Abstract
The presence of vancomycin-resistant enterococci (VRE) was looked for in fecal samples from 104 healthy volunteers (3 with hospital exposure), 100 selected hospitalized patients, and various environmental sources (44 commercial chickens, 5 farm-raised chickens, 3 turkeys, and 2 chicken farm lagoon slurries). Five probiotic preparations were also studied. No VRE with vanA or vanB genes were isolated from the healthy volunteers without hospital exposure, environmental sources, or probiotic preparations. VRE with vanB were found in the stools of 16% of the high-risk hospitalized patients and in one volunteer with hospital contact. All VRE examined could be classified into one of two clones by pulsed-field gel electrophoresis. VRE from 11 of the colonized patients were quantified and ranged from 10(3) to 10(6) CFU/g of stool. This study, in contrast to findings in Europe, failed to find evidence of VanA- or VanB-type VRE in the community or environmental sources in Houston, Texas, and suggests that these settings are not a likely source of VRE in hospitals in this geographic area.
Full Text
The Full Text of this article is available as a PDF (204.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aarestrup F. M. Occurrence of glycopeptide resistance among Enterococcus faecium isolates from conventional and ecological poultry farms. Microb Drug Resist. 1995 Fall;1(3):255–257. doi: 10.1089/mdr.1995.1.255. [DOI] [PubMed] [Google Scholar]
- Arthur M., Courvalin P. Genetics and mechanisms of glycopeptide resistance in enterococci. Antimicrob Agents Chemother. 1993 Aug;37(8):1563–1571. doi: 10.1128/aac.37.8.1563. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bates J., Jordens J. Z., Griffiths D. T. Farm animals as a putative reservoir for vancomycin-resistant enterococcal infection in man. J Antimicrob Chemother. 1994 Oct;34(4):507–514. doi: 10.1093/jac/34.4.507. [DOI] [PubMed] [Google Scholar]
- Bingen E. H., Denamur E., Lambert-Zechovsky N. Y., Elion J. Evidence for the genetic unrelatedness of nosocomial vancomycin-resistant Enterococcus faecium strains in a pediatric hospital. J Clin Microbiol. 1991 Sep;29(9):1888–1892. doi: 10.1128/jcm.29.9.1888-1892.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Boyce J. M., Opal S. M., Chow J. W., Zervos M. J., Potter-Bynoe G., Sherman C. B., Romulo R. L., Fortna S., Medeiros A. A. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol. 1994 May;32(5):1148–1153. doi: 10.1128/jcm.32.5.1148-1153.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chow J. W., Kuritza A., Shlaes D. M., Green M., Sahm D. F., Zervos M. J. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J Clin Microbiol. 1993 Jun;31(6):1609–1611. doi: 10.1128/jcm.31.6.1609-1611.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Clark N. C., Cooksey R. C., Hill B. C., Swenson J. M., Tenover F. C. Characterization of glycopeptide-resistant enterococci from U.S. hospitals. Antimicrob Agents Chemother. 1993 Nov;37(11):2311–2317. doi: 10.1128/aac.37.11.2311. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Coque T. M., Arduino R. C., Murray B. E. High-level resistance to aminoglycosides: comparison of community and nosocomial fecal isolates of enterococci. Clin Infect Dis. 1995 Apr;20(4):1048–1051. doi: 10.1093/clinids/20.4.1048. [DOI] [PubMed] [Google Scholar]
- Coque T. M., Murray B. E. Identification of Enterococcus faecalis strains by DNA hybridization and pulsed-field gel electrophoresis. J Clin Microbiol. 1995 Dec;33(12):3368–3369. doi: 10.1128/jcm.33.12.3368-3369.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Costa Y., Galimand M., Leclercq R., Duval J., Courvalin P. Characterization of the chromosomal aac(6')-Ii gene specific for Enterococcus faecium. Antimicrob Agents Chemother. 1993 Sep;37(9):1896–1903. doi: 10.1128/aac.37.9.1896. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dutka-Malen S., Blaimont B., Wauters G., Courvalin P. Emergence of high-level resistance to glycopeptides in Enterococcus gallinarum and Enterococcus casseliflavus. Antimicrob Agents Chemother. 1994 Jul;38(7):1675–1677. doi: 10.1128/aac.38.7.1675. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dutka-Malen S., Molinas C., Arthur M., Courvalin P. Sequence of the vanC gene of Enterococcus gallinarum BM4174 encoding a D-alanine:D-alanine ligase-related protein necessary for vancomycin resistance. Gene. 1992 Mar 1;112(1):53–58. doi: 10.1016/0378-1119(92)90302-6. [DOI] [PubMed] [Google Scholar]
