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Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1993 Jul;31(7):1695–1699. doi: 10.1128/jcm.31.7.1695-1699.1993

Ability of clinical laboratories to detect antimicrobial agent-resistant enterococci.

F C Tenover 1, J Tokars 1, J Swenson 1, S Paul 1, K Spitalny 1, W Jarvis 1
PMCID: PMC265616  PMID: 8349745

Abstract

To test the ability of clinical laboratories to detect antimicrobial resistance among enterococci, we sent four vancomycin-resistant enterococcal strains and one beta-lactamase-producing enterococcus to all 93 nongovernment, hospital-based clinical laboratories in New Jersey; 76 (82%) participated in the study. Each organism was tested by the laboratory's routine antimicrobial susceptibility testing method. The proportion of laboratories that correctly reported that an isolate was resistant to vancomycin varied according to the resistance level of the isolate: high-level resistance (MIC for Enterococcus faecium = 512 micrograms/ml), 96% of laboratories correct; moderate-level resistance (MIC for E. faecium = 64 micrograms/ml), 27% correct; low-level resistance (MIC for Enterococcus faecalis = 32 micrograms/ml), 16% correct; and intrinsic low-level resistance (MIC for Enterococcus gallinarum = 8 micrograms/ml), 74% correct. The beta-lactamase-producing E. faecalis isolate was identified as resistant to penicillin and ampicillin by 66 and 8% of laboratories, respectively, but only three laboratories recognized that it was a beta-lactamase producer. This survey suggests that many laboratories may fail to detect antimicrobial agent-resistant enterococci.

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Selected References

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  1. Bingen E., Lambert-Zechovsky N., Mariani-Kurkdjian P., Cezard J. P., Navarro J. Bacteremia caused by a vancomycin-resistant Enterococcus. Pediatr Infect Dis J. 1989 Jul;8(7):475–476. doi: 10.1097/00006454-198907000-00015. [DOI] [PubMed] [Google Scholar]
  2. Boyce J. M., Opal S. M., Potter-Bynoe G., LaForge R. G., Zervos M. J., Furtado G., Victor G., Medeiros A. A. Emergence and nosocomial transmission of ampicillin-resistant enterococci. Antimicrob Agents Chemother. 1992 May;36(5):1032–1039. doi: 10.1128/aac.36.5.1032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cercenado E., Eliopoulos G. M., Wennersten C. B., Moellering R. C., Jr Absence of synergistic activity between ampicillin and vancomycin against highly vancomycin-resistant enterococci. Antimicrob Agents Chemother. 1992 Oct;36(10):2201–2203. doi: 10.1128/aac.36.10.2201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Courvalin P. Resistance of enterococci to glycopeptides. Antimicrob Agents Chemother. 1990 Dec;34(12):2291–2296. doi: 10.1128/aac.34.12.2291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. 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]
  6. Grayson M. L., Eliopoulos G. M., Wennersten C. B., Ruoff K. L., De Girolami P. C., Ferraro M. J., Moellering R. C., Jr Increasing resistance to beta-lactam antibiotics among clinical isolates of Enterococcus faecium: a 22-year review at one institution. Antimicrob Agents Chemother. 1991 Nov;35(11):2180–2184. doi: 10.1128/aac.35.11.2180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Handwerger S., Perlman D. C., Altarac D., McAuliffe V. Concomitant high-level vancomycin and penicillin resistance in clinical isolates of enterococci. Clin Infect Dis. 1992 Mar;14(3):655–661. doi: 10.1093/clinids/14.3.655. [DOI] [PubMed] [Google Scholar]
  8. Hindes R. G., Willey S. H., Eliopoulos G. M., Rice L. B., Eliopoulos C. T., Murray B. E., Moellering R. C., Jr Treatment of experimental endocarditis caused by a beta-lactamase-producing strain of Enterococcus faecalis with high-level resistance to gentamicin. Antimicrob Agents Chemother. 1989 Jul;33(7):1019–1022. doi: 10.1128/aac.33.7.1019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kaplan A. H., Gilligan P. H., Facklam R. R. Recovery of resistant enterococci during vancomycin prophylaxis. J Clin Microbiol. 1988 Jun;26(6):1216–1218. doi: 10.1128/jcm.26.6.1216-1218.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Karanfil L. V., Murphy M., Josephson A., Gaynes R., Mandel L., Hill B. C., Swenson J. M. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol. 1992 Apr;13(4):195–200. doi: 10.1086/646509. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. 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]
  13. Murray B. E., Mederski-Samaroj B. Transferable beta-lactamase. A new mechanism for in vitro penicillin resistance in Streptococcus faecalis. J Clin Invest. 1983 Sep;72(3):1168–1171. doi: 10.1172/JCI111042. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Murray B. E., Singh K. V., Markowitz S. M., Lopardo H. A., Patterson J. E., Zervos M. J., Rubeglio E., Eliopoulos G. M., Rice L. B., Goldstein F. W. Evidence for clonal spread of a single strain of beta-lactamase-producing Enterococcus (Streptococcus) faecalis to six hospitals in five states. J Infect Dis. 1991 Apr;163(4):780–785. doi: 10.1093/infdis/163.4.780. [DOI] [PubMed] [Google Scholar]
  15. Rhinehart E., Smith N. E., Wennersten C., Gorss E., Freeman J., Eliopoulos G. M., Moellering R. C., Jr, Goldmann D. A. Rapid dissemination of beta-lactamase-producing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med. 1990 Dec 27;323(26):1814–1818. doi: 10.1056/NEJM199012273232606. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. Sahm D. F., Olsen L. In vitro detection of enterococcal vancomycin resistance. Antimicrob Agents Chemother. 1990 Sep;34(9):1846–1848. doi: 10.1128/aac.34.9.1846. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Schaberg D. R., Culver D. H., Gaynes R. P. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991 Sep 16;91(3B):72S–75S. doi: 10.1016/0002-9343(91)90346-y. [DOI] [PubMed] [Google Scholar]
  19. Swenson J. M., Ferraro M. J., Sahm D. F., Charache P., Tenover F. C. New vancomycin disk diffusion breakpoints for enterococci. The National Committee for Clinical Laboratory Standards Working Group on Enterococci. J Clin Microbiol. 1992 Oct;30(10):2525–2528. doi: 10.1128/jcm.30.10.2525-2528.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. 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]
  21. Tenover F. C. Novel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens. Am J Med. 1991 Sep 16;91(3B):76S–81S. doi: 10.1016/0002-9343(91)90347-z. [DOI] [PubMed] [Google Scholar]
  22. Willey B. M., Kreiswirth B. N., Simor A. E., Willaims G., Scriver S. R., Phillips A., Low D. E. Detection of vancomycin resistance in Enterococcus species. J Clin Microbiol. 1992 Jul;30(7):1621–1624. doi: 10.1128/jcm.30.7.1621-1624.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. 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]

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