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PMID: 16374593 Published · ppublish English Journal Article Review

Spread of ampicillin/vancomycin-resistant Enterococcus faecium of the epidemic-virulent clonal complex-17 carrying the genes esp and hyl in German hospitals.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology ·Vol. 24 ·No. 12 ·2005-12-00 ·Pages 815-25

Klare I, Konstabel C, Mueller-Bertling S, Werner G, Strommenger B, Kettlitz C, Borgmann S, Schulte B, Jonas D, Serr A, Fahr AM, Eigner U, Witte W

Abstract

The incidence of vancomycin-resistant Enterococcus faecium isolation was low (<or=5%) in German hospitals before 2003. Within the second half of 2003 and the first half of 2004, however, increasing frequencies of up to 14% were noticed in several hospitals in southwestern Germany. This increase was attributed mainly to the occurrence and spread of epidemic-virulent ampicillin/vancomycin-resistant, vanA- and vanB-positive E. faecium clones, most of which exhibited the virulence factors enterococcal surface protein (esp) and bacteriocin activity and some which exhibited hyaluronidase (hyl). E. faecium possessing hyaluronidase was initially found in U.S. hospitals and recently detected in several European hospitals and, subsequently, in German hospitals as well. Ampicillin/vancomycin-resistant E. faecium clones originating mainly from southwestern German hospitals were characterized by multilocus sequence typing since different sequence types (STs) belonging to the clonal complex-17 are currently disseminated worldwide. Multilocus sequence typing revealed that, in 1998 and 1999, ampicillin/vancomycin-resistant E. faecium clone ST-117 was prevalent in various German hospitals, while in 2003 and 2004, clone ST-203 dominated in several hospitals located in southwestern Germany. Both sequence types display single-locus variants of ST-78, which was frequently recorded in various Italian hospitals between 2000 and 2003, and all of these STs belong to the clonal complex-17. Expression of linezolid resistance was observed in ampicillin/glycopeptide-resistant E. faecium strains (VanA type) from two tertiary hospitals in southwestern Germany due to mutations in domain V of the 23S rDNA (G2576T). While in one hospital the resistance emerged during linezolid therapy, in the other hospital resistance was caused by transfer of an identical linezolid/ampicillin/glycopeptide-resistant E. faecium strain. In conclusion, it is very important to monitor the occurrence of epidemic-virulent clonal complex-17 strains of E. faecium to prevent their spread in hospitals, especially if they are resistant to glycopeptides and linezolid.

MeSH Terms
Acetamides/pharmacology Ampicillin Resistance Anti-Infective Agents/pharmacology Bacterial Proteins/genetics Cross Infection/epidemiology,microbiology DNA Restriction Enzymes Drug Resistance, Multiple, Bacterial Enterococcus faecium/classification,drug effects,genetics,pathogenicity Germany/epidemiology Gram-Positive Bacterial Infections/epidemiology,microbiology Humans Hyaluronoglucosaminidase/genetics Linezolid Membrane Proteins/genetics Oxazolidinones/pharmacology Phenotype Phylogeny Polymerase Chain Reaction/methods Vancomycin Resistance
Chemicals
Acetamides Anti-Infective Agents Bacterial Proteins Membrane Proteins Oxazolidinones enterococcal surface protein, esp DNA Restriction Enzymes Hyaluronoglucosaminidase Linezolid
Authors & Affiliations
13 authors, click to expand affiliations / ORCID
Klare I
Robert Koch Institute, Wernigerode Branch, Burgstr. 37, 38855, Wernigerode, Germany. [email protected]
Konstabel C
Mueller-Bertling S
Werner G
Strommenger B
Kettlitz C
Borgmann S
Schulte B
Jonas D
Serr A
Fahr A M
Eigner U
Witte W
References (62)
62 references, click to expand
  1. European survey of vancomycin-resistant enterococci in at-risk hospital wards and in vitro susceptibility testing of ramoplanin against these isolates.
    J Antimicrob Chemother. 2003 Jun;51 Suppl 3:iii5-12 PMID: 12801937
  2. 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.
