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

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

PLoS ONE ◽

10.1371/journal.pone.0249823 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249823

Author(s):

Degu Ashagrie ◽

Chalachew Genet ◽

Bayeh Abera

Keyword(s):

Venous Blood ◽

Multidrug Resistant ◽

Vancomycin Resistance ◽

World Health ◽

Diffusion Method ◽

P Value ◽

Coagulase Negative Staphylococci ◽

Vancomycin Resistant Enterococci ◽

Specialized Hospital ◽

Vancomycin Resistant

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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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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Emergence and spread of vancomycin resistance among enterococci in Europe

Eurosurveillance ◽

10.2807/ese.13.47.19046-en ◽

2008 ◽

Vol 13 (47) ◽

Author(s):

G Werner ◽

T M Coque ◽

A M Hammerum ◽

R Hope ◽

W Hryniewicz ◽

...

Keyword(s):

Population Analysis ◽

Vancomycin Resistance ◽

Vancomycin Resistant Enterococcus ◽

Phenotypic Marker ◽

Vancomycin Resistant Enterococci ◽

Distinct Subpopulation ◽

Typing Methods ◽

Vancomycin Resistant ◽

Hospital Acquired ◽

Animal Strains

Vancomycin-resistant enterococci (VRE) first appeared in the late 1980s in a few European countries. Nowadays, six types of acquired vancomycin resistance in enterococci are known; however, only VanA and to a lesser extent VanB are widely prevalent. Various genes encode acquired vancomycin resistance and these are typically associated with mobile genetic elements which allow resistance to spread clonally and laterally. The major reservoir of acquired vancomycin resistance is Enterococcus faecium; vancomycin-resistant Enterococcus faecalis are still rare. Population analysis of E. faecium has revealed a distinct subpopulation of hospital-acquired strain types, which can be differentiated by molecular typing methods (MLVA, MLST) from human commensal and animal strains. Hospital-acquired E. faecium have additional genomic content (accessory genome) including several factors known or supposed to be virulence-associated. Acquired ampicillin resistance is a major phenotypic marker of hospital-acquired E. faecium in Europe and experience has shown that it often precedes increasing rates of VRE with a delay of several years. Several factors are known to promote VRE colonisation and transmission; however, despite having populations with similar predispositions and preconditions, rates of VRE vary all over Europe.

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Transmission of Vancomycin-Resistant Enterococci in the Hospital Setting: Uncovering the Patient–Environment Interplay

Microorganisms ◽

10.3390/microorganisms8020203 ◽

2020 ◽

Vol 8 (2) ◽

pp. 203 ◽

Cited By ~ 3

Author(s):

Carlos L. Correa-Martinez ◽

Hauke Tönnies ◽

Neele J. Froböse ◽

Alexander Mellmann ◽

Stefanie Kampmeier

Keyword(s):

Core Genome ◽

Hospital Setting ◽

Hospital Environment ◽

Environmental Isolates ◽

Resistance Determinants ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

And Control ◽

Sequence Types

Vancomycin-resistant enterococci (VRE) are relevant nosocomial pathogens with an increasing incidence in the last decades. Their transmission is optimal in the hospital setting, as it offers two potential, large reservoirs that are closely related: susceptible patients and their environment. Here we investigate the role of the hospital environment in the nosocomial transmission of VRE by establishing concrete links between contaminated surfaces and colonized/infected patients in outbreak and non-outbreak settings. Environmental and patient VRE isolates were collected between 2013 and 2019 and analyzed by whole-genome sequencing (WGS), subsequent multilocus sequence typing (MLST), and core genome (cg) MLST. Pairs of isolates differing in <3 alleles were rated as closely related, making a transmission likely. Fifty-three environmental VRE isolates were analyzed. MLST sequence types (ST) ST203 (50.0%), ST192 (21.3%), ST117 (17.3%), ST721 (8.8%), ST80 (2%), and ST1489 (0.7%) were detected, carrying the resistance determinants vanA (72.7%), vanB (24%), or both (3.3%). Of the 53 environmental isolates, 51 were found to form five clusters with genetically related patient isolates (n = 97 isolates). WGS confirms the role of the environment in the transmission dynamics of VRE in both the outbreak and non-outbreak settings, highlighting the importance of prevention and control of VRE spread.

