Prevalence and Molecular Epidemiology of Glycopeptide‐Resistant Enterococci in Belgian Renal Dialysis Units

Abstract

The molecular epidemiology of glycopeptide-resistant enterococci (GRE) colonizing the intestinal tracts of Belgian renal dialysis patients was studied among 1318 patients of a population of 1800 dialysis patients from 29 dialysis centers. Of these, 185 patients (14.0%) were colonized with a VANA-positive GRE; GRE harboring the VANB gene were not detected. The majority of the VANA GRE (80.5%) were identified as Enterococcus faecium; 14.8% were identified as E. faecalis; and a limited number were identified as E. avium, E. casseliflavus, E. dispar, E. durans, or E. gallinarum. Genome analysis of 277 VANA-positive GRE by pulsed-field gel electrophoresis revealed a high genetic variability both within the different dialysis centers and within the patients' own GRE flora. No high-level gentamicin-resistant VANA-positive GRE were detected, and most strains remained susceptible to ampicillin. These findings do not support a hospital-driven endemicity of VANA-positive enterococcal isolates in Belgium.

Detection of vancomycin resistance among enterococcus faecalis isolated from dental caries population

“…[7] The percentage of Enterococci with ed from 0.3% in 1989 to 11% in 1996. [8] In this study we did not get even a single strain with vancomycin resistance.…”

Vancomycin‐Resistant Enterococci in Canada Revisited

“…Although five of the nine strains were resistant to ampicillin, none exhibited high level gentamicin resistance (20). Descheemaeker et al (21) recently reported on VRE in Belgian renal dialysis units. Of the 1318 patients screened, 14% were colonized with vancomycin-resistant E faecium or E faecalis, all of the van A genotype.…”

“…Other differences include the in vitro susceptibility of the enterococci. Most VRE in the United States are resistant to other antibiotics such as the fluoroquinolones, ampicillin and gentamicin, whereas those in Europe are more frequently susceptible to these two agents (15,20,21,40,41). Additionally, several studies of the epidemiology of VRE in Europe have shown a high genetic variability among the strains isolated (15,20,21,41).…”

“…Most VRE in the United States are resistant to other antibiotics such as the fluoroquinolones, ampicillin and gentamicin, whereas those in Europe are more frequently susceptible to these two agents (15,20,21,40,41). Additionally, several studies of the epidemiology of VRE in Europe have shown a high genetic variability among the strains isolated (15,20,21,41). This genetic variability suggests two possible means of occurrence: patients bring their VRE in from the community or there is spread of the enterococcal resistance genes from one strain to another (20,21).…”

“…Additionally, several studies of the epidemiology of VRE in Europe have shown a high genetic variability among the strains isolated (15,20,21,41). This genetic variability suggests two possible means of occurrence: patients bring their VRE in from the community or there is spread of the enterococcal resistance genes from one strain to another (20,21). On the other hand, many American studies have documented a clonal nature of spread, suggesting that nosocomial transmission is the major mode of transmission (11,12,15,42).…”