Global Spread of Vancomycin-resistant<i>Enterococcus faecium</i>from Distinct Nosocomial Genetic Complex

Willems, Rob J. L.; Top, Janetta; Santen, Marga van; Robinson, D. Ashley; Coque, Teresa M.; Baquero, Fernando; Grundmann, Hajo; Bonten, Marc J. M.

doi:10.3201/1106.041204

Cited by 485 publications

(441 citation statements)

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“…This may explain its rapid emergence as an etiological agent of nosocomial infections, noticed first in the United States and, more recently, in Europe and Asia (24,39; see also the European Antimicrobial Resistance Surveillance System at http://www.earss.rivm.nl). Molecular epidemiological studies of E. faecium isolates, resistant and susceptible to vancomycin and derived from different ecological niches, identified a specific clonal complex, designated CC-17, strongly associated with nosocomial outbreaks in five continents (45). Almost all CC-17 isolates are resistant to ␤-lactam antibiotics, and a substantial proportion contains a putative pathogenicity island, which carries the E. faecium variant of the enterococcal surface protein (esp) gene (17,45).…”

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“…Molecular epidemiological studies of E. faecium isolates, resistant and susceptible to vancomycin and derived from different ecological niches, identified a specific clonal complex, designated CC-17, strongly associated with nosocomial outbreaks in five continents (45). Almost all CC-17 isolates are resistant to ␤-lactam antibiotics, and a substantial proportion contains a putative pathogenicity island, which carries the E. faecium variant of the enterococcal surface protein (esp) gene (17,45). Esp of E. faecium shares a homology of up to 90% with the previously described Esp protein of E. faecalis, also located on a pathogenicity island (30) and expressed on the surface of the bacterium (31).…”

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Growth Condition-Dependent Esp Expression by Enterococcus faecium Affects Initial Adherence and Biofilm Formation

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A genetic subpopulation of Enterococcus faecium, called clonal complex 17 (CC-17), is strongly associated with hospital outbreaks and invasive infections. Most CC-17 strains contain a putative pathogenicity island encoding the E. faecium variant of enterococcal surface protein (Esp). Western blotting, flow cytometric analyses, and electron microscopy showed that Esp is expressed and exposed on the surface of E. faecium, though Esp expression and surface exposure are highly varied among different strains. Furthermore, Esp expression depends on growth conditions like temperature and anaerobioses. When grown at 37°C, five of six esp-positive E. faecium strains showed significantly increased levels of surface-exposed Esp compared to bacteria grown at 21°C, which was confirmed at the transcriptional level by real-time PCR. In addition, a significant increase in surface-exposed Esp was found in half of these strains when grown at 37°C under anaerobic conditions compared to the level in bacteria grown under aerobic conditions. Finally, amounts of surface-exposed Esp correlated with initial adherence to polystyrene (R 2 ‫؍‬ 0.7146) and biofilm formation (R 2 ‫؍‬ 0.7535). Polystyrene adherence was competitively inhibited by soluble recombinant N-terminal Esp. This study demonstrates that Esp expression on the surface of E. faecium (i) varies consistently between strains, (ii) is growth condition dependent, and (iii) is quantitatively correlated with initial adherence and biofilm formation. These data indicate that E. faecium senses and responds to changing environmental conditions, which might play a role in the early stages of infection when bacteria transit from oxygen-rich conditions at room temperature to anaerobic conditions at body temperature. In addition, variation of surface exposure may explain the contrasting findings reported on the role of Esp in biofilm formation.

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Growth Condition-Dependent Esp Expression by Enterococcus faecium Affects Initial Adherence and Biofilm Formation

et al. 2007

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“…hospitalier pouvait être identifié et distingué des clones isolés chez les animaux et les humains porteurs sains en communauté [5,24]. Ce groupe de clones appelé clonal complex 17 (CC17) est caractérisé par des marqueurs comme la résistance de haut niveau à l'ampicilline, la présence (non constante) des gènes de virulence esp et hly et la résistance aux fluoroquinolones [5].…”

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Les entérocoques résistants aux glycopeptides

Cattoir

Leclercq

2010

Med Sci (Paris)

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> Enterococcus faecium a développé une multirésistance aux antibiotiques dont les glycopeptides. Les glycopeptides (vancomycine et teicoplanine) agissent sur les entérocoques en se fixant sur les précurseurs de la paroi bacté-rienne dont ils empêchent ainsi la formation. La résistance est due à l'acquisition d'un opé-ron de gènes coopérant pour synthétiser des précurseurs sans affinité pour les glycopeptides. Des épidémies sont survenues récemment en milieu hospitalier dues à des souches de E. faecium appartenant à un complexe clonal (CC17) adapté à l'hôpital. Les épidémies peuvent être contrôlées par des mesures appropriées et de nouveaux antibiotiques qui sont disponibles. La dissémination de souches adaptées aux conditions hospitalières nécessite leur surveillance étroite. < Centre national de référence de la résistance aux antibiotiques, Laboratoire associé entérocoques, service de microbiologie,

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“…Internationally, the important resistance genotypes of VRE have been either vanA or vanB operons usually carried by Enterococcus faecium in a transposon located within a large transferrable plasmid. There is evidence of global spread of a clonal complex of hospital-associated ampicillin-resistant E. faecium (CC17) that includes both VSE and VRE (either vanA or vanB) and has a number of putative virulence factors for hospital adaption and spread 5,6 .…”

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Vancomycin-resistant enterococci in hospitals

Ferguson¹

2014

Microbiol. Aust.

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ESBL (CDS 100% and others 82%, 2011, 6:1b); and (iv) detection of meropenem resistance in Citrobacter freundii mediated by a carbapenemase (CDS method 95%, other methods 71%, 2013, 4:1b). The future of the CDSRegistrants as CDS users continue to grow and number over 200 at present. The CDS method is now being used by laboratories in South East Asia, India and South Africa. It is unfortunate that a number of Australian public laboratories have changed from using the CDS method to other methods as a result of executive decisions apparently based on reasons other than scientific merit. As long as antimicrobial susceptibility testing is performed in diagnostic laboratories the CDS will continue to provide a service to Australasian and a number of overseas laboratories. The original CDS team has been joined by younger scientific and medical staff who will carry on the tradition of supporting a high-performance national antibiotic susceptibility test method well into the future. AcknowledgementsWe acknowledge the Board of Education of the RCPA for its support of the development of a uniform method of susceptibility testing in Australia, the staff of SEALS Microbiology, many of whom have made significant contributions to the development of the CDS, The Australian Society for Microbiology (ASM) in supporting the Annual CDS Workshops and finally the CDS users whose feedback has led to so many improvements and enhancements of the CDS.

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Global Spread of Vancomycin-resistantEnterococcus faeciumfrom Distinct Nosocomial Genetic Complex

Cited by 485 publications

References 38 publications

Growth Condition-Dependent Esp Expression by Enterococcus faecium Affects Initial Adherence and Biofilm Formation

Growth Condition-Dependent Esp Expression by Enterococcus faecium Affects Initial Adherence and Biofilm Formation

Les entérocoques résistants aux glycopeptides

Vancomycin-resistant enterococci in hospitals

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