Molecular characterization of vancomycin-resistant Enterococcus faecium strains isolated from carriage and clinical samples in a tertiary hospital, Turkey

Gözalan, Ayşegül; Coşkun-Ari, Fatma Filiz; Özdem, Birsen; Ünaldı, Özlem; Çelikbilek, Nevreste; Kırca, Fisun; Aydoğan, Sibel; Müderris, Tuba; Güven, Tümer; Açıkgöz, Ziya Cibali; Durmaz, Rıza

doi:10.1099/jmm.0.000088

Cited by 22 publications

(26 citation statements)

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“…In our study, the presence of the esp gene was more common in infecting (17, 35 %) as compared with colonizing (eight, 6 %) or water isolates (nine, 13 %). The percentage of esp-positive infecting clinical isolates was comparable with that reported in other studies, where 41 % and 30 % of enterococci carried this gene (Gozalan et al, 2015;Upadhyaya et al, 2011). Even higher rates of esp carriage have been reported, ranging from 52 % to 77 % (Comerlato et al, 2013;Ruiz-Garbajosa et al, 2006;Tsikrikonis et al, 2012).…”

Section: Discussionsupporting

confidence: 75%

“…Even though the percentage of biofilm production from infecting isolates (54 %) is comparable to that reported in previous studies (38-93 %) (Comerlato et al, 2013;Duprè et al, 2003;Gozalan et al, 2015;Ira et al, 2013;Tsikrikonis et al, 2012), biofilm synthesis from colonizing isolates (13 %) was low (Johansson & Rasmussen, 2013;Tsikrikonis et al, 2012). Furthermore, Tsikrikonis et al (2012) found that 70 % of colonizing isolates were biofilm producers, whereas, in the study of Johansson & Rasmussen (2013), biofilm synthesis was more common in normal flora isolates as compared with those recovered from infective endocarditis.…”

Section: Discussionsupporting

confidence: 60%

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Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Papadimitriou-Olivgeris

Filippidou

Δρούγκα

et al. 2015

Journal of Medical Microbiology

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The goal of this study was to compare biofilm synthesis among enterococci recovered from clinical samples (infection or colonization) of patients as well as environmental samples in order to determine possible virulence factors and clonal relationship. During a two-year period, clinical samples (blood, catheter tips, bronchial secretions, wounds, peritoneal fluid, urine) and rectal swabs collected from hospitalized patients as well as environmental water samples were tested for the presence of Enterococcus faecalis and Enterococcus faecium. Antibiotic susceptibility testing was performed by the disc diffusion method and Etest. Strains were tested for the presence of vanA, vanB, esp, ace and asp genes by PCR. Clones were identified by PFGE (Sma I). From infected patients, 48 strains were identified: 24 Enterococcus faecium (10 vanApositive, 14 vancomycin-susceptible) and 24 Enterococcus faecalis (one vanA-positive, 23 vancomycin-susceptible). Among 143 colonizing isolates, 134 were Enterococcus faecium (58 vanA-positive, 11 vanB-positive, 65 vancomycin-susceptible) and nine Enterococcus faecalis (three vanA-positive, two vanB-positive, four vancomycin-susceptible). Among 167 environmental water samples, 51 Enterococcus faecalis and 19 Enterococcus faecium isolates, all glycopeptide-susceptible, were recovered. In total, 64 strains produced biofilm, whereas 34 were esp-positive, 64 asp-positive and 54 ace-positive. Biofilm production was associated with the presence of esp (P,0.001) and ace genes (P50.021), being higher in infecting (P,0.001) and water (P 0.005) isolates as compared with colonizing ones. Clones of environmental waterstrains were different than the patients' clones. The differences found in the incidence of antibiotic resistance, virulence factors and clones suggest that hospital and water enterococci are of different origin.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 60%

Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Papadimitriou-Olivgeris

Filippidou

Δρούγκα

et al. 2015

Journal of Medical Microbiology

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“…Libisch et al [18] reported that the vanA gene was the dominant gene among invasive isolates in Serbia. Similar results were obtained for hospitalized patients in Turkey [27]. As per Werner et al [28], the vanA and vanB resistance genotypes are by far the most prevalent in Europe.…”

Section: Discussionsupporting

confidence: 85%

“…VanC confers only lowlevel resistance to vancomycin [24,25]. Compared to other phenotypes, the VanA is the most common in European countries [26,27]. Our results confirmed this fact: 100% of VREfm strains belong toVanA phenotype.…”

Section: Discussionsupporting

confidence: 79%

The phenotypic and genotypic characterization of vancomycin-resistant enterococci in outpatients’ urine culture

et al. 2017

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Introduction/Objective In the era of emerging antibacterial resistance, the major burden of resistant strains is on hospitalized patients. Although community factors are also important in the spread of resistance, less attention has been paid to non-healthcare settings. The aim of the study is to determine the prevalence of vancomycin-resistant enterococci (VRE) in the outpatient's urine culture and to perform phenotypic and genotypic characterization of VRE strains. Methods During an 18-month period, a total of 5,164 Enterococcus spp. strains were isolated from urine and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing was performed by disk diffusion method and by gradient test for glycopeptideresistant strains. Genotypic characterization of VRE strains was done by multiplex polymerase chain reaction for the detection of the vancomycin resistance genes. Results Among the isolated enterococci, 5,060 (98%) were E. faecalis and 104 (2%) were E. faecium. E. faecalis strains were susceptible to all tested antibiotics except norfloxacin (33% of strains were resistant), while E. faecium showed high level of resistance to most of the tested agents (91.3% to ampicillin, 77% to norfloxacin, and 75% to nitrofurantoin), and 26% of strains were resistant to vancomycin and teicoplanin. VanA gene was detected in all vancomycin resistant E. faecium (VREfm) strains. Conclusion A high proportion of VREfm was noticed among outpatients in our country. All analyzed VREfm strains belonged to vanA genotype. Future surveillance studies of VRE are needed to follow up on this baseline study to monitor any possible changes in abundance and genotype of VRE in this population group.

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“…Similarly, Gözalan et al reported that all 55 VREfm strains carried the vanA gene. 13 In other studies, from Turkey, the rate of vanA carriage has been determined to be 84-100%. [14][15][16] The vanA type resistance is dominant in the United States and Europe, whereas vanB type resistance is more frequent in Australia and Southeast Asia.…”

Section: Discussionmentioning

confidence: 97%

<p>Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey</p>

Aşgın

Otlu

2020

IDR

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Purpose: Vancomycin-resistant enterococci (VRE) have become a global health threat in the last two decades. In this study, we aimed to determine antibiotic resistance using phenotypic and genotypic methods in VRE strains obtained from inpatients and to investigate clonal relatedness among strains. Methods: Identification and antibiotic susceptibility of 47 VRE strains obtained from inpatients at Karabuk University Hospital from 2014 to 2015 were determined using the BD Phoenix™ automated microbiology system. Vancomycin resistance genes (Van A and B) were detected by polymerase chain reaction. Clonal relatedness among the strains was evaluated by pulsed-field gel electrophoresis (PFGE). Results: All 47 VRE strains obtained from rectal (n=35), blood (n=7), and urine (n=5) samples were confirmed as Enterococcus faecium; they were resistant to ampicillin, gentamicin, vancomycin, and teicoplanin. One E. faecium isolate was intermediately resistant to linezolid. No strain was resistant to quinupristin-dalfopristin or daptomycin. Only vanA was detected among strains. According to the PFGE results, 31 of 47 strains were clonally related with a clustering rate of 66%. No common clone was detected. Conclusion: VRE infections are associated with high mortality, morbidity, and healthcare expenditures. Increasing resistance to last-line drugs, such as linezolid and daptomycin, among VRE strains is a great concern. Therefore, comprehensive measures should be performed to reduce VRE colonization. Although there was no common clone VRE outbreak, polyclonal spread was observed in our hospital. The high clustering rate indicated cross-contamination. Thus, a more effective infection control program should be implemented.

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Molecular characterization of vancomycin-resistant Enterococcus faecium strains isolated from carriage and clinical samples in a tertiary hospital, Turkey

Cited by 22 publications

References 46 publications

Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

Biofilm synthesis and presence of virulence factors among enterococci isolated from patients and water samples

The phenotypic and genotypic characterization of vancomycin-resistant enterococci in outpatients’ urine culture

<p>Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey</p>

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