- Dutka-Malen S., Molinas C., Arthur M., Courvalin P. The VANA glycopeptide resistance protein is related to D-alanyl-D-alanine ligase cell wall biosynthesis enzymes. Mol Gen Genet. 1990 Dec;224(3):364–372. doi: 10.1007/BF00262430. [DOI] [PubMed] [Google Scholar]
- Evers S., Sahm D. F., Courvalin P. The vanB gene of vancomycin-resistant Enterococcus faecalis V583 is structurally related to genes encoding D-Ala:D-Ala ligases and glycopeptide-resistance proteins VanA and VanC. Gene. 1993 Feb 14;124(1):143–144. doi: 10.1016/0378-1119(93)90779-3. [DOI] [PubMed] [Google Scholar]
- Hall L. M., Chen H. Y., Williams R. J. Vancomycin-resistant Enterococcus durans. Lancet. 1992 Oct 31;340(8827):1105–1105. doi: 10.1016/0140-6736(92)93133-8. [DOI] [PubMed] [Google Scholar]
- Handwerger S., Raucher B., Altarac D., Monka J., Marchione S., Singh K. V., Murray B. E., Wolff J., Walters B. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis. 1993 Jun;16(6):750–755. doi: 10.1093/clind/16.6.750. [DOI] [PubMed] [Google Scholar]
- Jordens J. Z., Bates J., Griffiths D. T. Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother. 1994 Oct;34(4):515–528. doi: 10.1093/jac/34.4.515. [DOI] [PubMed] [Google Scholar]
- Klare I., Heier H., Claus H., Böhme G., Marin S., Seltmann G., Hakenbeck R., Antanassova V., Witte W. Enterococcus faecium strains with vanA-mediated high-level glycopeptide resistance isolated from animal foodstuffs and fecal samples of humans in the community. Microb Drug Resist. 1995 Fall;1(3):265–272. doi: 10.1089/mdr.1995.1.265. [DOI] [PubMed] [Google Scholar]
- Klare I., Heier H., Claus H., Reissbrodt R., Witte W. vanA-mediated high-level glycopeptide resistance in Enterococcus faecium from animal husbandry. FEMS Microbiol Lett. 1995 Jan 15;125(2-3):165–171. doi: 10.1111/j.1574-6968.1995.tb07353.x. [DOI] [PubMed] [Google Scholar]
- Klare I., Heier H., Claus H., Witte W. Environmental strains of Enterococcus faecium with inducible high-level resistance to glycopeptides. FEMS Microbiol Lett. 1993 Jan 1;106(1):23–29. doi: 10.1111/j.1574-6968.1993.tb05930.x. [DOI] [PubMed] [Google Scholar]
- Korten V., Huang W. M., Murray B. E. Analysis by PCR and direct DNA sequencing of gyrA mutations associated with fluoroquinolone resistance in Enterococcus faecalis. Antimicrob Agents Chemother. 1994 Sep;38(9):2091–2094. doi: 10.1128/aac.38.9.2091. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leclercq R., Derlot E., Duval J., Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med. 1988 Jul 21;319(3):157–161. doi: 10.1056/NEJM198807213190307. [DOI] [PubMed] [Google Scholar]
- Leclercq R., Dutka-Malen S., Duval J., Courvalin P. Vancomycin resistance gene vanC is specific to Enterococcus gallinarum. Antimicrob Agents Chemother. 1992 Sep;36(9):2005–2008. doi: 10.1128/aac.36.9.2005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Livornese L. L., Jr, Dias S., Samel C., Romanowski B., Taylor S., May P., Pitsakis P., Woods G., Kaye D., Levison M. E. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med. 1992 Jul 15;117(2):112–116. doi: 10.7326/0003-4819-117-2-112. [DOI] [PubMed] [Google Scholar]
- Murray B. E., Singh K. V., Heath J. D., Sharma B. R., Weinstock G. M. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J Clin Microbiol. 1990 Sep;28(9):2059–2063. doi: 10.1128/jcm.28.9.2059-2063.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murray B. E. What can we do about vancomycin-resistant enterococci? Clin Infect Dis. 1995 May;20(5):1134–1136. doi: 10.1093/clinids/20.5.1134. [DOI] [PubMed] [Google Scholar]
