Epidemiologic Evaluation of Antimicrobial Resistance in Community-Acquired Enterococci

Silverman, Jan F.; Thal, L A; Perri, Mary Beth; Bostic, Grace; Zervos, Marcus J.

doi:10.1128/jcm.36.3.830-832.1998

Cited by 63 publications

(32 citation statements)

References 29 publications

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“…On the other hand, other studies have reported high prevalence rates compatible with our own: 17% in a recent French study (17), 12% in a German study (23), and 28% in a Belgian study (36). In the United States little is known about the presence of VRE in the community at large or the environment, but the limited available data are in contrast to the European data, since VRE appear to be absent or very rare in healthy people outside hospitals and in the environment (8,15,26,34).…”

Section: Discussionsupporting

confidence: 81%

Prevalence of Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Nonhospitalized Controls in a Cattle-Rearing Area of France

Gambarotto¹,

Ploy²,

Turlure

et al. 2000

J Clin Microbiol

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Vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens over the last decade, but little is known about their epidemiology. We report on the prevalence of VRE fecal colonization on the basis of a prospective study among patients hospitalized in a hematology intensive care unit and among nonhospitalized subjects living in the local community. A total of 243 rectal swabs from hematology patients and 169 stool samples from the control group were inoculated onto bile-esculin agar plates with and without 6 mg of vancomycin per liter and into an enrichment bile-esculin broth supplemented with 4 mg of vancomycin per liter. A total of 37% of the hospitalized patients and 11.8% of the subjects from the community were found to be VRE carriers. A total of 65 VRE strains were isolated: 12 (18.5%) E. faecium, 46 (70.7%) E. gallinarum, and 7 (10.8%) E. casseliflavus strains. No E. faecalis strains were detected. All the E. faecium strains were of the vanA genotype. Molecular typing by pulsed-field gel electrophoresis revealed a different pattern for each vanA VRE strain that originated from an individual subject. To our knowledge, this is the first study to be carried out in a cattle-rearing region of France. It reports a higher VRE prevalence than that reported in previous European or U.S. studies. A partial explanation is the use of an enrichment broth step which enabled detection of strains which would otherwise have been missed, but the fact that subjects and patients were recruited from a predominantly agricultural area where vancomycin-related antibiotics have recently been used in animal husbandry could also contribute to the high levels of VRE in patients and subjects alike.

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Section: Discussionsupporting

confidence: 81%

Prevalence of Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Nonhospitalized Controls in a Cattle-Rearing Area of France

Gambarotto¹,

Ploy²,

Turlure

et al. 2000

J Clin Microbiol

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“…It is not clear how GRE were introduced into US hospitals. In contrast to Europe, no community GRE reservoir has been detected [63,86,142]. However, these studies have been limited in population size, and the direct plating technique used is less sensitive than selective enrichment broth [89,90].…”

Section: The Us Situation: Vancomycin As a Human Feed Additivementioning

confidence: 99%

Human infections caused by glycopeptide-resistant Enterococcus spp: are they a zoonosis?

Sundsfjord

Simonsen

Courvalin

2001

Clinical Microbiology and Infection

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Following the detection of glycopeptide-resistant enterococci (GRE) in 1986 and their subsequent global dissemination during the 1990s, many studies have attempted to identify the reservoirs and lines of resistance transmission as a basis for intervention. The eradication of reservoirs and the prevention of GRE spread is of major importance for two reasons: (i) the emergence of high-level glycopeptide resistance in invasive enterococcal clinical isolates that are already multiresistant, has left clinicians with therapeutic options that are only at the experimental stage; and (ii) the resistance genes may spread to more virulent bacterial species such as Staphylococcus aureus, Streptococcus pneumoniae and Clostridium difficile. VanA-type strains, resistant to high levels of both vancomycin and teicoplanin, are the most commonly encountered enterococci with acquired glycopeptide resistance in humans. A widespread VanA-type GRE reservoir was detected early in farm animals that were exposed to the glycopeptide growth-promoter avoparcin. Numerous studies have provided indirect evidence for the transfer of VanA-type GRE and their resistance determinants from animal reservoirs to humans. The data collected have expanded our understanding of the promiscuous nature of antibiotic resistance, and have provided the groundwork for logical decision-making with the objective of deterring the dissemination of resistant bacteria and of their resistance genes.

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“…Glycopeptide-resistant enterococci (GRE) were first noted in Europe in 1986 (22,38) and were subsequently noted in the United States in 1987 (34). These GRE have rapidly emerged as major nosocomial pathogens throughout the United States (23); however, until now they have not been detected in the community or in livestock (9,35,37,43). In Europe, GRE are widely distributed in the community (12), in farm and pet animals (1,11), and on raw meat and meat products (5,6,41), although their prevalence in hospitals remains very low (39).…”

mentioning

confidence: 99%

Comparison of Glycopeptide-Resistant Enterococcus faecium Isolates and Glycopeptide Resistance Genes of Human and Animal Origins

Descheemaeker

Chapelle

Devriese³

et al. 1999

Antimicrob Agents Chemother

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One hundred thirty-two glycopeptide-resistant Enterococcus faecium (GREF) isolates from different hospitals and pig and poultry farms in Belgium were compared on the basis of (i) their antibiotic susceptibilities, (ii) their SmaI pulsed-field gel electrophoresis (PFGE) patterns, and (iii) the organization of their Tn1546 or related elements in order to detect possible phenotypic and genotypic relationships among both groups of isolates. Human and animal vanA-positive GREF isolates were found to have similar susceptibility patterns; they remained susceptible to gentamicin and were, in general, susceptible to ampicillin. PFGE demonstrated a very high degree of genomic heterogeneity in both groups of isolates. However, indistinguishable isolates were found within different farms or hospitals, and in two instances, epidemiologically unrelated pig and human isolates showed indistinguishable PFGE patterns. In total, eight different transposon types were identified, and all were related to the prototype transposon Tn1546. The two predominant types, Tn1546 and type 2 transposons, which differed at three band positions, were present in both human and animal isolates. Type 2 transposons were significantly associated with pig isolates. The other types were seldom detected. These data suggest a possible exchange of glycopeptide resistance markers between animals and humans.

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Epidemiologic Evaluation of Antimicrobial Resistance in Community-Acquired Enterococci

Cited by 63 publications

References 29 publications

Prevalence of Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Nonhospitalized Controls in a Cattle-Rearing Area of France

Prevalence of Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Nonhospitalized Controls in a Cattle-Rearing Area of France

Human infections caused by glycopeptide-resistant Enterococcus spp: are they a zoonosis?

Comparison of Glycopeptide-Resistant Enterococcus faecium Isolates and Glycopeptide Resistance Genes of Human and Animal Origins

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