Received 30 November 2000/Returned for modification 10 February 2001/Accepted 24 February 2001
|
|
- Barry French
- 5 years ago
- Views:
Transcription
1 JOURNAL OF CLINICAL MICROBIOLOGY, May 2001, p Vol. 39, No /01/$ DOI: /JCM Copyright 2001, American Society for Microbiology. All Rights Reserved. Outbreak of Vancomycin-Resistant Enterococcus faecium of the Phenotype VanB in a Hospital in Warsaw, Poland: Probable Transmission of the Resistance Determinants into an Endemic Vancomycin-Susceptible Strain MAGDALENA KAWALEC, 1 MAREK GNIADKOWSKI, 1 MARIA ZALESKA, 2 TOMASZ OZOROWSKI, 2 LECH KONOPKA, 2 AND WALERIA HRYNIEWICZ 1 * Sera & Vaccines Central Research Laboratory, Warsaw, 1 and Institute of Hematology and Blood Transfusion, Warsaw, 2 Poland Received 30 November 2000/Returned for modification 10 February 2001/Accepted 24 February 2001 The first outbreak caused by vancomycin-resistant enterococci of the VanB phenotype in Poland was analyzed. It occurred in a single ward of a Warsaw hospital which is a specialized center for the treatment of hematological disorders. Between July 1999 and February 2000, 11 patients in the ward were found to be infected and/or colonized by Enterococcus faecium that was resistant in vitro to vancomycin and susceptible to teicoplanin. PCR analysis confirmed that the vancomycin-resistant E. faecium (VREM) isolates carried the vanb gene, which is responsible for the VanB phenotype. Pulsed-field gel electrophoresis (PFGE) typing revealed that the isolates belonged to four distinct PFGE types and that one of these was clearly predominant, including isolates collected from seven different patients. The isolates contained one or more copies of the vanb gene cluster of the identical, unique DraI/PagI (BspHI) restriction fragment length polymorphism type, which resided in either the same or different plasmid molecules or chromosomal regions. All this data suggested that the outbreak was due to both clonal spread of a single strain and horizontal transfer of resistance genes among nonrelated strains, which could be mediated by plasmids and/or by vanb gene cluster-containing transposons. The comparative analysis of vancomycin-susceptible E. faecium (VSEM) isolates collected from infections in the same ward at the time of the VREM outbreak has led to identification of a widespread VSEM strain that was possibly related to the major VREM clone. It is very likely that this endemic VSEM strain has acquired vancomycin-resistance determinants and that the acquisition occurred more than once during the outbreak. Downloaded from Vancomycin-resistant enterococci (VRE) belong nowadays to the most important nosocomial pathogens worldwide (23, 25), and they usually cause infections in severely debilitated, immunocompromised patients who undergo prolonged and intensive antibiotic therapy (21, 24). The first VRE strains, Enterococcus faecium and Enterococcus faecalis, were isolated in 1986 in France (19) and in the United Kingdom (38), and since then they have been identified in many other countries (1, 7, 22, 35). In some countries VRE may significantly contribute to enterococcal populations circulating in hospitals; recently in the United States the prevalence of vancomycinresistant E. faecium (VREM) isolates was estimated at the level of 15% of nosocomial isolates of this species (3). Out of five different VRE phenotypes that are known to date, the so-called phenotypes VanA and VanB were identified first and they have remained the most important from the clinical point of view (13, 19, 20, 28, 32). The VanB phenotype originally reported in 1989 (33) is characterized by high-level resistance to vancomycin and susceptibility to teicoplanin (32). It is determined by a cluster of genes, vanr B,-S B,-Y B, -W, -H B,-B, and -X B, which usually reside within composite transposons like Tn1547 and similar elements (11, 31). Sequencing of numerous copies of the vanb gene has revealed a certain * Corresponding author. Mailing address: Sera & Vaccines Central Research Laboratory, ul. Chelmska 30/34, Warsaw, Poland. Phone: (48) Fax: (48) degree of its structural diversity, and three main gene variants, vanb1, vanb2, and vanb3, have been distinguished to date (7, 14, 27). In contrast to VanA enterococci, only a few VRE outbreaks have been attributed to microorganisms with the phenotype VanB, and these were caused either by the horizontal transfer of resistance determinants among nonrelated strains (4, 5, 30, 40) or by the clonal spread of epidemic strains (6, 10, 35, 37). The first reported identification of VRE in Poland occurred at the end of 1996 in a hospital in Gdańsk with the isolation of E. faecium of the phenotype VanA, and it was followed by a large VRE outbreak in this center (15, 16, 34). In mid-1999 the first VREM strains with the phenotype VanB were identified in two hospitals in Warsaw, Poland. In one hospital it was a sporadic case of selection restricted to a single patient (17), whereas in the second hospital a VREM outbreak started at that time and lasted until the beginning of In this study we present results of the analysis of this outbreak which, to date, has been the only outbreak caused by enterococci of the VanB phenotype identified in Poland. MATERIALS AND METHODS Clinical isolates. Thirteen VREM isolates were recovered from patients in a single ward of the Institute of Hematology and Blood Transfusion in Warsaw between July 1999 and February 2000 (Table 1). Nine VREM isolates were collected from infection sites of eight different patients, and these were cultured from Broviac-type central catheters, blood, and urine samples. The remaining isolates were identified from the stool of four colonized patients, only one of whom was also infected (altogether, three isolates from this patient, no. 464, 465, on November 23, 2018 by guest 1781
2 1782 KAWALEC ET AL. J. CLIN. MICROBIOL. TABLE 1. Data on clinical isolates and MICs of antimicrobial agents Isolate a Phenotype Source b Mo/yr of isolation Mating c PFGE typing L-PCR d REAP Tn1547 locus e MIC ( g/ml)f PEN AMP GEN STR VAN TEC CHL TET CIP 8284 VREM i 07/99 a1 A1 I ,024 2, VREM i 08/99 a2 A2 I ,024 2, VREM i 08/99 b1 A3 II ,024 2, VREM i 09/99 b3 A3 II , VREM i 10/99 c B II ,024 2, VREM i 01/00 b2 C II , VREM i 02/00 b3 A3 II ,024 2, VREM c 02/00 b4 A4 II ,024 2, VREM i 02/00 b3 A3 II ,024 2, VREM i 02/00 b5 A5 II ,024 2, VREM c 02/00 b3 A5 II ,024 2, VREM c 02/00 d D II , VREM c 02/00 b4 A4 II ,024 2, VSEM i 06/99 b9 ND ND ND ,024 2, VSEM i 09/99 b8 ND ND ND ,024 2, VSEM i 09/99 b7 ND ND ND ,024 2, VSEM i 10/99 b10 ND ND ND ,024 2, VSEM i 11/99 b6 ND ND ND ,024 2, VSEM i 12/99 b7 ND A5 ND ,024 2, a Isolates 464, 465, and 466 were recovered from a single patient. b i, infection; c, carriage. c and indicate isolates that produced and did not produce transconjugants, respectively. d and indicate isolates that produced and did not produce L-PCR product specific for the vanb gene cluster, respectively; ND, not detected. e Polymorphism of Tn1547-like insertion loci. f PEN, penicillin; AMP, ampicillin; GEN, gentamicin; STR, streptomycin; VAN, vancomycin; TEC, teicoplanin; CHL, chloramphenicol; TET, tetracycline; CIP, ciprofloxacin. and 466, were included in the study). The carriage testing was performed with the use of bile-esculin agar (Oxoid, Basingstoke, United Kingdom) plates supplemented with 10 g of colistin (Polfa Tarchomin, Warsaw, Poland)/ml, 10 g of nalidixic acid (Sigma Chemical Company, St. Louis, Mo.)/ml, and 6 g of vancomycin (Eli Lilly, Indianapolis, Ind.)/ml. Fourteen vancomycin-susceptible E. faecium (VSEM) isolates were included in the analysis, and these were all VSEM isolates identified as etiologic agents of infections in the same ward between June and December They were recovered from different patients than those from whom VREM isolates were derived. Genus identification of the isolates was performed according to Facklam and Collins (12), and the species were identified using the API ID32 STREP test (biomérieux, Charbonnieres-les-Bains, France), supplemented by potassium tellurite reduction and motility and pigment production tests (12). Antimicrobial susceptibility testing. MICs of different antimicrobial agents were evaluated by the agar-dilution method according to the NCCLS guidelines (26). The following agents were tested: penicillin, ampicillin, streptomycin, gentamicin, tetracycline, and chloramphenicol (Polfa Tarchomin), vancomycin (Eli Lilly), teicoplanin (Marion Merrell, Denham, United Kingdom), and ciprofloxacin (Bayer, Wuppertal, Germany). E. faecalis ATCC 29212, Staphylococcus aureus ATCC 29213, and the E. faecalis V583 VanB standard strain (11, 33) were used as reference strains. Resistance transfer (mating). The vancomycin-resistance transfer experiment was performed using the filter-mating procedure (18) with the E. faecium 64/3 strain resistant to rifampin and fusidic acid (39) as a recipient. Transconjugants were selected on brain heart infusion agar (Oxoid) plates containing 64 g of rifampin (Polfa Tarchomin)/ml, 64 g of fusidic acid (Leo Pharmaceutical Products, Ballerup, Denmark)/ml, and 32 g of vancomycin (Eli Lilly)/ml. PFGE typing. Genomic DNA preparations of the isolates, embedded in 0.75% agarose plugs (InCert Agarose; FMC Bioproducts, Rockland, Maine), were digested with the SmaI restriction enzyme (Takara, Otsu, Japan) and were separated in 1% agarose gel (Pulsed Field-Certified; Bio-Rad, Hercules, Calif.) by using a CHEF DRII system (Bio-Rad). DNA was purified as reported by Clark et al. (7), and pulsed-field gel electrophoresis (PFGE) was run under conditions described by de Lencastre et al. (9). Results were interpreted according to Tenover et al. (36). Detection of the vanb gene. Total DNAs of the isolates were obtained using a Genomic DNA Prep Plus kit (A&A Biotechnology, Gdańsk, Poland), and the vanb gene was detected by specific PCR with primers vanb (7) in a GeneAmp 2400 thermocycler (Perkin-Elmer, Norwalk, Conn.). Genomic DNA purified from the E. faecalis V583 VanB standard strain (11, 33) was used as a positive control, whereas DNA of the E. faecalis ATCC strain served as a negative control. Restriction fragment length polymorphism (RFLP) analysis of the vanb gene cluster. DNA fragments containing clusters of vanr B,-S B,-Y B, -W, -H B, -B, and -X B, genes were amplified from total DNA of the isolates by long PCR (L-PCR) with the use of primers vanb long and the procedure by Dahl et al. (8). The resulting L-PCR products were digested with DraI and PagI (isoschizomer of BspHI) restriction enzymes (MBI Fermentas, Vilnius, Lithuania) and electrophoresed in 1% agarose gels (SeaKem; FMC Bioproducts). Genomic DNA of the E. faecalis V583 VanB standard strain (11, 33) was used as a positive control. Restriction endonuclease analysis of plasmids (REAP) and RFLP analysis of the vanb gene cluster locus. Plasmid DNA was purified from lysozyme-treated bacterial cells (0.5 mg/ml; Sigma Chemical Company) by the alkaline lysis method (2) using a QIAGEN Plasmid Midi Kit (Hilden, Germany). DNA preparations were digested with DraI and PagI restrictases (MBI Fermentas), separated in 1% agarose gels (SeaKem; FMC Bioproducts), and blotted onto a Hybond-N membrane (Amersham Pharmacia Biotech, Little Chalfont, United Kingdom) for hybridization with the vanb gene cluster probe. The L-PCR amplicon of the vanb cluster present in the E. faecalis V583 VanB reference strain (11, 31) was used as the probe. Probe labeling, hybridization, and signal detection were performed with an ECL Random-Prime labeling and detection system (Amersham Pharmacia Biotech). Genomic DNA isolated from the E. faecalis V583 strain (11, 31) was used as a positive control. The SmaI (Takara)-digested total DNA of the isolates was separated by PFGE (as described above), blotted onto the Hybond-N membrane (Amersham Pharmacia Biotech), and hybridized with the vanb gene cluster probe (performed as described above). Total DNA of the E. faecalis V583 strain (11, 31) served as a positive control of hybridization. RESULTS Antimicrobial susceptibility testing of the VREM isolates. MICs of various antimicrobial agents for the 13 VREM isolates are presented in Table 1. All the isolates demonstrated a high level of resistance to vancomycin (MICs, 128 to 512 g/ ml) and susceptibility to teicoplanin (MICs, 0.25 to 4 g/ml). They were also uniformly resistant to penicillin, ampicillin, ciprofloxacin, and to high concentrations of aminoglycosides
3 VOL. 39, 2001 VanB OUTBREAK IN WARSAW 1783 FIG. 1. PFGE analysis of selected type b VREM and VSEM isolates (A) and hybridization of the PFGE-separated DNA with the vanb gene cluster probe (B). M, ladder DNA molecular weight standard (New England Biolabs, Beverly, Mass.). DNA bands that differentiated two similarity groups of PFGE type b-specific patterns, as well as bands that hybridized with the probe, are indicated. and were nonsusceptible to chloramphenicol. All but one isolate were resistant to tetracycline. PFGE typing of the VREM isolates. Results of the analysis are shown in Table 1; Fig. 1 contains the PFGE patterns of five selected isolates. Four different PFGE types (36) were distinguished among the VREM isolates. One of these, PFGE type b, was markedly predominant, as it was represented by nine isolates recovered from seven different patients. These isolates could be further classified into subtypes (36) b1 to b5, with four isolates from three patients included in the subtype b3. All isolates of the PFGE type b formed two general similarity groups based on some characteristics of their DNA banding patterns. Only isolates of subtypes b1 and b2 produced the biggest DNA band observed among the type b isolates of about 320 kb, whereas isolates of subtypes b3 to b5 were characterized by another specific DNA band of about 185 kb. The first two VREM isolates identified (8284 and 8309) revealed PFGE patterns designated as PFGE subtypes a1 and a2. The remaining two isolates (8967 and 504) belonged to unique PFGE type c and d. Vancomycin-resistance transfer and susceptibility testing of transconjugant strains. Results of mating are presented in Table 1. Only three VREM isolates produced vancomycinresistant transconjugants, and the efficiency of conjugation was low, ranging from 10 7 to 10 9 per donor cell. Susceptibility testing revealed that some other resistance determinants were cotransferred with the vancomycin resistance. Transconjugants of the isolates 8309 and 8967 were found to be resistant to tetracycline, the transconjugant of the isolate 504 demonstrated high-level resistance to streptomycin, and the transconjugant of the isolate 8967 revealed resistance to high concentrations of both aminoglycosides tested (data not shown). Detection of the vanb gene. The vanb gene detection was carried out with the use of primers vanb (7) that are specific for the vanb1 gene variant (8). PCR products of the expected size of about 450 bp were obtained for all the VREM isolates (results not shown). RFLP analysis of the vanb gene cluster. DNA fragments encompassing the vanb gene cluster regions were amplified by L-PCR, and products of the expected size of about 6 kb were obtained for 8 of 13 VREM isolates (Table 1). Results of their restriction analysis with the use of DraI and PagI (BspHI) enzymes are shown in Fig. 2. The amplified fragments produced the identical RFLP pattern, which was different from that specific for the original vanb gene cluster present in the E. faecalis V583 strain (8, 31). REAP and RFLP analysis of the vanb gene cluster locus. Results of the analyses are shown in Table 1 and Fig. 3. Plasmids purified from VREM isolates and digested with DraI and PagI (BspHI) restriction enzymes were electrophoresed (REAP) and subsequently hybridized with the vanb gene cluster probe (analysis of the vanb cluster locus RFLP). The REAP patterns
4 1784 KAWALEC ET AL. J. CLIN. MICROBIOL. FIG. 2. RFLP analysis of the vanrsywhbx region digested with DraI and PagI (BspHI). M, /BstEII DNA molecular weight standard (Kucharczyk TE, Warsaw, Poland). were found to be complex, as at least a significant fraction of the isolates contained multiple plasmid molecules of different sizes and abundance in their cells. The majority of isolates were characterized by either identical or very similar composition of plasmids (REAP patterns A1 to A5); however, even those isolates, which produced clearly distinct REAP patterns (REAP patterns B, C, and D), shared with all the others the same or related molecules. Results of the RFLP analysis of the vanb gene cluster locus are presented in Table 1 and Fig. 3. Hybridization patterns were obtained for all the VREM isolates, including those which had not produced the vanb gene cluster-containing L-PCR amplicons. Strikingly, the hybridizing bands could not be assigned to plasmid DNA restriction fragments visualized in REAP. Eleven isolates, including all isolates of PFGE types b, c, and d, were characterized by the same polymorph of the vanb gene cluster locus (RFLP, type II). The RFLP pattern specific for the two remaining isolates of PFGE type a (RFLP, type I) differed from the predominant one by faster migration of the biggest DNA restriction fragment. The vanb gene cluster probe was also used in hybridization with the SmaI-digested total DNA of the isolates separated by PFGE. Figure 1 shows results obtained for five selected isolates. A single hybridizing DNA band of about 90 kb was revealed for all but five VREM isolates, which belonged to PFGE types b and d. In the case of PFGE types b5 and c isolates, this band was accompanied by another one of about 210 and 120 kb, respectively. For the three remaining isolates (PFGE types a and b2), two or more bands of different sizes and hybridization intensity (from about 140 kb to about 350 kb) were observed. Epidemiological analysis of the VSEM isolates. Identification of numerous VREM isolates in the single ward of the hematological hospital in Warsaw prompted us to investigate their relatedness to VSEM strains that were present in the ward at the same time. Fourteen VSEM isolates, recovered from infections in the second half of 1999, were typed by PFGE along with all VREM isolates. Figure 1 presents PFGE patterns produced by three representative VSEM isolates and compares them with five selected VREM isolates. Altogether, six VSEM isolates were characterized by similar PFGE patterns and these were classified into PFGE type b, distinguished previously to include nine VREM isolates (Table 1). The VSEM-specific PFGE subtypes b6 to b10 also could be split into two general similarity groups that were observed before among VREM PFGE subtypes b1 to