Vancomycin-resistant enterococci and coagulase-negative staphylococci prevalence among patients attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia

Background Vancomycin resistant enterococci (VRE) and vancomycin resistance coagulase negative staphylococci (VRCoNS) are common pathogens causing difficult to treat health care associated infections (HAI). Hence, the World Health Organization listed VRE as one of the high priority pathogens for new antibiotic discovery and antimicrobial resistance surveillance. Despite this, data on the prevalence of VRE and VRCoNS in Ethiopia is scarce. Thus, the present study determined prevalence of VRE and VRCoNS among patients attending Felege-Hiwot comprehensive specialized hospital, Ethiopia. Methods A hospital based cross-sectional study was conducted on 384 patients selected conveniently from February to March 2020. Data on demographic and clinical variables were collected using a structured questionnaire by face-to-face interview. Simultaneously urine, venous blood and wound swab were collected and processed following standard bacteriological technique. Antimicrobial susceptibility test was performed by minimum inhibitory concentration method using E-test for vancomycin and Kirby-Bauer disc diffusion method for other classes of antibiotics. Data was entered and analyzed using SPSS version 23. Logistic regression was performed to identify factors associated with VRE infection. P. value < 0.05 was considered as statistically significant. Results The prevalence of enterococci and CoNS were 6.8% and 12% respectively. The prevalence of VRE was 34.61% (9/26), while all CoNS (46 isolates) were susceptible to vancomycin. The majority (66.7%) of VRE was isolated from blood samples. Furthermore all VRE (100%), 58.8% of vancomycin susceptible enterococci and 45.7% of CoNS were multidrug resistant (MDR). Having educational level of secondary school and below (AOR = 12.80, CI = 1.149–142.5), previous exposure to catheterization (AOR = 56.0, CI = 4.331–724.0) and previous antibiotic use practice (AOR = 26.25, CI = 3.041–226.2) were a significant associated explanatory factor for VRE infection. Conclusions The prevalence of vancomycin resistance enterococci, which is also multidrug resistant, was significantly high. Though no vancomycin resistance CoNS detected, the MDR level of CoNS was high. Thus to limit enterococci and CoNS infections and MDR development, focused infection prevention measures should be implemented.

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Increasing proportion of vancomycin resistance among enterococcal bacteraemias in Switzerland: a 6-year nation-wide surveillance, 2013 to 2018

Eurosurveillance ◽

10.2807/1560-7917.es.2020.25.35.1900575 ◽

2020 ◽

Vol 25 (35) ◽

Cited By ~ 1

Author(s):

Vanja Piezzi ◽

Michael Gasser ◽

Andrew Atkinson ◽

Andreas Kronenberg ◽

Danielle Vuichard-Gysin ◽

...

Keyword(s):

Multidrug Resistant ◽

Vancomycin Resistance ◽

Targeted Prevention ◽

Prevention Strategies ◽

Confidential Interval ◽

Blood Isolate ◽

Epidemiological Factors ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Using Data

Background Vancomycin-resistant enterococci (VRE), mostly Enterococcus faecium, are multidrug-resistant microorganisms that can cause nosocomial infections. VRE has increased throughout many European countries, but data from Switzerland are scarce. Aim The aim of this work was to characterise the epidemiology of enterococcal bacteraemias in Switzerland with a focus on VRE. Methods In this observational study, we retrospectively investigated bacteraemias from 81 healthcare institutions from January 2013 to December 2018 using data from the Swiss Centre for Antibiotic Resistance. Only the first blood isolate with E. faecalis or E. faecium from an individual patient was considered. We analysed the annual incidences of enterococcal bacteraemias and determined the proportion of VRE over time. We also assessed epidemiological factors potentially associated with VRE bacteraemia. Results We identified 5,369 enterococcal bacteraemias, of which 3,196 (59.5%) were due to E. faecalis and 2,173 (40.5%) to E. faecium. The incidence of enterococcal bacteraemias increased by 3.2% per year (95% confidential interval (CI): 1.6–4.8%), predominantly due to a substantial increase in E. faecalis bacteraemic episodes. Vancomycin resistance affected 30 (1.4%) E. faecium and one E. faecalis bacteraemic episodes. Among all E. faecium bacteraemias, the proportion of vancomycin-resistant isolates increased steadily from 2013 to 2018 (2% per year; 95% CI: 1.5–2.9%). No independent epidemiological factor for higher prevalence of vancomycin-resistant E. faecium bacteraemias was identified. Conclusions Vancomycin-resistant E. faecium bacteraemias remain infrequent in Switzerland. However, an important increase was observed between 2013 and 2018, highlighting the need for implementing active surveillance and targeted prevention strategies in the country.

