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

Abstract

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.

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

“…The esp expression on the surface of E. faecium seems to play a role in adherence and biofilm formation [28]. This gene could have a great role in the exchanging genetic mobile elements and could also be implicated in the adaptation of these bacteria to the hospital environment [29,30].Remarkably, our vanA E. faecium isolates presented a multiresistance phenotype, being resistant, in addition to glycopeptides, to erythromycin, tetracycline, ciprofloxacin, ampicillin, kanamycin, streptomycin, pristinamycin, and trimethoprimsulfamethoxazole. In the case of resistance genes erm(B) and tet(M), it is interesting to mention that they have been previously detected in the same conjugative plasmid as the van(A) gene, which indicates that coselection processes might have happened [31].…”

“…The agents tested were the following (μg/disk): vancomycin (30), teicoplanin [14]. Detection of pristinamycin resistance (15) and high-level resistance to gentamicin (500), kanamycin (1,000), and streptomycin (500) was performed according to the Antibiogram Committee of the French Society for Microbiology [15].…”

High diversity of vancomycin-resistant Enterococcus faecium isolated in Southern Brazil

“…Another study conducted with 29 isolates from a hospital in Southern Brazil observed that all isolates were VREfm carrying vanA gene and were part of a main clone (Resende et al, 2014).…”

“…The ability of Enterococcus faecium to rapidly acquire mobile genetic elements associated to antimicrobial resistance is well-established (Gilmore et al, 2013;Cattoir and Giard, 2014;García-Solache et al, 2016). Vancomycin-resistant Enterococcus faecium (VREfm) has become increasingly common in some hospital settings and their clonal spread has been described worldwide (Freitas et al, 2016;Mahony et al, 2018), including Brazil (Alves et al, 2017;Resende et al, 2014;Sacramento et al, 2017). Most VREfm isolated from Brazilian hospitals belong to clonal complex 17 (CC-17), i.e.…”

Enterococcus spp. resistentes à vancomicina e a sua disseminação em infecções no ambiente hospitalar

“…A vancomicina é bactericida para a maioria das bactérias Gram positivas e bacteriostática contra Enterococcus, no entanto, não apresenta efeito para as bactérias Gram negativas e micobactérias (Guimarães, Momesso, Pupo, 2010;Merlo, 2013 (Zanella et al, 2003, Oliveira, Bettcher, 2010Terra, Da Silva, 2017). Posteriormente ao primeiro caso de VRE no Brasil diversos estudos foram publicados relatando a disseminação de VRE em hospitais brasileiros (Zanella et al, 1997;Zanella et al, 2003;Palazzo et al, 2011;Bastião et al, 2012;Resende et al, 2014;Da Silva et al, 2014;Campos et al, 2014;Correia et al, 2015). E se tratando de perfil de resistência à vancomicina o E. faecium apresenta uma maior resistência quando comparado ao E. faecalis A resistência bacteriana desenvolvida pelas bactérias Gram positivas contra a vancomicina se dá através do mecanismo de reprogramação e modificação da estrutura-alvo da droga na estrutura bacteriana, prejudicando a capacidade de ação da droga no sítio alvo.…”