scholarly journals High diversity of vancomycin-resistant Enterococcus faecium isolated in Southern Brazil

2019 ◽  
Author(s):  
Renata O Soares ◽  
Gabriela R Cunha ◽  
Vinicius P Perez ◽  
Jussara L Siqueira ◽  
Gustavo E Sambrano ◽  
...  
Keyword(s):  
Profile Analysis ◽  
Southern Brazil ◽  
Porto Alegre ◽  
Vancomycin Resistant Enterococci ◽  
Antimicrobial Susceptibility Profile ◽  
Vancomycin Resistant ◽  
Clonal Spread ◽  
High Level ◽  
Relationship Of ◽  
Level Resistance

Background. Vancomycin-resistant enterococci (VRE) are common in some hospital settings and their clonal spread has been described in different regions of the world. We determined the antimicrobial susceptibility profile and the clonal relationship of VRE isolates recovered from inpatients at three general hospitals of Porto Alegre, Brazil. Results. Ninety-four VRE were characterized as Enterococcus faecium and exhibited resistance to teicoplanin, ampicillin, ciprofloxacin, and susceptibility to linezolid, quinupristin-dalfopristin and daptomycin. High level resistance to gentamicin was detected in 13.8% of them. All VREfm harbored vanA gene, while 85.1% and 94.7% harbored respectively esp and acm virulence genes. PFGE profile analysis revealed 23 clonal types including 79 isolates, while 15 isolates exhibited unique pattern type, showing a polyclonal distribution of VREfm in Southern Brazil. Conclusion. These findings contribute to the local understanding regarding the characteristics of the circulating VREs in the region.

scholarly journals High diversity of vancomycin-resistant Enterococcus faecium isolated in Southern Brazil

2019 ◽  
Author(s):  
Renata O Soares ◽  
Gabriela R Cunha ◽  
Vinicius P Perez ◽  
Jussara L Siqueira ◽  
Gustavo E Sambrano ◽  
...  
Keyword(s):  
Profile Analysis ◽  
Southern Brazil ◽  
Porto Alegre ◽  
Vancomycin Resistant Enterococci ◽  
Antimicrobial Susceptibility Profile ◽  
Vancomycin Resistant ◽  
Clonal Spread ◽  
High Level ◽  
Relationship Of ◽  
Level Resistance

Background. Vancomycin-resistant enterococci (VRE) are common in some hospital settings and their clonal spread has been described in different regions of the world. We determined the antimicrobial susceptibility profile and the clonal relationship of VRE isolates recovered from inpatients at three general hospitals of Porto Alegre, Brazil. Results. Ninety-four VRE were characterized as Enterococcus faecium and exhibited resistance to teicoplanin, ampicillin, ciprofloxacin, and susceptibility to linezolid, quinupristin-dalfopristin and daptomycin. High level resistance to gentamicin was detected in 13.8% of them. All VREfm harbored vanA gene, while 85.1% and 94.7% harbored respectively esp and acm virulence genes. PFGE profile analysis revealed 23 clonal types including 79 isolates, while 15 isolates exhibited unique pattern type, showing a polyclonal distribution of VREfm in Southern Brazil. Conclusion. These findings contribute to the local understanding regarding the characteristics of the circulating VREs in the region.

scholarly journals High-level vancomycin-resistant enterococci causing hospital infections

1989 ◽  
Vol 103 (1) ◽  
pp. 173-181 ◽  
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.

scholarly journals In Vitro Antimicrobial Activity of Fosfomycin, Rifampin, Vancomycin, Daptomycin Alone and in Combination Against Vancomycin-Resistant Enterococci

2021 ◽  
Author(s):  
Wei Yu ◽  
Yiheng Jiang ◽  
Hao Xu ◽  
Li Zhang ◽  
Xuehang Jin ◽  
...  
Keyword(s):  
Virulence Genes ◽  
Therapeutic Option ◽  
Bactericidal Effect ◽  
Resistance Determinant ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
High Level ◽  
Time Kill ◽  
Level Resistance

