Abstract
A point prevalence culture survey was carried out to investigate the prevalence of fecal carriage of vancomycin-resistant enterococci (VRE) among patients admitted to an 800-bed general hospital where no VRE had been isolated previously. Twenty-two of 636 patients (3.5%) were found to be VRE carriers. Eighteen strains were identified as Enterococcus faecium, three were identified as Enterococcus gallinarum, and one was identified as Enterococcus faecalis. The susceptibilities of the enterococci to ampicillin, vancomycin, and teicoplanin were determined by the disk diffusion and the agar dilution methods. High-level resistance (HLR) to gentamicin and streptomycin was determined by the agar screening method. Eighteen strains (82%) were highly resistant to vancomycin, and four strains (18%) were moderately resistant to vancomycin. Five strains were susceptible to teicoplanin (23%; MICs, < or = 8 micrograms/ml). Only one strain (4.5%, E. faecium) showed HLR to gentamicin, and six strains (27%) showed HLR to streptomycin (one E. faecalis and five E. faecium strains). All 18 E. faecium and 1 E. faecalis strain carried the vanA gene, and 3 E. gallinarum strains carried the vanC gene. An epidemiological investigation revealed several risk factors for VRE colonization: hospitalization and duration of stay in the hematology department and prior vancomycin treatment. The study demonstrates that the patient's gastrointestinal tract is a possible reservoir for VRE, even in hospitals where VRE infections have not yet been observed. Therefore, we conclude that infection control precautions and restriction of glycopeptide usage may be key issues in limiting the emergence and spread of nosocomial VRE infections.
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Selected References
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- 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]
- Boyle J. F., Soumakis S. A., Rendo A., Herrington J. A., Gianarkis D. G., Thurberg B. E., Painter B. G. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol. 1993 May;31(5):1280–1285. doi: 10.1128/jcm.31.5.1280-1285.1993. [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]
- Coene J., De Brauwer E., Gordts B., Van Landuyt H. Vancomycin-resistant Enterococcus faecalis: now also in Belgium. Acta Clin Belg. 1995;50(1):46–47. doi: 10.1080/17843286.1995.11718421. [DOI] [PubMed] [Google Scholar]
- Facklam R. R., Collins M. D. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol. 1989 Apr;27(4):731–734. doi: 10.1128/jcm.27.4.731-734.1989. [DOI] [PMC free article] [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]
- Jones R. N., Sader H. S., Erwin M. E., Anderson S. C. Emerging multiply resistant enterococci among clinical isolates. I. Prevalence data from 97 medical center surveillance study in the United States. Enterococcus Study Group. Diagn Microbiol Infect Dis. 1995 Feb;21(2):85–93. doi: 10.1016/0732-8893(94)00147-o. [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]
- Moellering R. C., Jr Emergence of Enterococcus as a significant pathogen. Clin Infect Dis. 1992 Jun;14(6):1173–1176. doi: 10.1093/clinids/14.6.1173. [DOI] [PubMed] [Google Scholar]
- Shlaes D. M., Binczewski B. Enterococcal resistance to vancomycin and related cyclic glycopeptide antibiotics. Eur J Clin Microbiol Infect Dis. 1990 Feb;9(2):106–110. doi: 10.1007/BF01963634. [DOI] [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]
- 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]