b5. The VSEM PFGE subtype b6 was similar to VREM subtypes b1 and b2, whereas the VSEM subtypes b7 to b10 resembled rather the VREM subtypes b3 to b5. Hybridization with the vanb gene cluster probe (Fig. 1) revealed that DNA bands that contained the vancomycin-resistance genes belonged to those for which PFGE patterns characteristic for VREM isolates differed from their VSEM-specific counterparts. Plasmid DNA purified from a single VSEM isolate (isolate 96 of the PFGE subtype b7) was subjected to restriction analysis together with plasmids obtained from VREM isolates (Table 1 and Fig. 3). The DraI/ PagI(BspHI) REAP pattern produced by the isolate was found to be identical to the variant characteristic for two VREM isolates (isolates 465 and 466 of PFGE subtypes b5 and b3, respectively). The antimicrobial susceptibility testing revealed that the PFGE type b VSEM isolates were multiresistant (Table 1). In addition to glycopeptides (vancomycin MICs, 0.5 to 2 g/ml; teicoplanin MICs, to 1 g/ml), the majority of these isolates were susceptible only to tetracycline. DISCUSSION The Institute of Hematology in Warsaw is a relatively small medical institution (200 beds) that specializes in the treatment of patients suffering from different types of hematological disorders. The VREM outbreak was restricted to its single ward (40 beds), which admits mainly hematological patients for repetitive short-term chemotherapy courses and neutropenic patients with infection symptoms who are usually hospitalized for prolonged periods and are intensively treated with antimicrobial agents. The antibiotic consumption is very high in the ward and includes those agents which are not active against enterococci due to their natural or broad acquired resistance. During the last 4 months of 1999, the mean monthly number of defined daily doses (DDDs) prescribed was 298 DDDs of expandedspectrum cephalosporins, 264 DDDs of antianaerobic agents (amoxycillin with clavulanate, ampicillin with sulbactam, piperacillin with tazobactam, clindamycin, and metronidazole), and 273 DDDs of cotrimoxazole. The monthly DDDs number of 28 reflected the consumption of vancomycin in the same period. Considering the mean number of patients in the ward per month as 250, it means that one patient was treated monthly with 3.5 DDDs of these antimicrobials, whereas the
5 VOL. 39, 2001 VanB OUTBREAK IN WARSAW 1785 FIG. 3. REAP analysis (A) and hybridization of plasmid DNA digested with DraI and PagI (BspHI) with the vanb gene cluster probe (B). M, /HindIII DNA molecular weight standard (Kucharczyk TE, Warsaw, Poland). Arrows indicate DNA bands that differentiated the type I and type II polymorphs of the Tn1547-like element insertion locus. mean hospitalization time was 5 days. Enterococci are among the most prevalent pathogens in the ward; between June and December 1999 enterococcal infections constituted 22.5% (n 25) of all infections identified, and E. faecium was responsible for 76.0% of these (n 19). All these factors have created a high-risk background for selection and spread of VRE strains, and especially VREM. The outbreak was caused by VREM of the VanB phenotype, and together with the emergence of a VREM strain in another Warsaw hospital at the same time (17), these represented the first incidences of VanB enterococci reported in Poland. Strains identified in both centers were selected independently and were not transmitted from one hospital to the other. Detection of the vanb gene by PCR with the primers vanb designed by Clark et al. (7) suggested that the gene variant present in the outbreak isolates was vanb1 (8). The RFLP analysis of the vanb gene cluster and its locus revealed that all the isolates contained the same DraI/PagI (BspHI) polymorph of the cluster. (However, some cluster sequence diversity must have occurred among the isolates, as was demonstrated by the failure of L-PCR amplification of the region in five isolates.) The polymorph was found to be different from those identified up to now (8), and strikingly it seemed to be more related to the polymorph RFLP-2, correlating with vanb2 and -B3 gene variants, than to RFLP-1, which has been observed as vanb1 specific to date (8). The PFGE analysis revealed a certain degree of clonal diversity of the outbreak isolates. Four different PFGE types of isolates were distinguished, and two of these, PFGE types a and b, were represented by more than one isolate. The first two VREM isolates identified belonged to the PFGE type a; however, during the outbreak the PFGE type b became clearly predominant, in 9 of 13 isolates that were collected. The PFGE type b VREM isolates formed five distinct subtypes, which could be classified into two general similarity groups. This data suggested that the outbreak was mostly clonal and that the main epidemic VREM strain was undergoing a rapid evolutionary differentiation due to various genetic events. Nevertheless, it is also very likely that, at least to some extent, the observed diversity of the PFGE type b E. faecium population existed before the emergence of vancomycin-resistance genes in the enterococcal population of the hospital (discussed below). Identification of VREM isolates belonging to PFGE types a, c, and d, as well as the diversity of the PFGE type b isolates, raised the problem of the origin of vancomycin-resistance determinants in the enterococcal population of the hospital. As was mentioned above, the vanb gene cluster region of all VREM isolates represented a single, specific RFLP type. Moreover, in almost all of the isolates, this gene cluster resided within the same wider sequence context which was demonstrated by the results of the DraI/PagI (BspHI) RFLP analysis of the vanb gene cluster locus. It might be postulated that the vancomycin-resistance genes emerged once and were subse-
6 1786 KAWALEC ET AL. J. CLIN. MICROBIOL. quently spread among different E. faecium strains by horizontal DNA transfer. Such transfer, at least in terms of plasmid conjugation, must have been common in the studied population, as was suggested by the observed similarity of REAP patterns produced by all the VREM isolates. However, it is very difficult to reveal the nature of the possible horizontal transmission of vancomycin-resistance genes during the outbreak. The vanb gene clusters are usually located within active, composite transposons of the Tn1547 type, which may be inserted into either chromosomal or plasmid DNA. Their horizontal spread either may proceed due to conjugative functions of the transposons themselves or may be mediated by plasmids or other transferable elements that contain the Tn1547-like transposons. The vanb locus RFLP analysis carried out with total DNA of the isolates cut with SmaI and separated by PFGE revealed that in almost all the isolates of PFGE types b, c, and d, the vanb gene cluster was located within a DNA fragment of about 90 kb. This could be a plasmid molecule (or part of it) that was disseminated among different strains; however, it cannot be excluded that the conjugative transposon was inserted in their chromosomal DNA in a site-specific manner. The three remaining isolates of PFGE types a and b2 most probably contained two, three, or more copies of the vanb gene cluster that were located either in other plasmids of a large molecular weight (140 to 350 kb) or in chromosomal regions or in both. In the DraI/PagI (BspHI) RFLP analysis of the vanb gene cluster locus, the intense hybridization was obtained with plasmid DNA preparations of the isolates; however, the hybridizing bands could not be identified within their REAP patterns. This suggested that the vanb gene clusters could be present in large and low-copy-number plasmids of poor representation in plasmid preparations, but also, it could not be excluded that the hybridization was due to chromosomal DNA contamination of these. All these data did not allow us to sort out precisely the mechanism of spread of the vanb gene cluster in the studied E. faecium population. It is possible that the cluster was transmitted by both transposonand plasmid-mediated events and that these were followed by multiplication of transposon copies in at least some of the strains or strain variants. Analysis was performed of VSEM isolates that were recovered in the same ward of the hospital at the time of the VREM outbreak in order to identify the endemic E. faecium strains which could have acquired VanB resistance genes. Out of 14 VSEM isolates collected from June to December 1999, 6 were found by PFGE to be possibly related to the VREM isolates of PFGE type b, whereas no VSEM isolate produced a PFGE pattern that was similar to those of VREM PFGE types a, c, and d. The five variants of VSEM-specific PFGE type b DNA patterns could also be classified into the two basic similarity groups that were distinguished among PFGE patterns of the type b VREM isolates. It is noteworthy that the SmaI DNA restriction fragments which contained the vanb gene clusters in VREM isolates belonged to those bands that differentiated PFGE patterns specific for VREM and VSEM isolates. These data indicated that the isolates of the PFGE type b, dominating within both VSEM and VREM populations, could represent the endemic E. faecium strain that had been circulating in the hospital environment for a relatively long time. Its spread was accompanied by continuous genetic diversification, and with time the strain produced numerous strain variants along the two main evolutionary lines. The high prevalence of the E. faecium PFGE type b in the single ward of the hospital has created a significant probability of acquisition of vancomycinresistance genes by its variants, since only these had been introduced. Vancomycin resistance probably emerged after the separation of the two main evolutionary lineages of the strain, and variants belonging to both of these could acquire the resistance genes by at least two different DNA transfer events. Therefore, the predominance of VREM of the PFGE type b isolates among all VREM isolates collected during the outbreak may have been due to both clonal spread and horizontal dissemination of the vanb gene cluster-containing elements. This is one of the few documented cases of identification of an endemic VSE strain that acquired either VanA or VanB resistance determinants in the hospital environment (29, 35; V. S. Albuquerque, C. M. F. Silva, E. A. Marques, L. M. Teixeira, and V. L. C. Merquior, Abstr. 