Abstract OBJECTIVESThe emergence of vancomycin resistant enterococci (VRE) is shortening the choices for clinical anti-infective therapy. The aim of this study was to investigate the mechanism of vancomycin resistance and evaluate the effect of fosfomycin (FM), rifampin (RIF), vancomycin (VAN), linezolid (LNZ), daptomycin (DAP) alone or in combination against VRE.METHODSEight VRE isolates were collected. A total of 18 antibiotics susceptibility tests were further done for VRE. Whole genome sequencing and bioinformatics analysis were performed. The effect of FM, RIF, VNA, LNZ, DAP alone or in combination was determined using anti-biofilm testing and the time-kill assay.RESULTSAll isolates were susceptible to LNZ and DPA. The high-level resistance determinant of VAN in these strains was due to VanA-type cassette. MLST revealed two different STs for vancomycin-resistant Enterococcus faecium (VREm) and four different STs for vancomycin-resistant E. faecalis (VREs). Virulence genes in VREs were more than VREm, especially for 4942 isolated from blood. Gene acm and uppS were only identified in VREm, while virulence genes related to cytolysin were only found in E. faecalis. Further in vitro anti-biofilm testing and time-kill assay found FM (83 mg/L) combined with DAP (20.6 mg/L) and DAP monotherapy (47.1 mg/L) showed bactericidal effect against 8 tested VRE strains at 24h. CONCLUSIONSThe high-level resistance determinant of VAN in these strains was due to VanA-type cassette. FM combined with DAP might be greater potential therapeutic option against VRE.

scholarly journals Outbreak of Mupirocin-Resistant Staphylococci in a Hospital in Warsaw, Poland, Due to Plasmid Transmission and Clonal Spread of Several Strains

1999 ◽  
Vol 37 (9) ◽  
pp. 2781-2788 ◽  
Author(s):  
Tomasz A. Łe˛ski ◽  
Marek Gniadkowski ◽  
Anna Skoczyńska ◽  
Elz˙bieta Stefaniuk ◽  
Krzysztof Trzciński ◽  
...  
Keyword(s):  
Resistance Mechanisms ◽  
Hospital Environment ◽  
Coagulase Negative Staphylococci ◽  
Large Hospital ◽  
Methicillin Resistant ◽  
Inappropriate Use ◽  
Clonal Spread ◽  
High Level ◽  
Almost All ◽  
Level Resistance

An outbreak of mupirocin-resistant (MuR) staphylococci was investigated in two wards of a large hospital in Warsaw, Poland. Fifty-three MuR isolates of Staphylococcus aureus, S. epidermidis, S. haemolyticus, S. xylosus, and S. capitis were identified over a 17-month survey which was carried out after introduction of the drug for the treatment of skin infections. The isolates were collected from patients with infections, environmental samples, and carriers; they constituted 19.5% of all staphylococcal isolates identified in the two wards during that time. Almost all the MuR isolates were also resistant to methicillin (methicillin-resistant S. aureus and methicillin-resistant coagulase-negative staphylococci). Seven of the outbreak isolates expressed a low-level-resistance phenotype (MuL), whereas the remaining majority of isolates were found to be highly resistant to mupirocin (MuH). The mupA gene, responsible for the MuH phenotype, has been assigned to three different polymorphic loci among the strains in the collection analyzed. The predominant polymorph, polymorph I (characterized by a mupA-containingEcoRI DNA fragment of about 16 kb), was located on a specific plasmid which was widely distributed among the entire staphylococcal population. All MuR S. aureus isolates were found to represent a single epidemic strain, which was clonally disseminated in both wards. The S. epidermidis population was much more diverse; however, at least four clusters of closely related isolates were identified, which suggested that some strains of this species were also clonally spread in the hospital environment. Six isolates of S. epidermidis were demonstrated to express the MuL and MuH resistance mechanisms simultaneously, and this is the first identification of such dual MuR phenotype-bearing strains. The outbreak was attributed to a high level and inappropriate use of mupirocin, and as a result the dermatological formulation of the drug has been removed from the hospital formulary.

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

PLoS ONE ◽  
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.

PREVALENCE OF HIGH LEVEL AMINOGLYCOSIDE RESISTANCE AND VANCOMYCIN RESISTANT ENTEROCOCCI IN ENTEROCOCCAL ISOLATES IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 3-5
Author(s):  
Sunita Agarwal ◽  
Nazneen Pathan ◽  
Shivra Batra ◽  
Rajni Sharma
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Automated System ◽  
Care Hospital ◽  
Enterococcus Species ◽  
Aminoglycoside Resistance ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
High Level