- Navarro F., Courvalin P. Analysis of genes encoding D-alanine-D-alanine ligase-related enzymes in Enterococcus casseliflavus and Enterococcus flavescens. Antimicrob Agents Chemother. 1994 Aug;38(8):1788–1793. doi: 10.1128/aac.38.8.1788. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Plessis P., Lamy T., Donnio P. Y., Autuly F., Grulois I., Le Prisé P. Y., Avril J. L. Epidemiologic analysis of glycopeptide-resistant Enterococcus strains in neutropenic patients receiving prolonged vancomycin administration. Eur J Clin Microbiol Infect Dis. 1995 Nov;14(11):959–963. doi: 10.1007/BF01691377. [DOI] [PubMed] [Google Scholar]
- Sahm D. F., Kissinger J., Gilmore M. S., Murray P. R., Mulder R., Solliday J., Clarke B. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother. 1989 Sep;33(9):1588–1591. doi: 10.1128/aac.33.9.1588. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shlaes D. M., Al-Obeid S., Shlaes J. H., Boisivon A., Williamson R. Inducible, transferable resistance to vancomycin in Enterococcus faecium, D399. J Antimicrob Chemother. 1989 Apr;23(4):503–508. doi: 10.1093/jac/23.4.503. [DOI] [PubMed] [Google Scholar]
- Shlaes D. M., Bouvet A., Devine C., Shlaes J. H., al-Obeid S., Williamson R. Inducible, transferable resistance to vancomycin in Enterococcus faecalis A256. Antimicrob Agents Chemother. 1989 Feb;33(2):198–203. doi: 10.1128/aac.33.2.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Swenson J. M., Hill B. C., Thornsberry C. Problems with the disk diffusion test for detection of vancomycin resistance in enterococci. J Clin Microbiol. 1989 Sep;27(9):2140–2142. doi: 10.1128/jcm.27.9.2140-2142.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tenover F. C., Tokars J., Swenson J., Paul S., Spitalny K., Jarvis W. Ability of clinical laboratories to detect antimicrobial agent-resistant enterococci. J Clin Microbiol. 1993 Jul;31(7):1695–1699. doi: 10.1128/jcm.31.7.1695-1699.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thal L. A., Chow J. W., Mahayni R., Bonilla H., Perri M. B., Donabedian S. A., Silverman J., Taber S., Zervos M. J. Characterization of antimicrobial resistance in enterococci of animal origin. Antimicrob Agents Chemother. 1995 Sep;39(9):2112–2115. doi: 10.1128/aac.39.9.2112. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Torres C., Reguera J. A., Sanmartin M. J., Pérez-Díaz J. C., Baquero F. vanA-mediated vancomycin-resistant Enterococcus spp. in sewage. J Antimicrob Chemother. 1994 Mar;33(3):553–561. doi: 10.1093/jac/33.3.553. [DOI] [PubMed] [Google Scholar]
- Uttley A. H., Collins C. H., Naidoo J., George R. C. Vancomycin-resistant enterococci. Lancet. 1988 Jan 2;1(8575-6):57–58. doi: 10.1016/s0140-6736(88)91037-9. [DOI] [PubMed] [Google Scholar]
- Uttley A. H., George R. C., Naidoo J., Woodford N., Johnson A. P., Collins C. H., Morrison D., Gilfillan A. J., Fitch L. E., Heptonstall J. High-level vancomycin-resistant enterococci causing hospital infections. Epidemiol Infect. 1989 Aug;103(1):173–181. doi: 10.1017/s0950268800030478. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Van der Auwera P., Pensart N., Korten V., Murray B. E., Leclercq R. Influence of oral glycopeptides on the fecal flora of human volunteers: selection of highly glycopeptide-resistant enterococci. J Infect Dis. 1996 May;173(5):1129–1136. doi: 10.1093/infdis/173.5.1129. [DOI] [PubMed] [Google Scholar]
- Vincent S., Knight R. G., Green M., Sahm D. F., Shlaes D. M. Vancomycin susceptibility and identification of motile enterococci. J Clin Microbiol. 1991 Oct;29(10):2335–2337. doi: 10.1128/jcm.29.10.2335-2337.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Williamson R., Al-Obeid S., Shlaes J. H., Goldstein F. W., Shlaes D. M. Inducible resistance to vancomycin in Enterococcus faecium D366. J Infect Dis. 1989 Jun;159(6):1095–1104. doi: 10.1093/infdis/159.6.1095. [DOI] [PubMed] [Google Scholar]
- Witte W., Klare I. Glycopeptide-resistant Enterococcus faecium outside Hospitals: a commentary. Microb Drug Resist. 1995 Fall;1(3):259–263. doi: 10.1089/mdr.1995.1.259. [DOI] [PubMed] [Google Scholar]