Clinical epidemiology of vancomycin-resistant Enterococcus gallinarum and Enterococcus casseliflavus bloodstream infections

Britt, Nicholas S.; Potter, Emily M.

doi:10.1016/j.jgar.2015.12.002

Cited by 27 publications

(26 citation statements)

References 15 publications

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“…Interestingly, the second most frequent enterococcus species in this study were the E. gallinarum / casseliflavus species at 17.4%, which is higher than expected from global reports for these species (i.e. ≤2%) [5, 6]. Although E. gallinarum / casseliflavus are infrequently isolated from clinical specimens, especially in the developed countries, several reports have implicated them as causes of serious invasive infections [5, 6].…”

Section: Discussionmentioning

confidence: 47%

“…≤2%) [5, 6]. Although E. gallinarum / casseliflavus are infrequently isolated from clinical specimens, especially in the developed countries, several reports have implicated them as causes of serious invasive infections [5, 6]. These species colonize the gut of hospitalized and non-hospitalized people with overall colonization rates ranging from 5.7–12.1% [6].…”

Section: Discussionmentioning

confidence: 99%

“…However, as we investigated isolates from symptomatic individuals, our findings should not be used to draw inferences on enterococcus colonization in the wider population. The clinical and epidemiological features of cases of E. casseliflavus/gallinarum bacteremia in the United States were reported [5, 6], with underlying conditions such as immunodeficiency, malignancy, receipt of transplant etc. reported in up to 95% of the patients [5, 6].…”

Section: Discussionmentioning

confidence: 99%

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Species, antibiotic susceptibility profiles and van gene frequencies among enterococci isolated from patients at Mulago National Referral Hospital in Kampala, Uganda

et al. 2019

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Background The increase in drug resistance to affordable antibiotics used to treat Gram positive bacterial infections has complicated the management of enterococcal infections. Resistance to vancomycin, one of the most powerful antibiotics, is of utmost concern as both intrinsic and acquired forms of resistance do occur in enterococci. This cross-sectional study aimed to determine the species, antibiotic susceptibility profiles and vanA / vanB gene frequencies among enterococci isolated from patients at Mulago Hospital in Kampala, Uganda. Methods Between November 2011 and October 2012, stool, urine, sputum and blood samples, as well as vaginal, endocervical, pus, ear and urethra swabs from 3229 patients were processed for isolation of bacteria, yielding 162 enterococci of which 115 were available for analysis (one isolate per specimen/patient). Species-level confirmation and susceptibility testing were determined with the Phoenix™ AST/ID Automated System, while vanA / vanB gene carriage was determined by PCR. Results Species-level identification revealed 72 isolates of E. faecalis , 20 E. gallinarum/casseliflavus, 5 E. faecium, 4 E. raffinosus and 2 isolates each for E. hirae and E. durans . Ten isolates could not be identified to species level. Antibiotic resistance was generally low especially to ampicillin, quinolones, nitrofurantoin, glycopeptides and linezolid, but high for erythromycin and tetracycline. Equally, vanA and vanB gene frequencies were low (i.e. 15.8 and 7.9%, respectively) and detected only in E. casseliflavus/gallinarum species that are intrinsically resistant to vancomycin . Vancomycin resistant isolates of E. faecalis and E. faecium were not detected. Conclusions Enterococcus species are frequent in clinical specimens at Mulago Hospital but they are highly susceptible to common antibiotics especially ampicillin. While vancomycin resistant enterococcal (VRE) isolates of E. faecium and E. faecalis are rare in the hospital and frequency of multidrug resistance is low, non- faecium and non- faecalis VRE isolates (i.e. E. gallinarum / casseliflavus ) are frequent, some with VanA/VanB (high-level) vancomycin resistance. Therefore, species-level identification of enterococci is necessary in resource limited settings to guide infection control and treatment of enterococcal infections. Electronic sup...

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Species, antibiotic susceptibility profiles and van gene frequencies among enterococci isolated from patients at Mulago National Referral Hospital in Kampala, Uganda

et al. 2019

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“…We further investigated the predicted vancomycin insensitivity of other taxonomic features and found 8 additional intrinsically vancomycin-resistant bacteria including Pediococcus strains [32][33][34] and Lactobacillus and Leuconostoc strains [35][36][37] as well as gram-negative and fungal strains. Enterococcus casseliflavus, which has low level resistance to vancomycin, was also identified [38]. Four taxa (Clostridium glycolicum [39], Gemella haemolysans [40], E. faecalis [41], and C. difficile [42]) are predicted to be vancomycin susceptible.…”

Section: Rbx2660 Transplanted Taxonomic Structures To Patientsmentioning

confidence: 99%

Impact of investigational microbiota therapeutic RBX2660 on the gut microbiome and resistome revealed by a placebo-controlled clinical trial