Introduction: The emergence of High Level Aminoglycoside Resistance (Resistant to Gentamycin and Streptomycin) and Vancomycin Resistant Enterococci among Indoor and Intensive Care Unit admitted patient presents a serious challenge for clinicians. Objective: To determine Enterococcal burden in blood and urine specimens and to detect the prevalence of High Level Aminoglycoside Resistance and Vancomycin Resistant Enterococci. Material & Methods: One hundred ten Enterococci were isolated from blood and urine samples and processed according to standard laboratory protocol. Species identication and sensitivity was done using the VITEK 2 automated system (Biomerieux France) with the cards GPID and AST 67 respectively. Results: Out of 110 Enterococci isolates, 36 were from blood and 74 from urine were detected. Different Species isolated were Enterococcal faecium (59%), Enterococcal faecalis (34%), Enterococcal rafnosus (2.7%), Enterococcal gallinarum (1.8%), Enterococcal casseliavus (0.9%) and Enterococcal duran (0.9%).Out of 36 blood isolates, 14 (38%) were found to be both High Level Gentamycin Resistant (HLGR) & High Level Streptomycin Resistant (HLSR), 10 (27%) were only HLGR and 8 (22%) were only HLSR. 20 strain (55%) of Enterococcus species isolated in blood were VRE. All VRE strains were found to be resistant to both aminoglycosides ( HLAR).Among the 74 urinary isolates, 24 (34%) were found to be both HLGR & HLSR, only HLGR was observed in 20 (27%) and HLSR was observed in 11 (14%) isolates. 24 strains (34%) of Enterococcus species were found to be vancomycin resistant in urine. 23 strains out of 24 were resistant to high level of aminoglycosides. Conclusion: The prevalence of HLAR and VRE is very high among Enterococcus specimens from indoor/ intensive care unit patients. Early species identication and antibiotic sensitivity result can help in better clinical outcome.

scholarly journals Analysis of Vancomycin-Resistant Enterococci in Hemato-Oncological Patients

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 785
Author(s):  
Kristýna Hricová ◽  
Taťána Štosová ◽  
Pavla Kučová ◽  
Kateřina Fišerová ◽  
Jan Bardoň ◽  
...  
Keyword(s):  
Surface Protein ◽  
Ionization Time ◽  
Flight Mass Spectrometry ◽  
Vancomycin Resistant Enterococci ◽  
Oncological Patients ◽  
Genes Encoding ◽  
Unique Restriction ◽  
Vancomycin Resistant ◽  
Relationship Of ◽  
The Relationship

Enterococci are important bacterial pathogens, and their significance is even greater in the case of vancomycin-resistant enterococci (VRE). The study analyzed the presence of VRE in the gastrointestinal tract (GIT) of hemato-oncological patients. Active screening using selective agars yielded VRE for phenotypic and genotypic analyses. Isolated strains were identified with MALDI-TOF MS, (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry) their susceptibility to antibiotics was tested, and resistance genes (vanA, vanB, vanC-1, vanC2-C3) and genes encoding virulence factors (asa1, gelE, cylA, esp, hyl) were detected. Pulsed-field gel electrophoresis was used to assess the relationship of the isolated strains. Over a period of three years, 103 VanA-type VRE were identified in 1405 hemato-oncological patients. The most frequently detected virulence factor was extracellular surface protein (84%), followed by hyaluronidase (40%). Unique restriction profiles were observed in 33% of strains; clonality was detected in 67% of isolates. The study found that 7% of hemato-oncological patients carried VRE in their GIT. In all cases, the species identified was Enterococcus faecium. No clone persisted for the entire 3-year study period. However, genetically different clusters were observed for shorter periods of time, no longer than eight months, with identical VRE spreading among patients.

scholarly journals Failure of VITEK2 to reliably detect vanB- mediated vancomycin resistance in Enterococcus faecium

2020 ◽  
Author(s):  
Sarah V. Walker ◽  
Martina Wolke ◽  
Georg Plum ◽  
Robert E. Weber ◽  
Guido Werner ◽  
...  
Keyword(s):  
Enterococcus Faecium ◽  
Vancomycin Resistance ◽  
Bacterial Suspension ◽  
Initial Growth ◽  
Low Level ◽  
Test Kit ◽  
Before And After ◽  
Vancomycin Resistant ◽  
High Level ◽  
Level Resistance