    J Clin Microbiol. 2001 May;39(5):1781-7 PMID: 11325990
  3. Bloodstream isolates of Enterococcus faecium enriched with the enterococcal surface protein gene, esp, show increased adhesion to eukaryotic cells.
    J Clin Microbiol. 2003 Nov;41(11):5183-5 PMID: 14605157
  4. High occurrence of esp among ampicillin-resistant and vancomycin-susceptible Enterococcus faecium clones from hospitalized patients.
    J Antimicrob Chemother. 2002 Dec;50(6):1035-8 PMID: 12461029
  5. Emerging linezolid-resistant Enterococcus faecalis and Enterococcus faecium isolated from two Austrian patients in the same intensive care unit.
    Eur J Clin Microbiol Infect Dis. 2002 Oct;21(10):751-4 PMID: 12415476
  6. A novel putative enterococcal pathogenicity island linked to the esp virulence gene of Enterococcus faecium and associated with epidemicity.
    J Bacteriol. 2004 Feb;186(3):672-82 PMID: 14729692
  7. A variant enterococcal surface protein Esp(fm) in Enterococcus faecium; distribution among food, commensal, medical, and environmental isolates.
    FEMS Microbiol Lett. 2002 Nov 5;216(2):269-75 PMID: 12435513
  8. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus.
    Infect Control Hosp Epidemiol. 2003 May;24(5):362-86 PMID: 12785411
  9. Population structure of Enterococcus faecium causing bacteremia in a Spanish university hospital: setting the scene for a future increase in vancomycin resistance?
    Antimicrob Agents Chemother. 2005 Jul;49(7):2693-700 PMID: 15980338
  10. Linezolid-resistant enterococci: report of the first isolates in the United Kingdom.
    J Antimicrob Chemother. 2002 Nov;50(5):743-6 PMID: 12407134
  11. Phenotypic identification of the genus Enterococcus and differentiation of phylogenetically distinct enterococcal species and species groups.
    J Appl Bacteriol. 1993 Nov;75(5):399-408 PMID: 8300442
  12. Spread of vancomycin-resistant enterococci: why did it happen in the United States?
    Infect Control Hosp Epidemiol. 1998 Aug;19(8):539-45 PMID: 9758052
  13. The enterococcal surface protein, Esp, is involved in Enterococcus faecalis biofilm formation.
    Appl Environ Microbiol. 2001 Oct;67(10):4538-45 PMID: 11571153
  14. Prevalence of vancomycin-resistant enterococci in Europe.
    Eur J Clin Microbiol Infect Dis. 2000 Nov;19(11):816-22 PMID: 11152305
  15. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC).
    MMWR Recomm Rep. 1995 Sep 22;44(RR-12):1-13 PMID: 7565541
  16. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing.
    J Clin Microbiol. 1995 Sep;33(9):2233-9 PMID: 7494007
  17. Infection-derived Enterococcus faecalis strains are enriched in esp, a gene encoding a novel surface protein.
    Infect Immun. 1999 Jan;67(1):193-200 PMID: 9864215
  18. Variant esp gene as a marker of a distinct genetic lineage of vancomycin-resistant Enterococcus faecium spreading in hospitals.
    Lancet. 2001 Mar 17;357(9259):853-5 PMID: 11265956
  19. vanA and vanB incorporate into an endemic ampicillin-resistant vancomycin-sensitive Enterococcus faecium strain: effect on interpretation of clonality.
    J Clin Microbiol. 1999 Dec;37(12):3934-9 PMID: 10565910
  20. Outbreak of vancomycin-resistant enterococci in a hospital in Gdask, Poland, due to horizontal transfer of different Tn1546-like transposon variants and clonal spread of several strains.
    J Clin Microbiol. 2000 Sep;38(9):3317-22 PMID: 10970377
  21. Nosocomial enterococci resistant to vancomycin--United States, 1989-1993.
    MMWR Morb Mortal Wkly Rep. 1993 Aug 6;42(30):597-9 PMID: 8336690
  22. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci.