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Vancomycin-Resistant Enterococci and Its Associated Risk Factors among HIV-Positive and -Negative Clients Attending Dessie Referral Hospital, Northeast Ethiopia

International Journal of Microbiology ◽

10.1155/2018/4753460 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Seid Ali ◽

Martha Alemayehu ◽

Mulat Dagnew ◽

Teklay Gebrecherkos

Keyword(s):

Risk Factors ◽

Multidrug Resistant ◽

Referral Hospital ◽

Health Concern ◽

Diffusion Method ◽

Hiv Positive ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Associated Risk Factors ◽

Dessie Referral Hospital

Background. Enterococci are becoming the most important public health concern and emerging as multidrug-resistant organisms around the world including Africa particularly in Ethiopia where there is a lack of availability of effective antimicrobial drugs. However, there is a paucity of data on the prevalence and associated risk factors of vancomycin-resistant enterococci in Ethiopia.Objective. This study was aimed to assess the prevalence of vancomycin-resistant enterococci and its associated risk factors among HIV-positive and -negative clients.Methods. A comparative cross-sectional study was conducted from February to May, 2017, on 300 participants at Dessie Referral Hospital. Data were gathered using a pretested structured questionnaire, stool samples were collected and inoculated on to bile esculin agar, and presumptive colonies were inoculated in brain-heart infusion broth containing 6.5% NaCl for selective identification of enterococci. Antibiotic susceptibility tests were done using the Kirby–Bauer disk diffusion method. Data were analyzed using SPSS version 22 software package.Results. A total of 300 study participants were enrolled in this study, of which 57.7% were females with a mean age of 34.4, a range of 19–73 years. The overall prevalence of enterococci was 37.3%. The prevalence of VRE was 6.3%. From all isolates, the prevalence of VRE among HIV-positive and -negative clients was 5.9% and 7.4%, respectively. Resistance gentamicin, ampicillin, penicillin, and erythromycin was 37.5%, 34.8%, 34.8%, and 22.3%, respectively. Prevalence of multidrug resistance was (29.5%). Being low in hemoglobin content was significantly associated with VRE.Conclusion. The high prevalence of VRE and multidrug-resistant enterococci in this study signals the emergence of VRE. Detection of VRE in this study indicates decreased antibiotic treatment options of multidrug-resistant enterococci. Therefore, there should be a need to perform continuous surveillance, rational use of antibiotics, and more detailed study using phenotypic and genotypic methods.

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Frequency of vancomycin-resistant Enterococci isolated from blood cultures from 2008 to 2010

Medicinski pregled ◽

10.2298/mpns1110481m ◽

2011 ◽

Vol 64 (9-10) ◽

pp. 481-485 ◽

Cited By ~ 3

Author(s):

Mira Mihajlovic-Ukropina ◽

Deana Medic ◽

Zora Jelesic ◽

Vera Gusman ◽

Biljana Milosavljevic

Keyword(s):