AbstractObjectivesThe increasing prevalence of vancomycin resistant enterococci (VRE) necessitates a reliable detection of VRE especially for low level resistance mediated by vanB in Enterococcus faecium. In this prospective study we analyzed if vanB mediated vancomycin resistance can be reliably detected by Vitek2.Methods1344 enterococcal isolates from routine clinical specimens were tested by Vitek2 (bioMérieux, Nürtingen, Germany). Additionally, a bacterial suspension (0.5 McFarland) was inoculated on a chromID VRE screening agar (bioMérieux) and incubated for 48 hours. If vancomycin was tested susceptible by Vitek2 but growth was detected on the screening agar a PCR for vanA/vanB was performed (GeneXpert vanA/B test kit, Cepheid, Frankfurt, Germany). MICs of vancomycin susceptible by Vitek but vanA/B positive isolates were determined before and after cultivation in a broth with increasing concentration of vancomycin.Results156/492 of E. faecium were VRE, predominantly vanB (87.0%) of which 14 were not identified as VRE by Vitek2 (sensitivity 91.0%). The majority (9/14) demonstrated high-level MICs by broth dilution. Even after exposure to increasing vancomycin concentrations MICs remained nearly identical. Three of the undetected isolates demonstrated initial growth on chromID VRE, after the vancomycin exposure additional 7 isolates demonstrated growth on chromID VRE.ConclusionsVitek2 fails to detect vanB mediated vancomycin resistance consistently, especially but not limited to low-level resistance. As this may lead to treatment failure and further dissemination of vanB VRE, additional methods (e.g. culture on VRE screening agar or PCR) are necessary to reliably identify vanB-positive enterococci in clinical routine.

scholarly journals Detection of various virulence factors in high level aminoglycoside resistance and vancomycin resistant enterococci isolates of uropathogenic Enterococci

2019 ◽  
Vol 7 (5) ◽  
pp. 1740
Author(s):  
Harshad Singh Naruka ◽  
Anita E. Chand ◽  
Pradhuman Singh Chauhan ◽  
Danish Mukhtar
Keyword(s):  
Virulence Factors ◽  
Common Factor ◽  
Opportunistic Pathogen ◽  
Government Medical College ◽  
Aminoglycoside Resistance ◽  
Medical College ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Study Association ◽  
High Level

Background: Enterococci are common commensal organism of enteric tract and act as opportunistic pathogen and may cause infection in community as well as in hospitalised individuals. In present study association of several types of virulence factors like haemolysin, gelatinase and biofilm formation have been studied among HLAR and Vancomycin resistant Enterococci (VRE) isolates of enterococci among UTI patients.Methods: The samples were collected from all hospitalized and OPD patients of MBS Hospital, JK Lone Hospital and NMC Hospital. Government Medical College, Kota, Rajasthan, India. A total of 360 isolates of enterococcus were collected during the period of 2 years from April 2016 to April 2018 in microbiology laboratory, Department of Microbiology, Government Medical College, Kota, Rajasthan, India. All virulence factors were detected by phenotypic methods and MIC values were detected for high level gentamicin and vancomycin.Results: Among all enterococcal isolates most common factor was biofilm production 191 (53.05%) followed by haemolysin 131 (36.38%) and gelatinase production 72 (20%). Total resistant (MIC> 500 µg/ml) isolates for gentamicin was 194 (89.4%). In agar dilution 14 (11.2%) isolates were found sensitive, 61 (48.8%) isolates were found intermediate and 50 (40%) isolates were found to be resistant for vancomycin. HLAR and VRE was maximum associated with haemolysin + bio-film followed by gelatinase+biofilm, haemolysin+gelatinase+bio- film and least with haemolysin + gelatinase.Conclusions: In present study enterococcus show significant production of biofilm and other virulence factors. With production of biofilm they become more resistant to routinely used concentration of antibiotics posing threat for treatment failure. A continuous monitoring is needed particularly for resistance to aminoglycoside and vancomycin to stop their institutional spread. Judicial use of antibiotics should be encouraged both in community as well as in institutions.

scholarly journals Survey of Antibiotic Resistance among Enterococci in North Rhine-Westphalia, Germany

1999 ◽  
Vol 37 (5) ◽  
pp. 1638-1641 ◽  
Author(s):  
R. R. Reinert ◽  
G. Conrads ◽  
J. J. Schlaeger ◽  
G. Werner ◽  
W. Witte ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Surveillance Study ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
High Level ◽  
Resistance Rates

A surveillance study on antibiotic resistance of enterococcal isolates (n = 730) was carried out in North Rhine-Westphalia, Germany, in 1997. Resistance rates to ampicillin (7.4%), high-level gentamicin (15.0%), high-level streptomycin (27.9%), ciprofloxacin (37.9%), vancomycin (1.5%), and teicoplanin (1.5%) were determined. All vancomycin-resistant enterococci (VRE) carried the vanA gene. SmaI andApaI macrorestriction patterns indicated an intra- and interhospital spread of VRE.

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