40th Intersci. Conf. Antimicrob. Agents Chemother., abstr. 1786, 2000; M. M. Kapala, B. M. Willey, F. Arce, G. Large, A. McGeer, and D. E. Low, Abstr. 38th Intersci. Conf. Antimicrob. Agents Chemother., abstr. H-141, 1998). Our findings together with the previous data support the opinion that the high diversity of VSE strains and strain variants may be an important reason for the observed VRE heterogeneity in a single center (35). Such findings underline the necessity of strict monitoring of infections caused by VSE. ACKNOWLEDGMENTS We thank Andrew Hazlewood for critical reading of the manuscript, Patrice Courvalin who kindly provided E. faecalis V583, and Wolfgang Witte for the E. faecium 64/3 strain. This work was partially financed by a grant from the Polish Committee for Scientific Research (KBN 4P05A ) and the U.S.- Poland Maria Sklodowska-Curie Joint Fund II, MZ/NIH REFERENCES 1. Bell, J. M., J. C. Paton, and J. Turnidge Emergence of vancomycinresistant enterococci in Australia: phenotypic and genotypic characteristics of isolates. J. Clin. Microbiol. 36: Birnboim, H. C., and J. Doly A rapid alkaline extraction procedure for screening recombinant plasmid DNA. Nucleic Acids Res. 7: Boyce, J. M., M. S. Favero, R. P. Gaynes, D. A. Goldmann, W. R. Jarvis, G. Pugliese, and R. A. Weinstein Populations at risk and routes of transmission, p In G. Pugliese and R. A. Weinstein (ed.), Issues & controversies in prevention and control of VRE. Etna Communications, Chicago, Ill. 4. Boyce, J. M., S. M. Opal, J. W. Chow, M. J. Zervos, G. Potter-Bynoe, C. B. Sherman, R. L. C. Romulo, S. Fortna, and A. A. Medeiros Outbreak of multidrug-resistant Enterococcus faecium with transferable vanb class vancomycin resistance. J. Clin. Microbiol. 32: Carias, L. L., S. D. Rudin, C. J. Donskey, and L. B. Rice Genetic linkage and cotransfer of a novel, vanb-containing transposon (Tn5382) and a low-affinity penicillin-binding protein 5 gene in a clinical vancomycinresistant Enterococcus faecium isolate. J. Bacteriol. 180: Chow, J. W., A. Kutitza, D. M. Shlaes, M. Green, D. F. Sahm, and M. J. Zervos Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J. Clin. Microbiol. 31: Clark, N., R. Cooksey, B. Hill, J. Swenson, and F. C. Tenover Characterization of glycopeptide-resistant enterococci from U.S. hospitals. Antimicrob. Agents Chemother. 37: Dahl, K. H., G. Skov Simonsen, Ř. Olsvik, and A. Sundsfjord Heterogeneity in vanb gene cluster of genetically diverse clinical strains of vancomycin-resistant enterococci. Antimicrob. Agents Chemother. 43: de Lencastre, H., E. P. Severina, R. B. Roberts, B. N. Kreiswirth, and A. Tomasz Testing the efficacy of a molecular surveillance network: methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resis-
7 VOL. 39, 2001 VanB OUTBREAK IN WARSAW 1787 tant Enterococcus faecium (VREF) genotypes in six hospitals in the metropolitan New York City area. The BARG Initiative Pilot Study Group. Bacterial Antibiotic Resistance Group. Microb. Drug. Resist. 2: Donskey, C. J., J. R. Schreiber, M. R. Jacobs, R. Shekar, R. A. Salata, S. Gordon, C. C. Whalen, F. Smith, and L. B. Rice A polyclonal outbreak of predominantly VanB vancomycin-resistant enterococci in northeast Ohio. Northeast Ohio Vancomycin-Resistant Enterococcus Surveillance Program. Clin. Infect. Dis. 29: Evers, S., P. E. Reynolds, and P. Courvalin Sequence of the vanb and ddl genes encoding D-alanine:D-lactate and D-alanine:D-alanine ligases in vancomycin-resistant Enterococcus faecalis V583. Gene 140: Facklam, R., and M. D. Collins Identification of Enterococcus species isolated from human infections by a conventional test scheme. J. Clin. Microbiol. 27: Fines, M., B. Perichon, P. Reynolds, D. F. Sahm, and P. Courvalin VanE, a new type of acquired glycopeptide resistance in Enterococcus faecalis BM4405. Antimicrob. Agents Chemother. 43: Gold, H. S., S. Ünal, E. Cercenado, C. Thauvin-Eliopulos, G. M. Eliopulos, C. B. Wennerstein, and R. C. Moellering, Jr A gene conferring resistance to vancomycin but not teicoplanin in isolates of Enterococcus faecalis and Enterococcus faecium demonstrates homology with vanb, vana, and vanc genes of enterococci. Antimicrob. Agents Chemother. 37: Hryniewicz, W., K. Szczypa, M. Bronk, A. Samet, A. Hellmann, and K. Trzciński First report of vancomycin-resistant Enterococcus faecium isolated in Poland. Clin. Microbiol. Infect. 5: Kawalec, M., M. Gniadkowski, and W. Hryniewicz Outbreak of vancomycin-resistant enterococci in a hospital in Gdańsk, Poland, due to horizontal transfer of different Tn1546-like transposon variants and clonal spread of several strains. J. Clin. Microbiol. 38: Kawalec, M., M. Gniadkowski, U. Zielińska, W. Klos, and W. Hryniewicz A vancomycin-resistant Enterococcus faecium strain carrying the vanb2 gene variant in a Polish hospital. J. Clin. Microbiol. 39: Klare, I., E. Collatz, S. Al-Obeid, J. Wagner, A. C. Rodloff, and W. Witte Glykopeptidresistenz bei Enterococcus faecium aus Besiedlungen und Infectionen von Patienten aus Intensivstationen Berliner Kliniken und einem Transplantationszentrum. ZAC Z. Antimikrob. Antineoplast. Chemother. 10: Leclercq, R., E. Derlot, J. Duval, and P. Courvalin Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N. Engl. J. Med. 319: Leclercq, R., S. Dutka-Malen, J. Duval, and P. Courvalin Vancomycin resistance gene vanc is specific to Enterococcus gallinarum. Antimicrob. Agents Chemother. 36: Maki, D. G., and W. A. Agger Enterococcal bacteremia: clinical features, the risk of endocarditis and management. Medicine 67: McGregor, K. F., and H.-K. Young Identification and characterization of vanb2 glycopeptide resistance elements in enterococci isolated in Scotland. Antimicrob. Agents Chemother. 44: Moellering, R. C., Jr Emergence of Enterococcus as a significant pathogen. Clin. Infect. Dis. 14: Murray, B. E The life and times of Enterococcus. Clin. Microbiol. Rev. 3: Murray, B. E Diversity among multidrug-resistant enterococci. Emerg. Infect. Dis. 4: National Committee for Clinical Laboratory Standards Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard M7-A5. National Committee for Clinical Laboratory Standards, Wayne, Pa. 27. Patel, R., J. R. Uhl, P. Kohner, M. K. Hopkins, J. M. Steckelberg, B. Kline, and F. R. I. Cockerill DNA sequence variation within vana, vanb, vanc-1, and vanc-2/3 genes of clinical Enterococcus isolates. Antimicrob. Agents Chemother. 42: Perichon, B., P. E. Reynolds, and P. Courvalin VanD-type glycopeptide-resistant Enterococcus faecium BM4339. Antimicrob. Agents Chemother. 41: Perlada, D. E., A. G. Smulian, and M. T. Cushion Molecular epidemiology and antibiotic susceptibility of enterococci in Cincinnati, Ohio: a prospective citywide survey. J. Clin. Microbiol. 35: Quintiliani, R., Jr., and P. Courvalin Conjugal transfer of the vancomycin-resistance determinant vanb between enterococci involves the movement of large genetic elements from chromosome to chromosome. FEMS Microbiol. Lett. 119: Quintiliani, R., Jr., and P. Courvalin Characterization of Tn1547, composite transposon flanked by the IS16 and IS256-like elements, that confers vancomycin resistance in Enterococcus faecalis BM4281. Gene 172: Quintiliani, R., Jr., S. Evers, and P. Courvalin The vanb gene confers various levels of self-transferable resistance to vancomycin in enterococci. J. Infect. Dis. 167: Sahm, D. F., J. Kissinger, M. S. Gilmore, B. E. Murray, R. Mulder, J. Solliday, and B. Clarke In vitro susceptibility studies of vancomycinresistant Enterococcus faecalis. Antimicrob. Agents Chemother. 33: Samet, A., M. Bronk, A. Hellmann, and J. Kur Isolation and epidemiological study of vancomycin-resistant Enterococcus faecium from patients of a haematological unit in Poland. J. Hosp. Infect. 41: Suppola, J. P., E. Kolho, S. Salmenlinna, E. Tarkka, J. Vuopio-Varkila, and M. Vaara vana and vanb incorporate into an endemic ampicillinresistant vancomycin-sensitive Enterococcus faecium strain: effect on interpretation of clonality. J. Clin. Microbiol. 37: Tenover, F. C., R. Arbeit, V. Goering, P. Mickelsen, B. M. Murray, D. Pershing, and B. Swaminathan Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J. Clin. Microbiol. 33: Thal, L., S. Donabedian, B. Robinson-Dunn, J. W. Chow, L. Dembry, D. B. Clewell, D. Alshab, and M. J. Zervos Molecular analysis of glycopeptide-resistant Enterococcus faecium isolates collected from Michigan hospitals over a 6-year period. J. Clin. Microbiol. 36: Uttley, A. H. C., R. C. George, J. Naidoo, N. Woodford, A. P. Johnson, C. H. Collins, D. Morrison, A. J. Gilfillan, L. E. Fitch, and J. Heptonstall High-level vancomycin-resistant enterococci causing hospital infections. Epidemiol. Infect. 103: Werner, G., I. Klare, and W. Witte Arrangement of the vana gene cluster in enterococci of different ecological origin. FEMS Microbiol. Lett. 155: Woodford, N., B. L. Jones, Z. Baccus, H. A. Ludlam, and D. F. J. Brown Linkage of vancomycin and high-level gentamicin resistance genes on the same plasmid in a clinical isolate of Enterococcus faecalis. J. Antimicrob. Chemother. 35:
