  
Animal Husbandry ◽  
Multidrug Resistant ◽  
Farm Animals ◽  
Resistant Bacteria ◽  
Antibiotic Resistant Bacteria ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Multiresistant Bacteria ◽  
Vancomycin Resistant

In recent years, antibiotic-resistant bacteria with an impact on human health, such as extended spectrum β-lactamase (ESBL)-containing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE), have become more common in food. This is due to the use of antibiotics in animal husbandry, which leads to the promotion of antibiotic resistance and thus also makes food a source of such resistant bacteria. Most studies dealing with this issue usually focus on the animals or processed food products to examine the antibiotic resistant bacteria. This study investigated the intestine as another main habitat besides the skin for multiresistant bacteria. For this purpose, faeces samples were taken directly from the intestines of swine (n = 71) and broiler (n = 100) during the slaughter process and analysed. All samples were from animals fed in Austria and slaughtered in Austrian slaughterhouses for food production. The samples were examined for the presence of ESBL-producing Enterobacteriaceae, MRSA, MRCoNS and VRE. The resistance genes of the isolated bacteria were detected and sequenced by PCR. Phenotypic ESBL-producing Escherichia coli could be isolated in 10% of broiler casings (10 out of 100) and 43.6% of swine casings (31 out of 71). In line with previous studies, the results of this study showed that CTX-M-1 was the dominant ESBL produced by E. coli from swine (n = 25, 83.3%) and SHV-12 from broilers (n = 13, 81.3%). Overall, the frequency of positive samples with multidrug-resistant bacteria was lower than in most comparable studies focusing on meat products.

scholarly journals Duplex Real-Time PCR Assay for Rapid Detection of Ampicillin-Resistant Enterococcus faecium

2004 ◽  
Vol 48 (2) ◽  
pp. 556-560 ◽  
Author(s):  
Stein Christian Mohn ◽  
Arve Ulvik ◽  
Roland Jureen ◽  
Rob J. L. Willems ◽  
Janetta Top ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Enterococcus Faecium ◽  
Rapid Detection ◽  
Resistant Bacteria ◽  
Pcr Assay ◽  
Culture Methods ◽  
Accurate Identification ◽  
Antibiotic Resistant ◽  
Highly Correlated

ABSTRACT Rapid and accurate identification of carriers of resistant microorganisms is an important aspect of efficient infection control in hospitals. Traditional identification methods of antibiotic-resistant bacteria usually take at least 3 to 4 days after sampling. A duplex real-time PCR assay was developed for rapid detection of ampicillin-resistant Enterococcus faecium (ARE). Primers and probes that are used in this assay specifically detected the d-Ala-d-Ala ligase gene of E. faecium and the modified penicillin-binding protein 5 gene (pbp5) carrying the Glu-to-Val substitution at position 629 (Val-629) in a set of 129 tested E. faecium strains with known pbp5 sequence. Presence of the Val-629 in the strain set from 11 different countries was highly correlated with ampicillin resistance. In a screening of hospitalized patients, the real-time PCR assay yielded a sensitivity and a specificity for the detection of ARE colonization of 95% and 100%, respectively. The results were obtained 4 h after samples were harvested from overnight broth of rectal swab samples, identifying both species and the resistance marker mutation in pbp5. This novel assay reliably identifies ARE 2 to 3 days more quickly than traditional culture methods, thereby increasing laboratory throughput, making it useful for rectal screening of ARE. The assay demonstrates the advantages of real-time PCR for detection of nosocomial pathogens.

scholarly journals Thinking Outside the Bug: Molecular Targets and Strategies to Overcome Antibiotic Resistance

2019 ◽  
Vol 20 (6) ◽  
pp. 1255 ◽  
Author(s):  
Ana Monserrat-Martinez ◽  
Yann Gambin ◽  
Emma Sierecki
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Infections ◽  
Rational Design ◽  
Disease Onset ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
New Antibiotics ◽  
Resistant Strains ◽  
Vancomycin Resistant ◽  
Antibiotic Discovery

Since their discovery in the early 20th century, antibiotics have been used as the primary weapon against bacterial infections. Due to their prophylactic effect, they are also used as part of the cocktail of drugs given to treat complex diseases such as cancer or during surgery, in order to prevent infection. This has resulted in a decrease of mortality from infectious diseases and an increase in life expectancy in the last 100 years. However, as a consequence of administering antibiotics broadly to the population and sometimes misusing them, antibiotic-resistant bacteria have appeared. The emergence of resistant strains is a global health threat to humanity. Highly-resistant bacteria like Staphylococcus aureus (methicillin-resistant) or Enterococcus faecium (vancomycin-resistant) have led to complications in intensive care units, increasing medical costs and putting patient lives at risk. The appearance of these resistant strains together with the difficulty in finding new antimicrobials has alarmed the scientific community. Most of the strategies currently employed to develop new antibiotics point towards novel approaches for drug design based on prodrugs or rational design of new molecules. However, targeting crucial bacterial processes by these means will keep creating evolutionary pressure towards drug resistance. In this review, we discuss antibiotic resistance and new options for antibiotic discovery, focusing in particular on new alternatives aiming to disarm the bacteria or empower the host to avoid disease onset.

First Outbreak of Colonization and Infection With Vancomycin-ResistantEnterococcus faeciumin a Tertiary Care Hospital in Singapore

2006 ◽  
Vol 27 (9) ◽  
pp. 991-993 ◽  
Author(s):  
Maciej Piotr Chlebicki ◽  
Moi Lin Ling ◽  
Tse Hsien Koh ◽  
Li Yang Hsu ◽  
Ban Hock Tan ◽  
...  
Keyword(s):  
Infection Control ◽  
Enterococcus Faecium ◽  
Public Hospital ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Measures ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Vancomycin Resistant

We report the first outbreak of vancomycin-resistantEnterococcus faeciumcolonization and infection among inpatients in the hematology ward of an acute tertiary care public hospital in Singapore. Two cases of bacteremia and 4 cases of gastrointestinal carriage were uncovered before implementation of strict infection control measures resulted in control of the outbreak.

scholarly journals Identification of a Novel Genomic Island Associated withvanD-Type Vancomycin Resistance in Six Dutch Vancomycin-ResistantEnterococcus faeciumIsolates

2018 ◽  
Vol 62 (3) ◽  
Author(s):  
Janetta Top ◽  
Jan C. Sinnige ◽  
Ellen C. Brouwer ◽  
Guido Werner ◽  
Jukka Corander ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Enterococcus Faecium ◽  
Genomic Island ◽  
Gene Clusters ◽  
Genomic Comparison ◽  
Variable Size ◽  
Content Type ◽  
Enterococcal Species ◽  
Vancomycin Resistant ◽  
Species Specific

ABSTRACTGenomic comparison of the first six DutchvanD-type vancomycin-resistantEnterococcus faecium(VRE) isolates with fourvanDgene clusters from other enterococcal species and anaerobic gut commensals revealed that thevanDgene cluster was located on a genomic island of variable size. Phylogenetic inferences revealed that the Dutch VRE isolates were genetically not closely related and that genetic variation of thevanD-containing genomic island was not species specific, suggesting that this island is transferred horizontally between enterococci and anaerobic gut commensals.

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