Kwak

Choi²,

Hink

et al. 2020

Microbiome

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Background: Intestinal microbiota restoration can be achieved by complementing a subject's perturbed microbiota with that of a healthy donor. Recurrent Clostridioides difficile infection (rCDI) is one key application of such treatment. Another emerging application of interest is reducing antibiotic-resistant genes (ARGs) and organisms (AROs). In this study, we investigated fecal specimens from a multicenter, randomized, double-blind, placebocontrolled phase 2b study of microbiota-based investigational drug RBX2660. Patients were administered either placebo, 1 dose of RBX2660 and 1 placebo, or 2 doses of RBX2660 via enema and longitudinally tracked for changes in their microbiome and antibiotic resistome. Results: All patients exhibited significant recovery of gut microbiome diversity and a decrease of ARG relative abundance during the first 7 days post-treatment. However, the microbiome and resistome shifts toward average configurations from unperturbed individuals were more significant and longer-lasting in RBX2660 recipients compared to placebo. We quantified microbiome and resistome modification by RBX2660 using a novel "transplantation index" metric. We identified taxonomic and metabolic features distinguishing the baseline microbiome of non-transplanted patients and taxa specifically enriched during the process of transplantation. We elucidated the correlation between resistome and taxonomic transplantations and post-treatment dynamics of patient-specific and RBX2660-specific ARGs. Whole genome sequencing of AROs cultured from RBX2660 product and patient samples indicate ARO eradication in patients via RBX2660 administration, but also, to a lesser extent, introduction of RBX2660-derived AROs.

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“…We further investigated the predicted vancomycin insensitivity of other taxonomic features and found 8 additional intrinsically vancomycin resistant bacteria including Pediococcus strains [32][33][34], Lactobacillus and Leuconostoc strains [35][36][37] as well as gram-negative and fungal strains. Enterococcus casseli avus, which has low level resistance to vancomycin, was also identi ed [38]. 4 taxa (Clostridium glycolicum [39], Gemella haemolysans [40], E. faecalis [41], and C. di cile [42]) are predicted to be vancomycin susceptible.…”

Section: Rbx2660 Transplanted Taxonomic Structures To Patientsmentioning

confidence: 99%

Impact of investigational microbiota therapeutic RBX2660 on the gut microbiome and resistome revealed by a placebo-controlled clinical trial

Kwak

Choi

Hink

et al. 2020

Preprint

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Background. Intestinal microbiota restoration can be achieved by complementing a subject’s perturbed microbiota with that of a healthy donor. Recurrent Clostridioides difficile infection (rCDI) is one key application of such treatment. Another emerging application of interest is reducing antibiotic resistant genes (ARGs) and organisms (AROs). In this study, we investigated fecal specimens from a multicenter, randomized, double-blind, placebo-controlled phase 2b study of microbiota-based investigational drug RBX2660. Patients were administered either placebo, 1 dose of RBX2660 and 1 placebo, or 2 doses of RBX2660 via enema and longitudinally tracked for changes in their microbiome and antibiotic resistome.Results. All patients exhibited significant recovery of gut microbiome diversity and a decrease of ARG relative abundance during the first 7 days post-treatment. However, the microbiome and resistome shifts towards average configurations from unperturbed individuals were more significant and longer-lasting in RBX2660 recipients compared to placebo. We quantified microbiome and resistome modification by RBX2660 using a novel ‘transplantation index’ metric. We identified taxonomic and metabolic features distinguishing the baseline microbiome of non-transplanted patients and taxa specifically enriched during the process of transplantation. We elucidated the correlation between resistome and taxonomic transplantations and post-treatment dynamics of patient-specific and RBX2660-specific ARGs. Whole genome sequencing of AROs cultured from RBX2660 product and patient samples indicate ARO eradication in patients via RBX2660 administration, but also, to a lesser extent, introduction of RBX2660-derived AROs.Conclusions. Through shotgun metagenomic sequencing, we elucidated the effects of RBX2660 in the microbiome and resistome. Antibiotic discontinuation alone resulted in significant recovery of gut microbial diversity and reduced ARG relative abundance, but RBX2660 administration more rapidly and completely changed the composition of patients’ microbiome, resistome, and ARO colonization by transplanting RBX2660 microbiota into the recipients. Although ARGs and AROs were transmitted through RBX2660, the resistome post-RBX2660 more closely resembled that of the administered product—a proxy for the donor—than an antibiotic perturbed state.Trial registration: NCT02299570. Registered 19 November 2014, https://clinicaltrials.gov/ct2/show/NCT02299570

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Clinical epidemiology of vancomycin-resistant Enterococcus gallinarum and Enterococcus casseliflavus bloodstream infections

Cited by 27 publications

References 15 publications

Species, antibiotic susceptibility profiles and van gene frequencies among enterococci isolated from patients at Mulago National Referral Hospital in Kampala, Uganda

Species, antibiotic susceptibility profiles and van gene frequencies among enterococci isolated from patients at Mulago National Referral Hospital in Kampala, Uganda

Impact of investigational microbiota therapeutic RBX2660 on the gut microbiome and resistome revealed by a placebo-controlled clinical trial

Impact of investigational microbiota therapeutic RBX2660 on the gut microbiome and resistome revealed by a placebo-controlled clinical trial

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