Received 21 April 1997/Returned for modification 30 June 1997/Accepted 28 August 1997
JOURNAL OF CLINICAL MICROBIOLOGY, Dec. 1997, p. 3258 3263 Vol. 35, No. 12 0095-1137/97/$04.00 0 Copyright 1997, American Society for Microbiology Comparison of Agar Dilution, Broth Microdilution, E-Test,
More informationMulti-clonal origin of macrolide-resistant Mycoplasma pneumoniae isolates. determined by multiple-locus variable-number tandem-repeat analysis
JCM Accepts, published online ahead of print on 30 May 2012 J. Clin. Microbiol. doi:10.1128/jcm.00678-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 Multi-clonal origin
More informationSurveillance of Enterococci in Belgium. M. Ieven, K. Loens, B. Jans and H. Goossens
Surveillance of Enterococci in Belgium M. Ieven, K. Loens, B. Jans and H. Goossens Surveillance of Enterococci in Belgium Overview Introduction and epidemiological surveillance Results of isolates received
More informationThe first Staphylococcus aureus isolates with reduced susceptibility to vancomycin in Poland
Journal of Antimicrobial Chemotherapy (2002) 50, 1065 1069 DOI: 10.1093/jac/dkf252 The first Staphylococcus aureus isolates with reduced susceptibility to vancomycin in Poland Jolanta Krzysztoá-Russjan
More informationCharacterization of community and hospital Staphylococcus aureus isolates in Southampton, UK
Journal of Medical Microbiology (2010), 59, 1084 1088 DOI 10.1099/jmm.0.018986-0 Characterization of community and hospital Staphylococcus aureus isolates in Southampton, UK S. M. Green, 1 P. Marsh, 1
More informationMolecular epidemiology and drug resistance mechanism of Salmonella species especially in S. Typhi strains isolated in Bangladesh
Molecular epidemiology and drug resistance mechanism of Salmonella species especially in S. Typhi strains isolated in Bangladesh Dr. Kaisar Ali Talukder Senior Scientist Icddr,b This presentation will
More informationIncreasing Genetic Relatedness of Ciprofloxacin-Resistant Streptococcus pneumoniae Isolated in Canada from 1997 to 2005
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Mar. 2008, p. 1190 1194 Vol. 52, No. 3 0066-4804/08/$08.00 0 doi:10.1128/aac.01260-07 Copyright 2008, American Society for Microbiology. All Rights Reserved. Increasing
More informationA Norazah, S M Liew, A G M Kamel, Y T Koh, V K E Lim. O r i g i n a l A r t i c l e
Singapore Med J 2001 Vol 42(1) : 015-019 O r i g i n a l A r t i c l e DNA Fingerprinting of Methicillin-Resistant Staphylococcus Aureus by Pulsed-Field Gel Electrophoresis (PFGE): Comparison of Strains
More informationInfection in a Teaching Hospital in London, United Kingdom
JOURNAL OF CLINICAL MICROBIOLOGY, Aug. 1992, p. 1953-1957 Vol. 30, No. 8 0095-1137/92/081953-05$02.00/0 Copyright X 1992, American Society for Microbiology Epidemiology of Enterococcus faecalis Urinary
More informationSURVEILLANCE FOR GLYCOPEPTIDE-RESISTANT ENTEROCOCCI
SURVEILLANCE FOR GLYCOPEPTIDE-RESISTANT ENTEROCOCCI Drs N Bosman, T Nana & C Sriruttan CMID NHLS Dr Charlotte Sriruttan SASCM 3/11 GLOBAL DATA VRE first isolated in Europe in 1987, (Leclercq R., et al
More informationORIGINAL ARTICLE. Italy
ORIGINAL ARTICLE Proficiency of Italian clinical laboratories in detecting reduced glycopeptide susceptibility in Enterococcus and Staphylococcus spp. using routine laboratory methodologies M. E. Jones
More informationof glycopeptide-resistant enterococci
~ ORIGINAL ARTICLE Comparison of agar-based media for primary isolation of glycopeptide-resistant enterococci l? R. Chadwickl, D. E]. Brown2, M. H. Wilcox2, T A. Collynsl, E. Walpo1e2, J. Dillon, R. Smith2,
More informationSri Lankan Journal of Infectious Diseases 2018 Vol.8(2): DOI: /sljid.v8i2.8221
115 Research article Epidemiology of invasive infections caused by vancomycin sensitive and resistant enterococcal strains among oncology patients at the National Cancer Institute of Sri Lanka from 1st
More informationNosocomial infection caused by vancomycin-susceptible multidrug-resistant Enterococcus faecalis over a long period in a university hospital in Japan
Microbiol Immunol 2014; 58: 607 614 doi: 10.1111/1348-0421.12190 ORIGINAL ARTICLE Nosocomial infection caused by vancomycin-susceptible multidrug-resistant Enterococcus faecalis over a long period in a
More informationIdentification of vat(e) in Enterococcus faecalis Isolates from Retail Poultry and Its Transferability to Enterococcus faecium
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Dec. 2002, p. 3823 3828 Vol. 46, No. 12 0066-4804/02/$04.00 0 DOI: 10.1128/AAC.46.12.3823 3828.2002 Identification of vat(e) in Enterococcus faecalis Isolates from
More information(PFGE) Clostridium di$cile
2009 205 (PFGE) Clostridium di$cile 1) 3) 2) 2) 2) 2, 4) 5) 1) 2) 3) 4) 5) 21 5 22 21 8 31 2004 1 2008 12 5 Clostridium di$cile (C. di$cile) 340 248 A /B 141 (56.9) A /B 26 (10.5) A /B 81 (32.7) 136 (PFGE)
More informationMolecular Characterization of Vancomycin-Resistant Enterococci from Hospitalized Patients and Poultry Products in The Netherlands
JOURNAL OF CLINICAL MICROBIOLOGY, July 1998, p. 1927 1932 Vol. 36, No. 7 0095-1137/98/$04.00 0 Copyright 1998, American Society for Microbiology. All Rights Reserved. Molecular Characterization of Vancomycin-Resistant
More informationFirst detection of the mcr-1 gene in Escherichia coli isolated from livestock between 2013
AAC Accepted Manuscript Posted Online 29 August 2016 Antimicrob. Agents Chemother. doi:10.1128/aac.01472-16 Copyright 2016, American Society for Microbiology. All Rights Reserved. 1 2 First detection of
More informationNOTES. Quinupristin-Dalfopristin Resistance in Enterococcus faecium Isolates from Humans, Farm Animals, and Grocery Store Meat in the United States
JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 2006, p. 3361 3365 Vol. 44, No. 9 0095-1137/06/$08.00 0 doi:10.1128/jcm.02412-05 Copyright 2006, American Society for Microbiology. All Rights Reserved. NOTES Quinupristin-Dalfopristin
More informationClinical Failure of Vancomycin Treatment of Staphylococcus aureus Infection in a Tertiary Care Hospital in Southern Brazil
224 BJID 2003; 7 (June) Clinical Failure of Vancomycin Treatment of Staphylococcus aureus Infection in a Tertiary Care Hospital in Southern Brazil Larissa Lutz, Adão Machado, Nadia Kuplich and Afonso Luís
More informationMolecular typing insight on diversity and antimicrobial resistance of Campylobacter jejuni from Belgian chicken meat
Molecular typing insight on diversity and antimicrobial resistance of Campylobacter jejuni from Belgian chicken meat Ihab Habib Ghent University Department of Public Health and Food Safety. Contents: Molecular
More informationSpectrum of vancomycin and susceptibility testing
Spectrum of vancomycin and susceptibility testing Olivier Denis Service de Microbiologie Laboratoire de bactériologie Service de Microbiologie Hôpital Erasme Glycopeptides Vancomycin 1958 < Amycolatopsis
More informationValidation of Vitek version 7.01 software for testing staphylococci against vancomycin
Diagnostic Microbiology and Infectious Disease 43 (2002) 135 140 www.elsevier.com/locate/diagmicrobio Validation of Vitek version 7.01 software for testing staphylococci against vancomycin P.M. Raney a,
More informationTyping of ônh ôstaphylococcus epidermidis ôns ô Colonizing in Human Nares by Pulsed-Field Gel Electrophoresis
Microbiol. Immunol., 39(5), 315-319, 1995 Typing of ônh ôstaphylococcus epidermidis ôns ô Colonizing in Human Nares by Pulsed-Field Gel Electrophoresis Lan Hu*, Akiko Umeda, and Kazunobu Amako Department
More informationEnterococci: Emerging Drug Resistant Bacteria In Hospital Acquired Infections At Hospital Kuala Lumpur, Malaysia
ISPUB.COM The Internet Journal of Microbiology Volume 9 Number 2 Enterococci: Emerging Drug Resistant Bacteria In Hospital Acquired Infections At Hospital Kuala R Ibrahim, M Mohamad, M Rahman Citation
More informationIncidence of Virulence Factors and Antibiotic Resistance among Enterococci Isolated from Food
APPLIED AND ENVIRONMENTAL MICROBIOLOGY, Sept. 2001, p. 4385 4389 Vol. 67, No. 9 0099-2240/01/$04.00 0 DOI: 10.1128/AEM.67.9.4385 4389.2001 Copyright 2001, American Society for Microbiology. All Rights
More informationDissemination of Macrolide-Resistant Streptococcus pneumoniae Isolates Containing Both erm(b) and mef(a) in South Korea
JOURNAL OF CLINICAL MICROBIOLOGY, Dec. 2003, p. 5787 5791 Vol. 41, No. 12 0095-1137/03/$08.00 0 DOI: 10.1128/JCM.41.12.5787 5791.2003 Copyright 2003, American Society for Microbiology. All Rights Reserved.