    Antimicrob Agents Chemother. 2002 Jun;46(6):1619-28 PMID: 12019066
  23. Vancomycin-resistant Enterococcus faecium isolates causing hospital outbreaks in northern Italy belong to the multilocus sequence typing C1 lineage.
    Microb Drug Resist. 2004 Summer;10(2):114-23 PMID: 15256026
  24. Reduction in vancomycin-resistant Enterococcus and Clostridium difficile infections following change to tympanic thermometers.
    Infect Control Hosp Epidemiol. 1998 May;19(5):333-6 PMID: 9613694
  25. The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens.
    Clin Infect Dis. 2004 Jul 15;39(2):219-26 PMID: 15307031
  26. Two episodes of vancomycin-resistant Enterococcus faecium outbreaks caused by two genetically different clones in a newborn intensive care unit.
    Int J Hyg Environ Health. 2004 Sep;207(4):386-9 PMID: 15471103
  27. Antimicrobial susceptibility of the pathogens of bacteraemia in the UK and Ireland 2001-2002: the BSAC Bacteraemia Resistance Surveillance Programme.
    J Antimicrob Chemother. 2004 Jun;53(6):1018-32 PMID: 15128723
  28. Vancomycin-resistant enterococci: mechanisms and clinical observations.
    Clin Infect Dis. 2001 Jul 15;33(2):210-9 PMID: 11418881
  29. Vancomycin-resistant enterococci: why are they here, and where do they come from?
    Lancet Infect Dis. 2001 Dec;1(5):314-25 PMID: 11871804
  30. Occurrence and spread of antibiotic resistances in Enterococcus faecium.
    Int J Food Microbiol. 2003 Dec 1;88(2-3):269-90 PMID: 14597000
  31. DNA banding pattern polymorphism in vancomycin-resistant Enterococcus faecium and criteria for defining strains.
    J Clin Microbiol. 1999 Apr;37(4):1084-91 PMID: 10074530
  32. Current perspectives on glycopeptide resistance.
    Clin Microbiol Rev. 1995 Oct;8(4):585-615 PMID: 8665471
  33. A database system for fragment patterns of genomic DNA of Staphylococcus aureus.
    Zentralbl Bakteriol. 1998 Jan;287(1-2):105-16 PMID: 9532269
  34. Conjugative transfer of the virulence gene, esp, among isolates of Enterococcus faecium and Enterococcus faecalis.
    J Antimicrob Chemother. 2004 Jul;54(1):232-5 PMID: 15192049
  35. Resistance patterns among nosocomial pathogens: trends over the past few years.
    Chest. 2001 Feb;119(2 Suppl):397S-404S PMID: 11171776
  36. Enterococcal glycopeptide resistance at an Italian teaching hospital.
    J Antimicrob Chemother. 2000 Jul;46(1):129-31 PMID: 10882702
  37. Vancomycin-resistant enterococci.
    Clin Microbiol Rev. 2000 Oct;13(4):686-707 PMID: 11023964
  38. Antimicrobial resistance trends and outbreak frequency in United States hospitals.
    Clin Infect Dis. 2004 Jan 1;38(1):78-85 PMID: 14679451
  39. Surveillance of linezolid resistance in Germany, 2001-2002.
    Clin Microbiol Infect. 2005 Jan;11(1):39-46 PMID: 15649302
  40. A potential virulence gene, hylEfm, predominates in Enterococcus faecium of clinical origin.
    J Infect Dis. 2003 Feb 1;187(3):508-12 PMID: 12552437
  41. Insights into the epidemiology and control of infection with vancomycin-resistant enterococci.
    Clin Infect Dis. 2000 Oct;31(4):1058-65 PMID: 11049790
  42. Historical yearly usage of vancomycin.
    Antimicrob Agents Chemother. 1998 May;42(5):1303-4 PMID: 9593175
  43. Susceptibility of gram-positive cocci from 25 UK hospitals to antimicrobial agents including linezolid. The Linezolid Study Group.
