Ecological replacement of Enterococcus faecalis by multiresistant clonal complex 17 Enterococcus faecium

Abstract

The proportion of enterococcal infections caused by ampicillin-resistant Enterococcus faecium (AREfm) in a European hospital increased from 2% in 1994 to 32% in 2005, with prevalence rates of AREfm endemicity of up to 35% in at least six hospital wards. Diabetes mellitus, three or more admissions in the preceding year, and use of beta-lactams and fluoroquinolones, were all associated with AREfm colonisation. Of 217 AREfm isolates that were genotyped, 97% belonged to clonal complex 17 (CC17). This ecological change mimics events preceding the emergence of vancomycin-resistant E. faecium (VREF) in the USA and may presage the emergence of CC17 VREF in European hospitals.

Screening municipal wastewater effluent and surface water used for drinking water production for the presence of ampicillin and vancomycin resistant enterococci

“…Applying ampicillin SBA, E. faecium was the only species observed in this study, which is in line with previous investigations by Anastasiou and Schmitt (2011), who found that a high percentage (88 -100%) of ARE present in surface water was AREfm. Considering that ARE have emerged in Europe as a frequent cause of invasive enterococcal infections even in countries with a low prevalence of VRE, such as the Netherlands (Top et al, 2007;Top et al, 2008b), the numbers of AREfm in WWTP effluent observed in this study indicate a reservoir of AREfm outside the healthcare setting. To confirm that the AREfm found in this study are hospitalassociated E. faecium (HA-Efm), additional analysis on the presence of enterococcal surface protein (esp) gene can provide additional information.…”

Role of House Flies in the Ecology of Enterococcus faecalis from Wastewater Treatment Facilities

“…Enterococcus faecalis and E. faecium are two of the most prevalent enterococcal species in the human gastrointestinal tract [6,20,21,53,62]. Over the past few decades enterococci have emerged as the third most common nosocomial pathogen [6,21], and among enterococci, E. faecalis is responsible for the majority of hospital-associated infections [32,68]. Antibiotic resistance of enterococci has been reported to every major class of antibiotics [34,40].…”

Environmental survival of vancomycin-sensitive ampicillin-resistant Enterococcus faecium (AREfm)

“…Antibiotic-resistant Enterococcus faecium, including vancomycin-and ampicillin-resistant E. faecium (VREFm) and vancomycin-sensitive and ampicillin-resistant E. faecium (AREfm) that belong to a specific hospital-adapted sub-population previously designated clonal complex (CC) 17-clade A strains according to current typing techniques-have become prominent in nosocomial infections, especially in the intensive care units (ICUs) of many hospitals [1][2][3]. This phenomenon was also observed in The Netherlands [3,4], including the Atrium Medical Centre Parkstad (Parkcity) in the South Limburg region.…”

“…This phenomenon was also observed in The Netherlands [3,4], including the Atrium Medical Centre Parkstad (Parkcity) in the South Limburg region. The dynamics of CC17 have been described previously [2][3][4].…”

“…AREfm are responsible for hospital infections, including bacteraemias [2,3], which necessitate vancomycin therapy. In contrast to VREFm, no specific targeted precautions against AREfm were suggested by the Dutch Working Group on Infection Prevention (WIP) [5].…”