More informationh g o Klare, Dietlitide Badstiibner, Carola Koristabel atid WoEfgang Witte
ORIGINAL ARTICLE Identification of enterococci and determination of their glycopeptide resistance in German and Austrian clinical microbiology laboratories Clin Microbial Infect 1999; 5: 535-539 h g o
More informationEmergence of Klebsiella pneumoniae ST258 with KPC-2 in Hong Kong. Title. Ho, PL; Tse, CWS; Lai, EL; Lo, WU; Chow, KH
Title Emergence of Klebsiella pneumoniae ST258 with KPC-2 in Hong Kong Author(s) Ho, PL; Tse, CWS; Lai, EL; Lo, WU; Chow, KH Citation International Journal Of Antimicrobial Agents, 2011, v. 37 n. 4, p.
More informationIn Vitro Susceptibilities of Aerobic and Facultative Non-Spore- Forming Gram-Positive Bacilli to HMR 3647 (RU 66647) and 14 Other Antimicrobials
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, May 1998, p. 1028 1033 Vol. 42, No. 5 0066-4804/98/$04.00 0 Copyright 1998, American Society for Microbiology In Vitro Susceptibilities of Aerobic and Facultative
More informationA genomic dissection of travel associated ESBL producing Salmonella Typhi originating from the Philippines
A genomic dissection of travel associated ESBL producing Salmonella Typhi originating from the Philippines A one-off occurrence or threat to the effective treatment of typhoid fever? Rene S. Hendriksen,
More informationRapid identification and resistance assessment: The future is mass spectrometry
Rapid identification and resistance assessment: The future is mass spectrometry Dr Sanmarié Schlebusch Director of Microbiology Mater Pathology Brisbane Outline Introduction Plug and play Pre-prep and
More informationNew genomic typing method MLST
New genomic typing method MLST Bon KIMURA fingerprinting PFGE DNA multilocus sequence typingmlst alleles PFGE MLST 1990 PCR 1 PCR DNA PFGE 1 PFGE RAPDrandomly amplified polymorphic DNA 3 AFLPAmplified
More informationResistance to linezolid in enterococci and staphylococci referred to the national reference laboratory
Resistance to linezolid in enterococci and staphylococci referred to the national reference laboratory Dr Danièle Meunier, AMRHAI BSAC - Antimicrobial Susceptibility Testing User Days Oxazolidinone Linezolid
More informationEvaluation of methicillin-resistant Staphylococcus aureus (MRSA) colonization in pigs and people that work with pigs in Ontario Veterinary College
Evaluation of methicillin-resistant Staphylococcus aureus (MRSA) colonization in pigs and people that work with pigs in Ontario Veterinary College Final Report September 2007 This research has been possible
More informationReport: antimicrobial resistance in commensal Enterococcus spp. from poultry, pigs, cows and veal calves
Veterinary and Agrochemical Research Centre Report: antimicrobial resistance in commensal Enterococcus spp. from poultry, pigs, cows and veal calves P. Butaye 1 Introduction Enterococci are regarded as
More informationIn vitro assessment of dual drug combinations to inhibit growth of Neisseria gonorrhoeae
AAC Accepted Manuscript Posted Online 26 January 2015 Antimicrob. Agents Chemother. doi:10.1128/aac.04127-14 Copyright 2015, American Society for Microbiology. All Rights Reserved. 1 2 In vitro assessment
More informationTHE INCIDENCE of infections caused by
Vancomycin Prescribing Practices in Hospitalized Chronic Hemodialysis Patients Kevin Green, MD, Gerald Schulman, MD, David W. Haas, MD, William Schaffner, MD, and Erika M.C. D Agata, MD, MPH To determine
More informationMolecular Epidemiology of Staphylococcus epidermidis in a Neonatal Intensive Care Unit over a Three-Year Period
JOURNAL OF CLINICAL MICROBIOLOGY, May 2000, p. 1740 1746 Vol. 38, No. 5 0095-1137/00/$04.00 0 Copyright 2000, American Society for Microbiology. All Rights Reserved. Molecular Epidemiology of Staphylococcus
More information(multidrug-resistant Pseudomonas aeruginosa; MDRP)
220 2009 (multidrug-resistant Pseudomonas aeruginosa; MDRP) 21 4 1 21 10 4 amikacin (AMK), imipenem/cilastatin (IPM), ciprofloxacin (CPFX) multidrug-resistant Pseudomonas aeruginosa (MDRP) CHROMagar TM
More informationReceived 2 October 2002/Returned for modification 29 November 2002/Accepted 7 January 2003
JOURNAL OF CLINICAL MICROBIOLOGY, Apr. 2003, p. 1687 1693 Vol. 41, No. 4 0095-1137/03/$08.00 0 DOI: 10.1128/JCM.41.4.1687 1693.2003 Copyright 2003, American Society for Microbiology. All Rights Reserved.
