Characterization of Vancomycin Resistant Enterococci in Hospitalized Patients and Role of Gut Colonization

Background: Due to increased prevalence of vancomycin resistant enterococci (VRE) in hospital settings as an important nosocomial pathogen, microbiology laboratories should be prepared with test protocol for prompt detection and reporting of these resistant organisms. This helps in appropriate treatment of patients without delay and implementation of infection control measures in order to prevent spread of such infections. With this background present study was conducted to demonstrate utility of bile esculin azide agar with vancomycin (BEAV) for screening of enterococci for vancomycin drug resistance.Methods: Over a period of one year 200 stool samples were collected from hospitalized patients in a tertiary care hospital. Samples were inoculated on bile esculin azide agar with vancomycin (6ug/ml) to screen for vancomycin drug resistance in enterococci isolated from stool samples. Vancomycin drug resistance was confirmed by agar dilution method.Results: Out of 200 stool samples collected from hospitalized patients, 13 (6.5%) samples showed growth on bile esculin azide agar with vancomycin (6 µg/ml). Of these 13 isolates, 12 (92.3%) isolates were confirmed as VRE by agar dilution method and demonstrated minimum inhibitory concentration (MIC) of ≥32 µg/ml and all 12 isolates were identified as E. faecium. One (7.7%) isolate grown on BEAV was identified as E. gallinarum and showed MIC value of 8 µg/ml.Conclusions: Present study recommends use of bile esculin azide agar with vancomycin (6 µg/ml) as a screening medium for isolation of VRE from stool samples which usually carries mixed commensal flora of gastrointestinal tract.

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Recovery and Characterization of a 30.7-kDa Protein from Bacillus licheniformis Associated with Inhibitory Activity Against Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococci, and Listeria monocytogenes

Marine Biotechnology ◽

10.1007/s10126-005-6160-4 ◽

2006 ◽

Vol 8 (6) ◽

pp. 587-592 ◽

Cited By ~ 9

Author(s):

Mamdoh T. Jamal ◽

Peter C. Morris ◽

Rasmus Hansen ◽

Derek J. Jamieson ◽

J. Grant Burgess ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Listeria Monocytogenes ◽

Bacillus Licheniformis ◽

Inhibitory Activity ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

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Prevalence and characterization of vancomycin-resistant enterococci in chicken intestines and humans of korea

Archives of Pharmacal Research ◽

10.1007/bf02980113 ◽

2004 ◽

Vol 27 (2) ◽

pp. 246-253 ◽

Cited By ~ 11

Author(s):

Chi Nam Seong ◽

Eun Sook Shim ◽

Shin Moo Kim ◽

Jin Cheol Yoo

Keyword(s):

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

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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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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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Risk factors for intestinal colonization with vancomycin resistant enterococci’ A prospective study in a level III pediatric intensive care unit

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_32_17 ◽

2018 ◽

Vol 10 (01) ◽

pp. 089-094 ◽

Cited By ~ 1

Author(s):

Rajesh Amberpet ◽

Sujatha Sistla ◽

Subhash Chandra Parija ◽

Ramachandran Rameshkumar

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Dilution Method ◽

Agar Dilution Method ◽

Gut Colonization ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

A Prospective Study

Abstract PURPOSE: Vancomycin-resistant enterococci (VRE) emerged as one of the major nosocomial pathogens across the globe. Gut colonization rate with VRE is higher in patients admitted to intensive care units (ICUs) due to the higher antibiotic pressure. VRE colonization increases the risk of developing infection up to 5–10 folds. The aim of this study was to determine the rates of VRE colonization among the patients admitted to pediatric ICU (PICU) and risk factors associated with it. MATERIALS AND METHODS: Rectal swabs were collected after 48 h of admission to PICU from 198 patients. The samples were inoculated onto bile esculin sodium azide agar with 6 mg/ml of vancomycin. Growth on this medium was identified by the standard biochemical test, and minimum inhibitory concentration of vancomycin and teicoplanin was detected by agar dilution method. Resistance genes for vancomycin were detected by polymerase chain reaction. Risk factors were assessed by logistic regression analysis. RESULTS: The rates of VRE colonization in patients admitted to PICU was 18.6%. The majority of the isolates were Enterococcus faecium (75.6%) followed by Enterococcus faecalis (24.4%). One patient acquired a VRE bloodstream infection (2.6%) among colonized patients, and none of the noncolonized patients acquired the infection. Consumption of vancomycin was found to be the only risk factor significantly associated with VRE colonization. CONCLUSION: Routine surveillance and isolation of patients found to be VRE colonized may not be possible in tertiary care hospitals; however, educating health-care workers, promoting handwashing with antiseptic soaps or solutions, and antibiotic Stewardship policy may help in the reduction of vancomycin resistance and VRE colonization.

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