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Draft Genome Sequence of a Vancomycin-Resistant and Vancomycin-Dependent Enterococcus faecium Isolate

Genome Announcements ◽

10.1128/genomea.00059-16 ◽

2016 ◽

Vol 4 (2) ◽

Author(s):

Marion Blaschitz ◽

Sarah Lepuschitz ◽

Laura Wagner ◽

Franz Allerberger ◽

Alexander Indra ◽

...

Keyword(s):

Genome Sequence ◽

Enterococcus Faecium ◽

Prolonged Exposure ◽

Draft Genome ◽

Vancomycin Resistance ◽

Draft Genome Sequence ◽

Nosocomial Pathogens ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Faecium Isolate

Vancomycin-resistant enterococci have emerged as major nosocomial pathogens worldwide. While antimicrobial pressure promotes nosocomial colonization with these enterococci, prolonged exposure to vancomycin may foster the transition from vancomycin resistance to vancomycin dependence. Here, we report the draft genome sequence of a vancomycin-dependent Enterococcus faecium isolate showing partial teicoplanin dependence.

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Vancomycin Resistance Is Maintained in Enterococci in the Viable but Nonculturable State and after Division Is Resumed

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.47.3.1154-1156.2003 ◽

2003 ◽

Vol 47 (3) ◽

pp. 1154-1156 ◽

Cited By ~ 38

Author(s):

Maria del Mar Lleò ◽

Barbara Bonato ◽

Caterina Signoretto ◽

Pietro Canepari

Keyword(s):

Vancomycin Resistance ◽

Survival Strategy ◽

Vbnc State ◽

Additional Risk ◽

Viable But Nonculturable ◽

Vancomycin Resistant Enterococci ◽

Nonculturable State ◽

Resistance Trait ◽

Vancomycin Resistant ◽

Viable But Nonculturable State

ABSTRACT Stressed vancomycin-resistant enterococci (VRE) can activate a survival strategy known as the viable but nonculturable (VBNC) state and are able to maintain vancomycin resistance. During restoration of division they continue to express the vancomycin resistance trait. We suggest that VBNC enterococci may constitute further reservoirs of VRE and therefore represent an additional risk for human health.

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High-level vancomycin-resistant enterococci causing hospital infections

Epidemiology and Infection ◽

10.1017/s0950268800030478 ◽

1989 ◽

Vol 103 (1) ◽

pp. 173-181 ◽

Cited By ~ 178

Author(s):

A. H. C. Uttley ◽

R. C. George ◽

J. Naidoo ◽

N. Woodford ◽

A. P. Johnson ◽

...

Keyword(s):

Plasmid Dna ◽

Vancomycin Resistance ◽

Recipient Strain ◽

Hospital Infections ◽

Minimal Inhibitory Concentrations ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Many Sources ◽

High Level ◽

Level Resistance

SUMMARYNosocomial infection or colonization due to enterococci with high-level resistance to vancomycin (minimal inhibitory concentrations [MICs] between 64 and > 2000 mg/L) has occurred in 41 patients with renal disease. These vancomycin-resistant enterococci were cultured from many sources including blood. All but one strain contained one or more plasmids ranging in molecular weight from 1·0 to 40 Megadaltons (MDa). Vancomycin resistance was transferable by conjugation to a susceptible recipient strain ofEnterococcus faecalisbut this was not always associated with plasmid DNA. The emergence of transferable high-level vancomycin resistance in enterococci causing significant clinical infections is of particular importance since vancomycin is widely regarded as a reserve drug for the management of infections with multi-resistant Gram-positive organisms.

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Reality Check: Should We Try to Detect and Isolate Vancomycin-Resistant Enterococci Patients?

Infection Control and Hospital Epidemiology ◽

10.1086/501874 ◽

2001 ◽

Vol 22 (02) ◽

pp. 116-119 ◽

Cited By ~ 18

Author(s):

Belinda Ostrowsky ◽

James T. Steinberg ◽

Barry Farr ◽

Annette H. Sohn ◽

Ronda L. Sinkowitz-Cochran ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Vancomycin Resistance ◽

Healthcare Facilities ◽

Reality Check ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

AbstractAntimicrobial resistance, including vancomycin resistance in enterococci (VRE), is a growing problem in healthcare facilities. This “Reality Check” session focused on the question of whether we should try to detect and isolate patients colonized or infected with VRE.

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