More informationMethicillin-Resistant Staphylococcus aureus (MRSA) S urveillance Report 2008 Background Methods
Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance Report 2008 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Department of Human Services
More informationVeterinary and Agrochemical Research Centre
Veterinary and Agrochemical Research Centre Report on susceptibility of Salmonella serotypes in Belgium. P. Butaye Susceptibility of Salmonella strains was assessed by MIC determination using Sensititer
More informationMechanism of VanA Resistance. VRE Outbreaks & What I Learned in Kindergarten. vanb Resistance. Glycopeptide-resistant Enterococcal Phenotypes
VRE Outbreaks & What I Learned in Kindergarten Mechanism of VanA Resistance Dr. Dick Zoutman Queen s University Hosted by Paul Webber paul@webbertraining.com Glycopeptide-resistant Enterococcal Phenotypes
More informationReceived 24 August 2010/Returned for modification 7 November 2010/Accepted 7 February 2011
JOURNAL OF CLINICAL MICROBIOLOGY, Apr. 2011, p. 1583 1587 Vol. 49, No. 4 0095-1137/11/$12.00 doi:10.1128/jcm.01719-10 Copyright 2011, American Society for Microbiology. All Rights Reserved. Clinical and
More informationEPIDEMIOLOGY AND CONTROL OF THE FIRST REPORTED VANCOMYCIN-RESISTANT ENTEROCOCCUS OUTBREAK AT A TERTIARY-CARE HOSPITAL IN BANGKOK, THAILAND
EPIDEMIOLOGY AND CONTROL OF THE FIRST REPORTED VANCOMYCIN-RESISTANT ENTEROCOCCUS OUTBREAK AT A TERTIARY-CARE HOSPITAL IN BANGKOK, THAILAND Darunee Chotiprasitsakul 1, Pitak Santanirand 2, Phantanee Thitichai
More informationAntibiotic treatment of streptococcal and enterococcal endocarditis: an overview
European Heart Journal (1995) 16 {Supplement B), 75-79 Antibiotic treatment of streptococcal and enterococcal endocarditis: an overview P. FRANCIOLI Division of Hospital Preventative Medicine and Department
More informationKeywords coagulase-negative staphylococci, colonization, cross-transmission, infection control measures, intensive care unit
Critical Care February 2004 Vol 8 No 1 Agvald-Öhman et al. Research Multiresistant coagulase-negative staphylococci disseminate frequently between intubated patients in a multidisciplinary intensive care
More informationExploring the evolution of MRSA with Whole Genome Sequencing
Exploring the evolution of MRSA with Whole Genome Sequencing PhD student: Zheng WANG Supervisor: Professor Margaret IP Department of Microbiology, CUHK Joint Graduate Seminar Department of Microbiology,
More informationPublished Quarterly Mangalore, South India ISSN Volume 3, Issue 4; October-December 2004
Published Quarterly Mangalore, South India ISSN 0972-5997 Volume 3, Issue 4; October-December 2004 Original Article Plasmid-Encoded Multidrug Resistance of Salmonella typhi and some Enteric Bacteria in
More informationWhole genome sequencing & new strain typing methods in IPC. Lyn Gilbert ACIPC conference Hobart, November 2015
Whole genome sequencing & new strain typing methods in IPC Lyn Gilbert ACIPC conference Hobart, November 2015 Why do strain typing? Evolution, population genetics, geographic distribution 2 Why strain
More informationIn Vitro Susceptibility of Staphylococci and Enterococci to Vancomycin and Teicoplanin
In Vitro Susceptibility of Staphylococci and Enterococci to Vancomycin and Teicoplanin 19 A. Guzek, K. Korzeniewski, Aneta Nitsch-Osuch, Z. Rybicki, and E. Prokop Abstract Hospital-acquired infections
More informationThe Year in Infection Control
The Year in Infection Control Andie Lee Departments of Infectious Diseases and Microbiology Royal Prince Alfred Hospital Sydney, Australia 1 1.223 million Pubmed publications last 12 months 2 Selection
More informationResistance to new anti-grampositive. Roland Leclercq, Microbiology, CHU Cote de Nacre, Caen, France
Resistance to new anti-grampositive agents Roland Leclercq, Microbiology, CHU Cote de Nacre, Caen, France Recently available antimicrobials against MDR Gram-positive infections Cyclic lipopeptide: daptomycin
More informationMultidrug-Resistant Pseudomonas aeruginosa: Risk Factors and Clinical Impact
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Jan. 2006, p. 43 48 Vol. 50, No. 1 0066-4804/06/$08.00 0 doi:10.1128/aac.50.1.43 48.2006 Copyright 2006, American Society for Microbiology. All Rights Reserved. Multidrug-Resistant
More informationAffinity of Doripenem and Comparators to Penicillin-Binding Proteins in Escherichia coli and ACCEPTED
AAC Accepts, published online ahead of print on February 00 Antimicrob. Agents Chemother. doi:./aac.01-0 Copyright 00, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationAbstract. Brief Communication. KT Lim, YA Hanifah, MYM Yusof, *KL Thong. Introduction
Indian Journal of Medical Microbiology, (2012) 30(2): 203-7 1 Brief Communication erma, ermc, tetm and tetk are essential for erythromycin and tetracycline resistance among methicillin-resistant Staphylococcus
More informationIdentification and characterization of linezolid-resistant USA300 Staphylococcus aureus
AAC Accepts, published online ahead of print on 18 August 2014 Antimicrob. Agents Chemother. doi:10.1128/aac.03380-14 Copyright 2014, American Society for Microbiology. All Rights Reserved. 1 2 Identification
More informationGlobal Spread of Vancomycinresistant. from Distinct Nosocomial Genetic Complex
Chapter Global Spread of Vancomycinresistant Enterococcus faecium from Distinct Nosocomial Genetic Complex Rob J.L. Willems, 1 Janetta Top, 1 Marga van Santen, 2 D. Ashley Robinson, 3 Teresa M. Coque,
More informationTRANSIENT INTESTINAL CARRIAGE AFTER INGESTION OF ANTIBIOTIC-RESISTANT E. FAECIUM FROM MEAT
TRANSIENT INTESTINAL CARRIAGE AFTER INGESTION OF ANTIBIOTIC-RESISTANT E. FAECIUM FROM MEAT TRANSIENT INTESTINAL CARRIAGE AFTER INGESTION OF ANTIBIOTIC-RESISTANT ENTEROCOCCUS FAECIUM FROM CHICKEN AND PORK
More informationMolecular characterisation of CTX-M-type extendedspectrum β-lactamases of Escherichia coli isolated from a Portuguese University Hospital
EJHP Science Volume 17 2011 Issue 3 P. 1-5 2011 Pharma Publishing and Media Europe. All rights reserved 1781-7595 25 www.ejhp.eu Molecular characterisation of CTX-M-type extendedspectrum β-lactamases of
More informationModerate-Level Resistance to Glycopeptide LY Mediated by Genes of the vana and vanb Clusters in Enterococci
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Aug. 1999, p. 1875 1880 Vol. 43, No. 8 0066-4804/99/$04.00 0 Copyright 1999, American Society for Microbiology. All Rights Reserved. Moderate-Level Resistance to
More informationMaterials and Methods
652 Laboratory Characterization of Methicillin-Resistant Staphylococcus aureus in Canadian Hospitals: Results of 5 Years of National Surveillance, 1995 1999 Andrew E. Simor, 1 Marianna Ofner-Agostini,
More informationQUANTIFYING HUMAN HEALTH RISKS FROM USE OF VIRGINIAMYCIN IN CHICKENS
QUANTIFYING HUMAN HEALTH RISKS FROM USE OF VIRGINIAMYCIN IN CHICKENS L. Anthony Cox, Ph.D. Cox Associates, Denver, CO and Kenneth W. Bafundo, Ph.D. Phibro Animal Health Fairfield, NJ OBJECTIVE Familiarization
More informationSteven D. Brown* and Maria M. Traczewski. The Clinical Microbiology Institute, 9725 SW Commerce Circle, Wilsonville, Oregon 97070
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, May 2010, p. 2063 2069 Vol. 54, No. 5 0066-4804/10/$12.00 doi:10.1128/aac.01569-09 Copyright 2010, American Society for Microbiology. All Rights Reserved. Comparative
More informationVRE. Is There Validity to VRE Admission Screening? Dr. Michelle Alfa, Diagnos>c Services Manitoba A Webber Training Teleclass. Overview of Session:
Dr. Michelle Alfa, Ph.D., FCCM Medical Director, Clinical Microbiology Discipline, Diagnostic Services Manitoba Hosted by Paul Webber paul@webbertraining.com December 19, 2013 Session Rated PG99: Scenes
More informationResFinder 4.0: towards in silico antibiograms
ResFinder 4.0: towards in silico antibiograms Valeria Bortolaia, DVM, PhD Research group for Genomic Epidemiology National Food Institute Technical University of Denmark The path to WGS-based AMR prediction
More informationReceived 16 September 1999/Returned for modification 24 December 1999/Accepted 31 January 2000
JOURNAL OF CLINICAL MICROBIOLOGY, Apr. 2000, p. 1575 1580 Vol. 38, No. 4 0095-1137/00/$04.00 0 Copyright 2000, American Society for Microbiology. All Rights Reserved. A Novel Multiresistant Streptococcus
More informationEscherichia coli diagnostics
Escherichia coli diagnostics Workshop on Whole Genome Sequencing and Analysis, 19-21 Mar. 2018 Learning objective: After this lecture and exercise, you should be able to describe how the CGE methods for
More informationAnnual Surveillance Summary: Vancomycin- Resistant Enterococci (VRE) Infections in the Military Health System (MHS), 2016
Annual Surveillance Summary: Vancomycin- Resistant Enterococci (VRE) Infections in the Military Health System (MHS), 2016 Kristen Rossi and Uzo Chukwuma Approved for public release. Distribution is unlimited.
