Skip to main content
PMC home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Dec;35(12):3026–3031. doi: 10.1128/jcm.35.12.3026-3031.1997

Fecal carriage of vancomycin-resistant enterococci in hospitalized patients and those living in the community in The Netherlands.

H P Endtz 1, N van den Braak 1, A van Belkum 1, J A Kluytmans 1, J G Koeleman 1, L Spanjaard 1, A Voss 1, A J Weersink 1, C M Vandenbroucke-Grauls 1, A G Buiting 1, A van Duin 1, H A Verbrugh 1
PMCID: PMC230116  PMID: 9399488

Abstract

In order to determine the prevalence of vancomycin-resistant enterococci (VRE) in The Netherlands, 624 hospitalized patients from intensive care units or hemato-oncology wards in nine hospitals and 200 patients living in the community were screened for VRE colonization. Enterococci were found in 49% of the hospitalized patients and in 80% of the patients living in the community. Of these strains, 43 and 32%, respectively, were Enterococcus faecium. VRE were isolated from 12 of 624 (2%) and 4 of 200 (2%) hospitalized patients and patients living in the community, respectively. PCR analysis of these 16 strains and 11 additional clinical VRE isolates from one of the participating hospitals revealed 24 vanA gene-containing, 1 vanB gene-containing, and 2 vanC1 gene-containing strains. All strains were cross-resistant to avoparcin but were sensitive to the novel glycopeptide antibiotic LY333328. Genotyping of the strains by arbitrarily primed PCR and pulsed-field gel electrophoresis revealed a high degree of genetic heterogeneity. This underscores a lack of hospital-driven endemicity of VRE clones. It is suggested that the VRE in hospitalized patients have originated from unknown sources in the community.

