Clonal outbreak of ST17 multidrug-resistant Enterococcus faecium harbouring an Inc18-like::Tn1546 plasmid in a haemo-oncology ward of a Spanish hospital

Valdezate, Sylvia; Miranda, Consuelo; Navarro, Ana; Freitas, Ana R.; Cabrera, Jorge Julio; Carrasco, Gema; Coque, Teresa M.; Jiménez-Romano, Elena; Sáez-Nieto, Juan Antonio

doi:10.1093/jac/dkr545

Cited by 32 publications

(19 citation statements)

References 9 publications

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“…In several recent studies carried out in different countries around the world (including Tunisia), VRE outbreaks seem to be related to monoclonal spread [6,25,26]. The homogeneity detected among our acquired vancomycin-resistant E. faecium isolates could be explained by the endemic dissemination of these VRE strains in the hospital.…”

Section: Discussionmentioning

confidence: 56%

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Dziri

Lozano

Saïd

et al. 2016

J Infect Dev Ctries

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Introduction: The role of the hospital environment as a reservoir of resistant bacteria in Tunisia has been poorly investigated; however, it could be responsible for the transmission of multidrug-resistant bacteria. The objective was to study the prevalence of Enterococcus in the environment of a Tunisian hospital and the antibiotic resistance phenotype/genotype in recovered isolates, with special reference to vancomycin resistance. Methodology: A total of 300 samples were taken (March-June, 2013) and inoculated in Slanetz-Bartley agar plates supplemented or not supplemented with 8 µg/mL of vancomycin. Antibiotic resistance genes were tested by polymerase chain reaction (PCR). The clonal relatedness of the vanA isolates was assessed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence testing (MLST). Results: Enterococci were recovered in 33.3% of tested samples inoculated in SB medium. E faecium was the most prevalent species, followed by E. faecalis and E. casseliflavus. Antimicrobial resistance genes detected were as follows (number of isolates): erm(B) (71), tet(M) (18), aph(3')-IIIa (27), ant(6)-Ia (15), cat(A) (4), and van(C2) (6). Vancomycin-resistant-enterococci (VRE) were recovered from 14 samples (4.7%), when tested in SB-VAN. The 14 VRE (one per positive sample) were identified as E. faecium and contained the van(A),erm(B), tet(M), ant(6)-Ia, and aph(3')-IIIa genes. Thirteen of the VRE strains were ascribed by PFGE and MLST to a novel clone (new ST910), and only one VRE strain was typed as ST80 included in CC17. Conclusions: The emergence and spread of new clones of VRE, especially in the hospital environment in this country, could become particularly problematic.

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Section: Discussionmentioning

confidence: 56%

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Dziri

Lozano

Saïd

et al. 2016

J Infect Dev Ctries

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“…Around the world and even in Brazil, most recent VRE fm outbreaks have been found to be related to monoclonal spread [36,[39][40][41]. Our data describes a monoclonal outbreak, with two major subclones, during a period of almost a year.…”

Section: Discussionmentioning

confidence: 78%

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

Resende

Caierão

Prates

et al. 2014

J Infect Dev Ctries

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Introduction: In Porto Alegre (South Brazil), since the first VRE isolation in 2000 until the middle of the last decade, the epidemiology of enterococcal infections presented the peculiarity that, as opposed to other regions of the country, almost all VRE were E. faecalis. The aim of this study was to investigate the microbiological and epidemiological characteristics of a VRE outbreak that occurred between August 2010 and September 2011 in Porto Alegre, South Brazil. Methodology: Twenty-nine isolates from inpatients of Mãe de Deus Hospital that were identified and characterized for their susceptibility profile, vancomycin genotype, presence of esp gene, biofilm production, and clonal relationship were collected. Patients' records were reviewed for clinical information. Results: All isolates were identified as vancomycin/ampicillin resistant E. faecium carrying the vanA gene. Almost all were susceptible to gentamicin and streptomycin. Most patients died and were associated with a hemodialysis unit stay. All but the first isolate were clustered in a main clone. Conclusions: An important change in vancomycin-resistant enterococci was observed. Studies like this are necessary to monitor the dissemination of VRE, especially of some individual clones.

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“…The software identified 499 specimens that, upon second review, appeared to be positive for VRE, indicating that the software may be more sensitive than the manual reading of chromogenic plates. The addition of 499 positive specimens could have large downstream effects on patient care; appropriate infection control procedures could be implemented, as unidentified reservoirs can lead to clonal outbreaks (23). However, further studies measuring the impact on patient care of implementation of the software are required.…”

Section: Discussionmentioning

confidence: 99%

Automatic Digital Analysis of Chromogenic Media for Vancomycin-Resistant-Enterococcus Screens Using Copan WASPLab

et al. 2016

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Vancomycin-resistant enterococci (VRE) are an important cause of health care-acquired infections (HAIs). Studies have shown that active surveillance of high-risk patients for VRE colonization can aid in reducing HAIs; however, these screens generate a significant cost to the laboratory and health care system. Digital imaging capable of differentiating negative and "nonnegative" chromogenic agar can reduce the labor cost of these screens and potentially improve patient care. In this study, we evaluated the performance of the WASPLab Chromogenic Detection Module (CDM) (Copan, Brescia, Italy) software to analyze VRE chromogenic agar and compared the results to technologist plate reading. Specimens collected at 3 laboratories were cultured using the WASPLab CDM and plated to each site's standard-of-care chromogenic media, which included Colorex VRE (BioMed Diagnostics, White City, OR) or Oxoid VRE (Oxoid, Basingstoke, United Kingdom). Digital images were scored using the CDM software after 24 or 40 h of growth, and all manual reading was performed using digital images on a high-definition (HD) monitor. In total, 104,730 specimens were enrolled and automation agreed with manual analysis for 90.1% of all specimens tested, with sensitivity and specificity of 100% and 89.5%, respectively. Automation results were discordant for 10,348 specimens, and all discordant images were reviewed by a laboratory supervisor or director. After a second review, 499 specimens were identified as representing missed positive cultures falsely called negative by the technologist, 1,616 were identified as containing borderline color results (negative result but with no package insert color visible), and 8,234 specimens were identified as containing colorimetric pigmentation due to residual matrix from the specimen or yeast (Candida). Overall, the CDM was accurate at identifying negative VRE plates, which comprised 84% (87,973) of the specimens in this study. Members of the genus Enterococcus are commensal colonizers of the gastrointestinal tract but can cause a variety of serious nosocomial infections, including bacteremia, endocarditis, intraabdominal and pelvic infections, urinary tract infections, and, in rare cases, central nervous system infections (1-4). Treatment can be difficult, as E. faecalis has been observed to be 10 to 100 times more resistant to ␤-lactams than other streptococcal species and E. faecium is 4 to 16 times more resistant than E. faecalis (5). Vancomycin had been used for years to successfully treat enterococcal infections; however, in 1988, the first case of a vancomycinresistant-enterococcus (VRE) infection was reported (6). Resistance is conferred by the van operon, carried in either the chromosome or a plasmid, and is inducible in response to membrane disruption caused by vancomycin (7,8). Currently, resistance is widespread, with prevalence rates ranging from 1.0% to 35.5% of all Enterococcus specimens isolated, depending on the geographical location, and is more commonly found in E. faecium (4).The success of ...

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Clonal outbreak of ST17 multidrug-resistant Enterococcus faecium harbouring an Inc18-like::Tn1546 plasmid in a haemo-oncology ward of a Spanish hospital

Cited by 32 publications

References 9 publications

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Multidrug-resistant enterococci in the hospital environment: detection of novel vancomycin-resistant E. faecium clone ST910

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

Automatic Digital Analysis of Chromogenic Media for Vancomycin-Resistant-Enterococcus Screens Using Copan WASPLab

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