More informationNew Technology for Detecting Multidrug-Resistant Pathogens in the Clinical Microbiology Laboratory
New Technology for Detecting Multidrug-Resistant Pathogens in the Clinical Microbiology Laboratory Lance R. Peterson* and Gary A. Noskin* *Northwestern Memorial Hospital and Northwestern University Medical
More informationAntimicrobial prophylaxis in liver transplant A multicenter survey endorsed by the European Liver and Intestine Transplant Association
Antimicrobial prophylaxis in liver transplant A multicenter survey endorsed by the European Liver and Intestine Transplant Association Els Vandecasteele, Jan De Waele, Dominique Vandijck, Stijn Blot, Dirk
More informationWestern Australian Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE) Epidemiology and Typing Report
Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research Microbiology and Infectious Diseases Department PathWest Laboratory Medicine-WA, Royal Perth Hospital
More informationEnterobacter aerogenes
Enterobacter aerogenes Piagnerelli M 1, Carlier E 1, Deplano A 3, Lejeune P 1, Govaerts D 2 1 Departments of Intensive Care and 2 Microbiology, A. Vésale Hospital. 6110 Montigny-le-Tilleul. 3 Department
More informationAdenium Biotech. Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet - Søren Neve, PhD, project director, ex Lundbeck, Novozymes
Adenium Biotech Management: - Peter Nordkild, MD, CEO, ex Novo Nordisk, Ferring, Egalet - Søren Neve, PhD, project director, ex Lundbeck, Novozymes Board of Directors: - Stephan Christgau, PhD, chairman,
More informationChain of Infection Agent Mode of transmission Contact (direct, indirect, droplet spread) Airborne Common-vehicle spread Host
Goals Microbiology of Healthcare-associated Infections William A. Rutala, Ph.D., M.P.H. Director, Statewide Program for Infection Control and Epidemiology and Research Professor of Medicine, University
More informationEUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL. (Adopted on 23 January 2003)
EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL Directorate C - Scientific Opinions C2 - Management of scientific committees; scientific co-operation and networks REPORT OF THE SCIENTIFIC
More informationReceived 10 October 2008/Returned for modification 15 March 2009/Accepted 1 June 2009
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Aug. 2009, p. 3447 3452 Vol. 53, No. 8 0066-4804/09/$08.00 0 doi:10.1128/aac.01365-08 Copyright 2009, American Society for Microbiology. All Rights Reserved. Prospective
More informationReport on the Japanese Veterinary Antimicrobial Resistance Monitoring System
Report on the Japanese Veterinary Antimicrobial Resistance Monitoring System 2014 2015 National Veterinary Assay Laboratory Ministry of Agriculture, Forestry and Fisheries 2018 Contents Introduction...
More informationStreptococcus pneumoniae 356 moxifloxacin (MFLX), garenoxacin (GRNX) sitafloxacin
2009 21 1) 1, 2) 1, 2) 1) 1) 2) 1) 1) 1) 1) 1) 1, 2) 1) 2) 20 2 29 21 1 14 Streptococcus pneumoniae 356 moxifloxacin (MFLX), garenoxacin (GRNX) sitafloxacin (STFX), DX619 S. pneumoniae S. pneumoniae 60
More informationAMR prediction based on WGS data
AMR prediction based on WGS data Valeria Bortolaia, DVM, PhD Research Group for Genomic Epidemiology National Food Institute Technical University of Denmark This lecture How to use WGS for AMR surveillance?
More informationDetection of vana and vanb Genetic Determinants in Vancomycin Resistant Enterococci in Kashmir Region of North India-A Hospital Based Study
British Microbiology Research Journal 17(2): 1-8, 2016, Article no.bmrj.29246 ISSN: 2231-0886, NLM ID: 101608140 SCIENCEDOMAIN international www.sciencedomain.org Detection of vana and vanb Genetic Determinants
More informationNew Insights into Peptidoglycan Biosynthesis. Louis B. Rice Warren Alpert Medical School of Brown University Providence, RI
New Insights into Peptidoglycan Biosynthesis Louis B. Rice Warren Alpert Medical School of Brown University Providence, RI Outline of Presentation Review role of penicillin-binding proteins in cell wall
More informationEpidemiology and Laboratory Diagnosis of Fungal Diseases
Medical Mycology (BIOL 4849) Summer 2007 Dr. Cooper Epidemiology of Mycoses Epidemiology and Laboratory Diagnosis of Fungal Diseases Mycosis (pl., mycoses) - an infection caused by a fungus Two broad categories
More informationEnhanced EARS-Net Surveillance 2017 First Half
1 Enhanced EARS-Net Surveillance 2017 First Half In this report Main results for 2017, first half Breakdown of factors by organism and resistance subtype Device-association Data quality assessment Key
More informationUniversity of Alberta Hospital Antibiogram for 2007 and 2008 Division of Medical Microbiology Department of Laboratory Medicine and Pathology
University of Alberta Hospital Antibiogram for 2007 and 2008 Division of Medical Microbiology Department of Laboratory Medicine and Pathology This material is supported in part by unrestricted educational
More informationReport on susceptibility of Salmonella serotypes in Belgium Vicky Jasson
CODA-CERVA Report on susceptibility of Salmonella serotypes in Belgium 2014. Vicky Jasson Veterinary and Agrochemical Research Centre 1 Introduction Salmonella is one of the most important bacterial zoonotic
More informationGenetic Analysis of Faropenem-resistant Enterococcus faecalis in Urinary Isolates
J. Antibiot. 61(4): 213 221, 2008 ORIGINAL ARTICLE THE JOURNAL OF ANTIBIOTICS Genetic Analysis of Faropenem-resistant Enterococcus faecalis in Urinary Isolates Noriyuki Hiraga, Tetsuro Muratani, Seiji
More informationReceived 30 March 2005; returned 16 June 2005; revised 8 September 2005; accepted 12 September 2005
Journal of Antimicrobial Chemotherapy (2005) 56, 1047 1052 doi:10.1093/jac/dki362 Advance Access publication 20 October 2005 Evaluation of PPI-0903M (T91825), a novel cephalosporin: bactericidal activity,
More informationDiscussion points CLSI M100 S19 Update. #1 format of tables has changed. #2 non susceptible category
Discussion points 2009 CLSI M100 S19 Update Nebraska Public Health Laboratory Changes most important to routine antimicrobial susceptibility testing. Documents available Janet Hindler discussion slide
More informationMolecular Epidemiology of Penicillin-Susceptible, Multidrug- Resistant Serotype 6B Pneumococci Isolated from Children in Greece
JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 2001, p. 581 585 Vol. 39, No. 2 0095-1137/01/$04.00 0 DOI: 10.1128/JCM.39.2.581 585.2001 Copyright 2001, American Society for Microbiology. All Rights Reserved. Molecular
More informationChapter 19: The Genetics of Viruses and Bacteria
Chapter 19: The Genetics of Viruses and Bacteria What is Microbiology? Microbiology is the science that studies microorganisms = living things that are too small to be seen with the naked eye Microorganisms
More informationEndocardite infectieuse
Endocardite infectieuse 1. Raccourcir le traitement: jusqu où? 2. Proposer un traitement ambulatoire: à partir de quand? Endocardite infectieuse A B 90 P = 0.014 20 P = 0.0005 % infective endocarditis
More information1) 1) 1) 2) 2) (ICU) Key words: (ICU), ( ) 1 30 TEL: FAX: Vol. 17 No
2007 277 1) 1) 1) 2) 2) 3) 4) 5) 6) 1) 2) 3) 4) 5) 6) 18 10 17 19 8 20 16 7 1 (ICU) 20 2x 1.6 2.2 2SD 14 1 4 1 10 7 3 2 9 7.6; 95 2.37 24.62 6 4 5 1 DNA SpeI 9 2 A 7 B 2 A 3 B 1 ICU ICU 7 20 10 5 Key words:
More informationReceived 7 February 2003/Returned for modification 7 April 2003/Accepted 17 April 2003
JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 2003, p. 4194 4216 Vol. 41, No. 9 0095-1137/03/$08.00 0 DOI: 10.1128/JCM.41.9.4194 4216.2003 Clonal Distribution of Invasive Pneumococcal Isolates from Children
More informationMolecular Epidemiology of Serratia marcescens in Two Hospitals in Danzig, Poland, over a 5-Year Period
JOURNAL OF CLINICAL MICROBIOLOGY, July 2004, p. 3108 3116 Vol. 42, No. 7 0095-1137/04/$08.00 0 DOI: 10.1128/JCM.42.7.3108 3116.2004 Copyright 2004, American Society for Microbiology. All Rights Reserved.
More informationMolecular Characterization of Penicillin-Resistant Streptococcus pneumoniae Isolates from Bulgaria
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 1999, p. 638 648 Vol. 37, No. 3 0095-1137/99/$04.00 0 Copyright 1999, American Society for Microbiology. All Rights Reserved. Molecular Characterization of Penicillin-Resistant
More informationPre- and Postvaccination Clonal Compositions of Invasive Pneumococcal Serotypes for Isolates Collected in the United States in 1999, 2001, and 2002
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 2006, p. 999 1017 Vol. 44, No. 3 0095-1137/06/$08.00 0 doi:10.1128/jcm.44.3.999 1017.2006 Copyright 2006, American Society for Microbiology. All Rights Reserved.
More informationProficiency of Clinical Laboratories in Spain in Detecting Vancomycin-Resistant Enterococcus spp.
JOURNAL OF CLINICAL MICROBIOLOGY, July 1999, p. 2148 2152 Vol. 37, No. 7 0095-1137/99/$04.00 0 Proficiency of Clinical Laboratories in Spain in Detecting Vancomycin-Resistant Enterococcus spp. JUAN ALONSO-ECHANOVE,
More information