Full Text

The Full Text of this article is available as a PDF (712.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barbier N., Saulnier P., Chachaty E., Dumontier S., Andremont A. Random amplified polymorphic DNA typing versus pulsed-field gel electrophoresis for epidemiological typing of vancomycin-resistant enterococci. J Clin Microbiol. 1996 May;34(5):1096–1099. doi: 10.1128/jcm.34.5.1096-1099.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Benno Y., Suzuki K., Suzuki K., Narisawa K., Bruce W. R., Mitsuoka T. Comparison of the fecal microflora in rural Japanese and urban Canadians. Microbiol Immunol. 1986;30(6):521–532. doi: 10.1111/j.1348-0421.1986.tb02978.x. [DOI] [PubMed] [Google Scholar]
  3. Boom R., Sol C. J., Salimans M. M., Jansen C. L., Wertheim-van Dillen P. M., van der Noordaa J. Rapid and simple method for purification of nucleic acids. J Clin Microbiol. 1990 Mar;28(3):495–503. doi: 10.1128/jcm.28.3.495-503.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Coque T. M., Tomayko J. F., Ricke S. C., Okhyusen P. C., Murray B. E. Vancomycin-resistant enterococci from nosocomial, community, and animal sources in the United States. Antimicrob Agents Chemother. 1996 Nov;40(11):2605–2609. doi: 10.1128/aac.40.11.2605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Devriese L. A., Ieven M., Goossens H., Vandamme P., Pot B., Hommez J., Haesebrouck F. Presence of vancomycin-resistant enterococci in farm and pet animals. Antimicrob Agents Chemother. 1996 Oct;40(10):2285–2287. doi: 10.1128/aac.40.10.2285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Donabedian S., Chow J. W., Shlaes D. M., Green M., Zervos M. J. DNA hybridization and contour-clamped homogeneous electric field electrophoresis for identification of enterococci to the species level. J Clin Microbiol. 1995 Jan;33(1):141–145. doi: 10.1128/jcm.33.1.141-145.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Donnelly J. P., Voss A., Witte W., Murray B. E. Does the use in animals of antimicrobial agents, including glycopeptide antibiotics, influence the efficacy of antimicrobial therapy in humans? J Antimicrob Chemother. 1996 Feb;37(2):389–392. doi: 10.1093/jac/37.2.389. [DOI] [PubMed] [Google Scholar]
  8. Dutka-Malen S., Evers S., Courvalin P. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR. J Clin Microbiol. 1995 Jan;33(1):24–27. doi: 10.1128/jcm.33.1.24-27.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Edmond M. B., Wenzel R. P., Pasculle A. W. Vancomycin-resistant Staphylococcus aureus: perspectives on measures needed for control. Ann Intern Med. 1996 Feb 1;124(3):329–334. doi: 10.7326/0003-4819-124-3-199602010-00008. [DOI] [PubMed] [Google Scholar]
  10. Emori T. G., Gaynes R. P. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev. 1993 Oct;6(4):428–442. doi: 10.1128/cmr.6.4.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Facklam R., Pigott N., Franklin R., Elliott J. Evaluation of three disk tests for identification of enterococci, leuconostocs, and pediococci. J Clin Microbiol. 1995 Apr;33(4):885–887. doi: 10.1128/jcm.33.4.885-887.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ford M., Perry J. D., Gould F. K. Use of cephalexin-aztreonam-arabinose agar for selective isolation of Enterococcus faecium. J Clin Microbiol. 1994 Dec;32(12):2999–3001. doi: 10.1128/jcm.32.12.2999-3001.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gliddon M. J., Poole C. A., Johannsen F. H., Bucher E., Thalmann A., Dresbach C., Abramowski B. Microbiological assay of avoparcin in animal feeds and pre-mixes--co-operative study. Analyst. 1992 Sep;117(9):1401–1405. doi: 10.1039/an9921701401. [DOI] [PubMed] [Google Scholar]
  14. Gordts B., Van Landuyt H., Ieven M., Vandamme P., Goossens H. Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol. 1995 Nov;33(11):2842–2846. doi: 10.1128/jcm.33.11.2842-2846.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. 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]
  16. Jones R. N., Barrett M. S., Erwin M. E. In vitro activity and spectrum of LY333328, a novel glycopeptide derivative. Antimicrob Agents Chemother. 1997 Feb;41(2):488–493. doi: 10.1128/aac.41.2.488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. 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]
  18. 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]
  19. Miranda A. G., Singh K. V., Murray B. E. DNA fingerprinting of Enterococcus faecium by pulsed-field gel electrophoresis may be a useful epidemiologic tool. J Clin Microbiol. 1991 Dec;29(12):2752–2757. doi: 10.1128/jcm.29.12.2752-2757.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Montecalvo M. A., Horowitz H., Gedris C., Carbonaro C., Tenover F. C., Issah A., Cook P., Wormser G. P. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother. 1994 Jun;38(6):1363–1367. doi: 10.1128/aac.38.6.1363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Murray B. E. The life and times of the Enterococcus. Clin Microbiol Rev. 1990 Jan;3(1):46–65. doi: 10.1128/cmr.3.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. 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]
  23. Nicas T. I., Mullen D. L., Flokowitsch J. E., Preston D. A., Snyder N. J., Stratford R. E., Cooper R. D. Activities of the semisynthetic glycopeptide LY191145 against vancomycin-resistant enterococci and other gram-positive bacteria. Antimicrob Agents Chemother. 1995 Nov;39(11):2585–2587. doi: 10.1128/aac.39.11.2585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Noble C. J. Carriage of group D streptococci in the human bowel. J Clin Pathol. 1978 Dec;31(12):1182–1186. doi: 10.1136/jcp.31.12.1182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Papanicolaou G. A., Meyers B. R., Meyers J., Mendelson M. H., Lou W., Emre S., Sheiner P., Miller C. Nosocomial infections with vancomycin-resistant Enterococcus faecium in liver transplant recipients: risk factors for acquisition and mortality. Clin Infect Dis. 1996 Oct;23(4):760–766. doi: 10.1093/clinids/23.4.760. [DOI] [PubMed] [Google Scholar]
  26. Schulz J. E., Sahm D. F. Reliability of the E test for detection of ampicillin, vancomycin, and high-level aminoglycoside resistance in Enterococcus spp. J Clin Microbiol. 1993 Dec;31(12):3336–3339. doi: 10.1128/jcm.31.12.3336-3339.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Schwalbe R. S., McIntosh A. C., Qaiyumi S., Johnson J. A., Johnson R. J., Furness K. M., Holloway W. J., Steele-Moore L. In vitro activity of LY333328, an investigational glycopeptide antibiotic, against enterococci and staphylococci. Antimicrob Agents Chemother. 1996 Oct;40(10):2416–2419. doi: 10.1128/aac.40.10.2416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Spera R. V., Jr, Farber B. F. Multiply-resistant Enterococcus faecium. The nosocomial pathogen of the 1990s. JAMA. 1992 Nov 11;268(18):2563–2564. [PubMed] [Google Scholar]
  29. Suppola J. P., Volin L., Valtonen V. V., Vaara M. Overgrowth of Enterococcus faecium in the feces of patients with hematologic malignancies. Clin Infect Dis. 1996 Oct;23(4):694–697. doi: 10.1093/clinids/23.4.694. [DOI] [PubMed] [Google Scholar]
  30. Tenover F. C., Arbeit R. D., Goering R. V., Mickelsen P. A., Murray B. E., Persing D. H., Swaminathan B. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995 Sep;33(9):2233–2239. doi: 10.1128/jcm.33.9.2233-2239.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. 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]
  32. 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]
  33. van Belkum A., Kluytmans J., van Leeuwen W., Bax R., Quint W., Peters E., Fluit A., Vandenbroucke-Grauls C., van den Brule A., Koeleman H. Multicenter evaluation of arbitrarily primed PCR for typing of Staphylococcus aureus strains. J Clin Microbiol. 1995 Jun;33(6):1537–1547. doi: 10.1128/jcm.33.6.1537-1547.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. van Belkun A., van den Braak N., Thomassen R., Verbrugh H., Endtz H. Vancomycin-resistant enterococci in cats and dogs. Lancet. 1996 Oct 12;348(9033):1038–1039. doi: 10.1016/s0140-6736(05)64973-2. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES