Identification of vancomycin-resistant enterococci clones and inter-hospital spread during an outbreak in Taiwan

Abstract

BackgroundIn 2003, nosocomial infections caused by vancomycin-resistant enterococci (VRE) occurred rarely in Taiwan. Between 2003 and 2010, however, the average prevalence of vancomycin resistance among enterococci spp. increased from 2% to 16% in community hospitals and from 3% to 21% in medical centers of Taiwan. We used molecular methods to investigate the epidemiology of VRE in a tertiary teaching hospital in Taiwan.MethodsBetween February 2009 and February 2011, rectal samples and infection site specimens were collected from all inpatients in the nephrology ward after patient consent was obtained. VRE strain types were determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).ResultsA total of 59 vanA gene-containing VRE isolates (1 per patient) were obtained; 24 originated from rectal sample surveillance of patients who exhibited no symptoms (22 Enterococcus faecium and 2 Enterococcus faecalis), and 35 had developed infections over 3 days after admission (32 E. faecium, 2 E. faecalis, and 1 Enterococcus durans). The 59 VRE isolates demonstrated vancomycin minimum inhibitory concentrations (MICs) of ≥256 μg/m. The MIC range for linezolid, tigecycline, and daptomycin was 0.25–1.5 μg/mL, 0.032–0.25 and 1–4 μg/mL, respectively. For 56 isolates, the MIC for teicoplanin was >8 μg/mL. The predominant types in the nephrology ward were MLST types 414, 78, and18 as well as PFGE types A, C, and D.ConclusionVREs are endemic in nephrology wards. MLST 414 is the most predominant strain. The increase VRE prevalence is due to cross-transmission of VRE clones ST 414,78,18 by undetected VRE carriers. Because similar VRE STs had been reported in a different hospital of Taiwan, this finding may indicate inter-hospital VRE spread in Taiwan. Active surveillance and effective infection control policies are important controlling the spread of VRE in high risk hospital zones. All endemic VRE strains are resistant to teicoplanin but are sensitive to daptomycin, linezolid, and tigecycline.

A study of high level aminoglycoside resistant enterococci

“…In this study all the VRE among the HLAR enterococci were confirmed by MIC and found not to be only resistant to vancomycin and teicoplanin (≥32 µg/ml), but also showed high level Vancomycin and Teicoplanin resistance (256 µg/ml) and were all proved to be Van A genotype explaining the presence of high level resistance to both vancomycin and teicoplanin. These results were in agreement with other multiple studies (Vaibhav et al, 2013;Lee et al, 2013). On the other hand Ira et al (2013) reported that 96.9% were Van A genotype and were E. faecalis except one isolate which was Enterococcus gallinuram in combination with intrinsic Van C genotype, 2 isolates were Van B, both were Enterococcus muntidii.…”

Molecular Appraisement of Isolated Antibiotic Resistant Enterococci from Vaginal Specimen in Spontaneously Abortion Women’s

“…Like the results of our study, more similarity amongst E. faecalis strains than E. faecium was observed previously [16]. Recent studies, provided the evidence that the strains could disseminate easily due to either lack of hygiene in hospital's staff or lack of appropriate isolation in patients possessing infection caused by resistant strains and this phenomenon could occur in different hospitals as well as society [30,[32][33][34][35]. If the control of infection does not exert in hospitals, these resistant strains possessing virulent genes would be disseminated either from one individual to another one or from one hospital to another one via patients or staffs.…”

Synergistic Antibacterial Activity of Ecklonia cava Extract against Anti-biotic Resistant Enterococcus faecalis

“…Vancomycin VRE vancomycin-resistant S. aureus (VRSA) linezolid tigecycline (Lee et al, 2013). , alternative therapeutic method (Eom et al, 2013a(Eom et al, , 2014Lee et al, 2014;Nshimiyumukiza et al, 2015).…”