    J Antimicrob Chemother. 2000 Dec;46(6):931-40 PMID: 11102412
  44. Beta-lactam antibiotics and gastrointestinal colonization with vancomycin-resistant enterococci.
    J Infect Dis. 2004 Mar 15;189(6):1113-8 PMID: 14999616
  45. Survey for virulence determinants among Enterococcus faecalis isolated from different sources.
    J Med Microbiol. 2004 Jan;53(Pt 1):13-20 PMID: 14663100
  46. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium at a German university pediatric hospital.
    Int J Hyg Environ Health. 2000 Oct;203(2):147-52 PMID: 11109567
  47. Molecular detection of linezolid resistance in Enterococcus faecium and Enterococcus faecalis by use of 5' nuclease real-time PCR compared to a modified classical approach.
    J Clin Microbiol. 2004 Nov;42(11):5327-31 PMID: 15528734
  48. Clonal spread of a vancomycin-resistant Enterococcus faecium strain among bloodstream-infecting isolates in Italy.
    J Clin Microbiol. 2005 Apr;43(4):1575-80 PMID: 15814968
  49. Detection of oxazolidinone-resistant Enterococcus faecalis and Enterococcus faecium strains by real-time PCR and PCR-restriction fragment length polymorphism analysis.
    J Clin Microbiol. 2002 Nov;40(11):4298-300 PMID: 12409414
  50. Emerging resistance among bacterial pathogens in the intensive care unit--a European and North American Surveillance study (2000-2002).
    Ann Clin Microbiol Antimicrob. 2004 Jul 29;3:14 PMID: 15283864
  51. Effect of parenteral fluoroquinolone administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract.
    Antimicrob Agents Chemother. 2004 Jan;48(1):326-8 PMID: 14693559
  52. Linezolid-resistant, vancomycin-resistant Enterococcus faecium infection in patients without prior exposure to linezolid.
    Clin Infect Dis. 2003 Jun 1;36(11):E146-8 PMID: 12766857
  53. [Risk factors and prevention of the acquisition and transmission of glycopeptide resistant enterococci].
    Pathol Biol (Paris). 2001 Oct;49(8):641-8 PMID: 11692752
  54. Multiple-locus variable-number tandem repeat analysis, a novel typing scheme to study the genetic relatedness and epidemiology of Enterococcus faecium isolates.
    J Clin Microbiol. 2004 Oct;42(10):4503-11 PMID: 15472301
  55. Role of Enterococcus faecalis surface protein Esp in the pathogenesis of ascending urinary tract infection.
    Infect Immun. 2001 Jul;69(7):4366-72 PMID: 11401975
  56. The occurrence of vancomycin-resistant enterococci in hematological patients in relation to antibiotic use.
    New Microbiol. 2002 Apr;25(2):205-12 PMID: 12019727
  57. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex.
    Emerg Infect Dis. 2005 Jun;11(6):821-8 PMID: 15963275
  58. Strains of glycopeptide-resistant Enterococcus faecium can alter their van genotypes during an outbreak.
    J Clin Microbiol. 1997 Nov;35(11):2966-8 PMID: 9350769
  59. Approaches to vancomycin-resistant enterococci.
    Curr Opin Infect Dis. 2004 Dec;17(6):541-7 PMID: 15640708
  60. Linezolid-resistant Enterococcus faecium and Enterococcus faecalis isolated from a septic patient: report of first isolates in Germany.
    Infection. 2004 Jun;32(3):182-3 PMID: 15188081
  61. Emerging linezolid-resistant, vancomycin resistant Enterococcus faecium from a patient of a haematological unit in Poland.
    Pol J Microbiol. 2004;53(3):193-6 PMID: 15702920
  62. Multilocus sequence typing scheme for Enterococcus faecium.
    J Clin Microbiol. 2002 Jun;40(6):1963-71 PMID: 12037049
Article Info
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Abbr.
Eur J Clin Microbiol Infect Dis
ISSN
0934-9723
DOI
10.1007/s10096-005-0056-0
Email
[email protected]
Published
2005-12-00
Pages
815-25
Language
English
Region
Germany
NLM ID
8804297
Subset
IM
Corrections
CommentIn
PMID: 16362382
External Links
PubMed source DOI: 10.1007/s10096-005-0056-0 View journal details
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