Antimicrobial Agents ◽

Multidrug Resistant ◽

Blood Cultures ◽

Hospitalized Patients ◽

Diffusion Method ◽

Aminoglycoside Resistance ◽

Vancomycin Resistant Enterococci ◽

Enterococcus Spp ◽

Vancomycin Resistant ◽

High Level

Introduction. Enterococci are important hospital-acquired pathogens. The most commonly isolated species of the genus, Enterococcus faecalis and Enterococcus faecium are the third to fourth-most prevalent nosocomial pathogens worldwide. The aim of this study was to determine the frequency of resistance to vancomycin and other antimicrobial agents of Enterococcus spp strains isolated from blood cultures of hospitalized patients. Material and methods. During the three-year period, from 2008 to 2010, 132 strains of Enterococcus spp isolated from blood cultures of hospitalized patients were tested for their susceptibility to ampicillin, vancomycin, gentamycin (high-level resistance), erythromycin, chloramphenicol, teicoplanin, ciprofloxacin by disc diffusion method according to the Clinical and Laboratory Standards Institute recommendations. Susceptibility of vancomycin resistant E. faecium to the same antibiotics and to linezolid, quinopristin/dalfopristin and tigecyclin was determined using VITEK system. Results and discussion. Resistance to vancomycin was detected in 21 (15.9%) Enterococcus spp strains. The percentage of resistance to other antimicrobial agents varied from 23.1% for chloramphenicol to 81.3% for ciproflxacin. All vancomycin resistant enterococci were identified as E. faecium and belonged to phenotype VanA. The resistance to other antibiotics was very high, except for linezolid and quinopristin/dalfopristin (4.7%). The high-level aminoglycoside resistance was 87.6% for gentamycin and 95.2% for streptomycin. All isolates were resistant to ampicillin, teicoplanin and ciprofloxacin. Conclusion. The detected high frequency of multidrug-resistant isolates among vancomycin resistant enterococci is of great importance and suggests the need for further monitoring of susceptibility in order to take adequate measures to prevent and control spreading of resistant strains.

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Identification of Vancomycin Resistance Determinants in Twin Cities of Rawalpindi/Islamabad

Abasyn Journal Life Sciences ◽

10.34091/ajls.4.1.13 ◽

2021 ◽

pp. 112-118

Author(s):

Sidra Rehmat Ullah ◽

Saadia Andleeb ◽

Taskeen Raza ◽

Khalid Mehmood

Keyword(s):

Age Groups ◽

Pcr Amplification ◽

Vancomycin Resistance ◽

Twin Cities ◽

P Value ◽

Blood Samples ◽

Resistance Determinants ◽

Vana Gene ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

Vancomycin resistant Enterococci have emerged rapidly in the recent years leading to treatment failure. The aim of this work was to identify vancomycin resistance determinants; vanA and vanB genes in Enterococci. The blood, urine and throat samples were collected from 150 patients from local hospitals of twin cities of Rawalpindi/Islamabad. Forty-nine phenotypically confirmed isolates were further confirmed by PCR amplification for vancomycin determinants (genes for vanA and vanB) for vancomycin resistant Enterococci. Dependence and frequency distribution of VRE and VSE bacteraemia with respect to age, gender and source was also studied. Phenotypically resistant strains were positive for vanA while negative for vanB. vancomycin susceptible enterococci (VSE) could be isolated more from urine samples as compared to blood whereas vancomycin resistant enterococci (VRE) was found more prevalent in the blood samples (p value= 0.000). VRE was more frequently isolated from patients aged 50 or above whereas VSE prevalence was same in both age groups (p value=0.002). Gender was not found to have any significant impact on VRE or VSE bacteraemia. This study reports vanA gene cluster responsible for resistance in Pakistani population and frequently isolation of VRE from blood samples. Keywords: Enterococcus, Vancomycin resistant Enterococci, Pakistan

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Prevalence of vancomycin-resistant enterococcus in Africa in one health approach: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-77696-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Tsegaye Alemayehu ◽

Mengistu Hailemariam

Keyword(s):

