Infection with Vancomycin-Resistant "Streptococci" Due to Leuconostoc Species

Rubin, Lorry G.; Velwzzi, Ernestine; Shapiro, Jeffrey D.; Isenberg, Henry D.

doi:10.1093/infdis/157.1.216

Cited by 45 publications

(30 citation statements)

References 8 publications

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“…Reports of vancomycin-resistant enterococci has highlighted the difficulties of identification and distinction between enterococci and other biochemically similar genera within the family Streptococcaceae, especially Pediococcus, Leuco-nOstoc and Lactobacillus (8)(9)(10)(11)(12). The frequency with which species of these.other genera occur in clinical specimens and thus the potential for confusion in the diagnostic laboratory is not known.…”

Section: Martens Mg Faro S Hunter Ha Smith D Riddlementioning

confidence: 99%

Frequency and antimicrobial susceptibility of clinical isolates of enterococci

Guiney

Urwin

1993

Eur. J. Clin. Microbiol. Infect. Dis.

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A study was performed to determine the frequency and antimicrobial susceptibility of Enterococcus species in clinical specimens. Of 943 aesculin-positive isolates, 873 (92%) were identified as enterococci (737 Enterococcus faecalis, 129 Enterococcus faecium and 7 other Enterococcus species). High-level resistance to gentamicin was found in 15.2% of Enterococcus faecalis, but not in Enterococcus faecium; 58% of Enterococcus faecium were resistant to gentamicin at a concentration of 64 mg/l. None of the isolates were shown to possess vancomycin resistance.

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Section: Martens Mg Faro S Hunter Ha Smith D Riddlementioning

confidence: 99%

Frequency and antimicrobial susceptibility of clinical isolates of enterococci

Guiney

Urwin

1993

Eur. J. Clin. Microbiol. Infect. Dis.

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“…Given the numerous reports that have been published since 1988 (5,10,13,20,21,27), it appears indisputable that nonenterococcal vancomycin-resistant, gram-positive organisms should now be considered clinically significant when isolated in the proper circumstances. But because of problems in recognition and identification of this group, many of these strains may have been overlooked or misidentified.…”

Section: Susceptibility Of Vancomycin-resistant Speciesmentioning

confidence: 99%

“…have been reported (2,3,5,10,12,13,(19)(20)(21)27), including a case of meningitis in a previously healthy 16-year-old girl (4). There has been only one report of infections caused by Pediococcus sp.…”

mentioning

confidence: 99%

Antimicrobial susceptibility of vancomycin-resistant Leuconostoc, Pediococcus, and Lactobacillus species

Swenson

Facklam

Thornsberry

1990

Antimicrob Agents Chemother

185

107

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Eighty-five strains of vancomycin-resistant gram-positive bacteria from three genera, Leuconostoc, Pediococcus, and Lactobacilus, were tested to determine susceptibility to 24 antimicrobial agents by broth microdilution and to 10 agents by disk diffusion. The MICs of vancomycin and teicoplanin ranged from 64 to >512 ,ug/ml; however, the MICs of daptomycin, a new lipopeptide, were all .0.25 ,ug/ml. None of the organisms were resistant to imipenem, minocycline, chloramphenicol, gentamicin, or daptomycin. The MICs of penicillin were in the moderately susceptible range for all but three strains. Susceptibility to the other agents varied by genus and, in some cases, by species. When disk diffusion results were compared with MICs for drugs recommended for streptococci by the National Committee for Clinical Laboratory Standards, Vilanova, Pa., few very major or major errors were obtained, but the number of minor errors was 19.3%. Therefore, we recommend that MIC testing be used instead of disk diffusion testing for these organisms.Because of the increase in nosocomial infections caused by gram-positive cocci, especially staphylococci (both Staphylococcus aureus and coagulase-negative staphylococci) (T. Horan, D. Culver, W. Jarvis, G. Emori, S. Banerjee, W. Martone, and C. Thornsberry, Antimicrob. Newsl. 5:65-67, 1988), and because of the growing prevalence of methicillin resistance in staphylococci (9), vancomycin has been used more often for treating patients who have or who are suspected of having infections caused by gram-positive organisms. Reports of clinical infections caused by vancomycin-resistant organisms have been more frequent in recent years, with resistance in staphylococci (22), enterococci (14-16, 26), and lactobacilli (1, 8, 11) described. Clinically significant vancomycin resistance in Leuconostoc and Pediococcus spp. was rarely reported before 1985 (19). The first case of a clinically significant infection caused by a Leuconostoc sp. was reported as being caused by a Streptococcus sanguis II strain in 1984 (24). The identity of the strain reported was later questioned (C. Thornsberry and R. Facklam, Antimicrob. Newsl. 1:63-64, 1984) and reidentified as Leuconostoc sp. by one of us (R.R.F.).Since then, a number of clinically significant infections caused by Leuconostoc spp. have been reported (2,3,5,10,12,13,(19)(20)(21)27), including a case of meningitis in a previously healthy 16-year-old girl (4). There has been only one report of infections caused by Pediococcus sp. (3), although many such strains from clinical sources have been submitted to the Centers for Disease Control for identification or antimicrobial susceptibility studies (7). Vancomycin resistance in lactobacilli has also been reported (1, 8, 11), but resistance of and clinical infection caused by Lactobacillus confusus, an organism that may often be confused with these gram-positive cocci, have not been documented.Because of the possibility that these organisms may be pathogens, we tested a number of them to determine pat-* Correspon...

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“…obtained from the stool of one baby, the throats of staff, and environmental surfaces failed to yield similar organisms (48,94). In another study involving three patients infected with vancomycin-resistant leuconostocs, swabs from the gingivae and skin of 22 hospital workers who were in contact with the patients failed to yield leuconostocs (54).…”

Section: Leuconostocmentioning

confidence: 99%