One Health ◽

Meta Analysis ◽

Vancomycin Resistance ◽

World Health ◽

Shared Environment ◽

Vancomycin Resistant Enterococci ◽

Pooled Prevalence ◽

Inconsistency Index ◽

The World ◽

Vancomycin Resistant

AbstractVancomycin-resistant enterococci are a global challenge currently as reported by the World Health Organization. It is also important to recognize that combating antimicrobial resistance needs to recognize the interconnections between people, animals, plants and their shared environment in creating public health, the so-called One Health approach. Although the presence of VRE has been described in many regions of the world, there is a lack of comprehensive data indicating their prevalence of in Africa. Therefore, this study aimed to aggregate the result of studies describing VRE reported across multiple regions in Africa. A literature search was conducted on PubMed, Google scholar, and Hinari with the term “Vancomycin resistance enterococcus in Africa” on August 1–3, 2019. All available articles were downloaded to “Endnote version 7.1” then to Microsoft Word 2013. Articles determined to meet our criteria for the review was extracted to Microsoft Excel 2013. Those articles that reported the prevalence of vancomycin resistance Enterococcus obtained from all sample types and published from 2010 to 2019 in the English language were included for the review. A meta-analysis was conducted with OpenMetaAnalyst version R.3.1.0 software. The effect size was determined using a binary random effect model and statically significant considered when p < 0.05. Heterogeneity determined with the inconsistency index. A leave one out analysis used to perform the sensitivity analysis. There were 151 articles identified from the database searches; of this, 36 articles included after extensive review with two independent authors. Out of 4073 samples collected, 1488 isolates identified with an overall pooled prevalence of VRE 26.8% (95% CI; 10.7–43.0%) in Africa with a one-health perspective. The analysis showed that considerable heterogeneity among the studies (I2 = 99.97%; p < 0.001). Subgroup analysis in-country, African region, laboratory method, year of publication, and sample source showed that a high prevalence was identified from South Africa (74.8%), South African regions (74.8%), PCR (959.2%), 2010–2015 years (30.3%) and environmental (52.2%), respectively. This meta-analysis indicates that there was a high-pooled prevalence of vancomycin-resistant enterococci in African. A lot should be done to prevent and control the transmission of vancomycin resistance enterococci to a human being from the environment in the continent.

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Vancomycin resistant Enterococci and its associated factors among HIV infected patients on anti-retroviral therapy in Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0251727 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0251727

Author(s):

Belayneh Regasa Dadi ◽

Zerihun Solomon ◽

Mheret Tesfaye

Keyword(s):

Antimicrobial Susceptibility ◽

Associated Factors ◽

Multivariable Analysis ◽

Diffusion Method ◽

Resistance Pattern ◽

P Value ◽

Multivariable Logistic Regression Model ◽

Cross Sectional ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

Background The emergence of vancomycin resistant Enterococci (VRE) has alarmed the global community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the incidence of vancomycin resistant Enterococci and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART). Methods Institution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. Bivariable and multivariable logistic regression model was used to analyze the association between dependent and independent variables. P-values in the multivariable analysis, adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. P-value ≤0.05 was considered as significant. Results Enterococci spp was isolated on 123/200 (61.50%) patients. Among these isolates, the incidence of vancomycin resistant Enterococci was 11.4% [95% CI: (6.0–17.0)]. Antimicrobial susceptibility patterns against Enterococci showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibioticexposurer more than two weeks [AOR = 7.35; 95% CI: (1.2144.64)] and hospitalization for the last six months [AOR = 5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci. Conclusions In our study high incidence of vancomycin resistant Enterococci was found. Previous exposure to antibiotics for more than two weeks and hospitalization for more than six months were significantly associated with vancomycin resistant Enterococci. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.

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Vancomycin Resistance and Antibiotic Susceptibility of Enterococci in Raw Meat

Journal of Food Protection ◽

10.4315/0362-028x-63.7.912 ◽

2000 ◽

Vol 63 (7) ◽

pp. 912-915 ◽

Cited By ~ 48

Author(s):

MARIA PAVIA ◽

CARMELO G. A. NOBILE ◽

LETTERIO SALPIETRO ◽

ITALO F. ANGELILLO

Keyword(s):

Kappa Statistic ◽

Vancomycin Resistance ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Vancomycin Resistant Enterococci ◽

Retail Outlets ◽

Antimicrobial Susceptibility Tests ◽

Vancomycin Resistant ◽

Overall Resistance ◽

Susceptibility Tests

The purpose of this study was to investigate antimicrobial resistance, in particular to vancomycin, of enterococci in samples (100) of meat (beef, chicken, turkey, lamb, and pork) sold in retail outlets of Catanzaro (Italy). Enterococci were identified to the species level. Antimicrobial susceptibility tests for a large spectrum of antibiotics including glycopeptides were performed by the disk diffusion method. Kappa statistic was used to evaluate associations of resistance to vancomycin with other antimicrobials. Enterococci were isolated from 45% of the samples, mostly from chicken meat (65.4%). Overall, 29% of samples were contaminated by vancomycin-resistant enterococci (VRE), whereas among those positive they represented 64.4% of isolates. Higher prevalence of vancomycin resistance was found in chicken samples (76.5%). The overall resistance to teicoplanin (TRE) was 30%, whereas among those positive, TRE represented 66.7% of isolates. The most frequent isolates were Enterococcus faecium (35.6%) and Enterococcus faecalis (33.3%). Resistance to vancomycin and teicoplanin was observed in 75% and 78.5% of E. faecium, and in 40% and 46.7% of E. faecalis, respectively. Most strains were susceptible to ampicillin (80%), while 88.9% were resistant to methicillin. The most effective antimicrobials were imipenem (73.3% susceptible) and rifampin (80%). The highest prevalence of resistance was for streptomycin (88.9%), tetracycline (84.4%), and erythromycin (75.6%). Resistance to vancomycin was significantly associated to methicillin, teicoplanin, erythromycin, tetracycline, and chloramphenicol. Further investigations about enterococcal colonization and infections in community and hospital subjects are needed.

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Staphylococcal Colonisation of Intravenous Cannula and Antimicrobial Patterns of Isolated Staphylococcus Species

Nepal Journal of Science and Technology ◽

10.3126/njst.v14i2.10426 ◽

2014 ◽

Vol 14 (2) ◽

pp. 131-136

Author(s):

R Mahto ◽

J Amatya ◽

R Amatya ◽

D Adhikari

Keyword(s):

Multidrug Resistant ◽

Diffusion Method ◽

Coagulase Negative Staphylococci ◽

Intravenous Cannula ◽

Antimicrobial Susceptibility Pattern ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern ◽

Antibiotic Susceptibility Test ◽

Slide Test ◽

Vancomycin Resistant

Cannula-related infections are amongst the most important nosocomial infections. Staphylococcus aureus and coagulase negative Staphylococci (CONS) are the most frequent causes of colonizing the intravenous cannula through which infection may occur. The aim of the study was to isolate the colonized staphylococci and to study the antimicrobial sensitivity pattern against them. Cultures of cannula tips were raised by semi-quantitative method. Antibiotic susceptibility test was performed by Kirby Bauer disc diffusion method as per The Clinical and Laboratory Standard Institute (CLSI) guidelines. Coagulase positive Staphylococcus was confirmed by coagulase slide test followed by tube test. CONS were distinguished by novobiocin sensitivity test. Out of 200 samples of cannula tips collected and processed, 45 (22.5%) isolates were S. aureus, 15 (7.5%) were S. epidermidis and 16 (8%) were other CONS. The highest occurance (30.7%) of S. aureus and the CONS (18.4%) was found in the nephrology ward and the surgical ward respectively. All the 76 isolates were tested for antimicrobial susceptibility pattern. Novobiocin was used to differentiate S. epidermidis from other CONS. All isolates were sensitive to ampicillin and ofloxacin. Out of total, 46.7% isolates of S. aureus and 12.9% isolates of CONS were multidrug resistant; 35.5% and 20 % isolates of S. aureus were oxacillin (methicillin) resistant and vancomycin resistant respectively. Four (12.9%) isolates of CONS [2(13.3%) of other CONS and 2(12.5%) of S. epidermidis] were oxacillin (methicillin) and vancomycin resistant. In our study, vancomycin resistant staphylococci were found and it was concluded that the precautions for inserting intravenous cannula is necessary as different kinds of pathogens may colonize such devices. DOI: http://dx.doi.org/10.3126/njst.v14i2.10426 Nepal Journal of Science and Technology Vol. 14, No. 2 (2013) 131-136

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Vancomycin resistant enterococci gut Colonization and its associated factors among HIV infected patients on anti-Retro viral therapy in Ethiopia

10.21203/rs.3.rs-96175/v1 ◽

2020 ◽

Author(s):

Belayneh Regasa ◽

Zerihun Solomon ◽

Mheret Tesfaye

Keyword(s):

Associated Factors ◽

Cross Sectional Study ◽

Diffusion Method ◽

Resistance Pattern ◽

P Value ◽

Cross Sectional ◽

Gut Colonization ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Study Participants

Abstract BackgroundThe emergence of vancomycin resistant Enterococci (VRE) has alarmed the global infectious diseases community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the prevalence of vancomycin resistant Enterococci gut colonization and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART).MethodsInstitution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. P-value <0.05 was considered as significant.ResultsAmong a total of 200 study participants, colonization of Enterococci spp was isolated on 123 (61.50%) respondents. Among these isolates, the prevalence of vancomycin resistant Enterococci colonization was 11.4% [95% CI: (6.0-17.0)]. Enterococci isolates tested against commonly prescribed antibiotics showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibiotic exposure for more than two weeks [AOR=7.35; 95% CI: (1.2144.64)] and hospitalization in the last six months [AOR=5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci gut colonization.ConclusionHigh prevalence of vancomycin resistant Enterococci gut colonization was found. Previous exposure to antibiotics for more than two weeks and previous hospitalization for more than six months were significant factors for vancomycin resistant Enterococci colonization. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.

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Novel genomic islands and a new vanD-subtype in the first sporadic VanD-type vancomycin resistant enterococci in Norway

PLoS ONE ◽

10.1371/journal.pone.0255187 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255187

Author(s):

Mushtaq T. S. AL Rubaye ◽

Jessin Janice ◽

Jørgen Vildershøj Bjørnholt ◽

Aleksandra Jakovljev ◽

Maria Elisabeth Hultström ◽

...

Keyword(s):

Gene Clusters ◽

Vancomycin Resistance ◽

Genomic Islands ◽

Vancomycin Resistant Enterococci ◽

Chromosomal Site ◽

Enterococcus Casseliflavus ◽

Temporal Occurrence ◽

Vancomycin Resistant ◽

High Level

Background Vancomycin-resistant enterococci (VRE) represent several types of transferable vancomycin resistance gene clusters. The vanD type, associated with moderate to high level vancomycin resistance, has only sporadically been described in clinical isolates. The aim of this study was to perform a genetic characterization of the first VanD-type VRE strains detected in Norway. Methods The VanD-type VRE-strains (n = 6) from two patient cases were examined by antimicrobial susceptibility testing and whole genome sequencing (WGS) to uncover Van-phenotype, strain phylogeny, the vanD gene clusters, and their genetic surroundings. The putative transferability of vanD was examined by circularization PCR and filter mating. Results The VanD-type Enterococcus faecium (n = 4) and Enterococcus casseliflavus (n = 2) strains recovered from two cases (A and B), expressed moderate to high level vancomycin resistance (MIC 64—>256 mg/L) and various levels of teicoplanin susceptibility (MIC 2—>256 mg/L). WGS analyses revealed phylogenetically different E. faecium strains (A1, A2, and A3 of case A and B1 from case B) as well as vanD gene clusters located on different novel genomic islands (GIs). The E. casseliflavus strains (B2 and B3 of case B) were not clonally related, but harbored nearly identical novel GIs. The vanD cluster of case B strains represents a novel vanD-subtype. All the vanD-GIs were integrated at the same chromosomal site and contained genes consistent with a Clostridiales origin. Circular forms of the vanD-GIs were detected in all strains except B1. Transfer of vanD to an E. faecium recipient was unsuccessful. Conclusions We describe the first VanD-type E. casseliflavus strains, a novel vanD-subtype, and three novel vanD-GIs with a genetic content consistent with a Clostridiales order origin. Despite temporal occurrence, case A and B E. faecium strains were phylogenetically diverse and harbored different vanD subtypes and vanD-GIs.

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