Prevalence of Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Nonhospitalized Controls in a Cattle-Rearing Area of France

Abstract

Vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens over the last decade, but little is known about their epidemiology. We report on the prevalence of VRE fecal colonization on the basis of a prospective study among patients hospitalized in a hematology intensive care unit and among nonhospitalized subjects living in the local community. A total of 243 rectal swabs from hematology patients and 169 stool samples from the control group were inoculated onto bile-esculin agar plates with and without 6 mg of vancomycin per liter and into an enrichment bile-esculin broth supplemented with 4 mg of vancomycin per liter. A total of 37% of the hospitalized patients and 11.8% of the subjects from the community were found to be VRE carriers. A total of 65 VRE strains were isolated: 12 (18.5%) E. faecium, 46 (70.7%) E. gallinarum, and 7 (10.8%) E. casseliflavus strains. No E. faecalis strains were detected. All the E. faecium strains were of the vanA genotype. Molecular typing by pulsed-field gel electrophoresis revealed a different pattern for each vanA VRE strain that originated from an individual subject. To our knowledge, this is the first study to be carried out in a cattle-rearing region of France. It reports a higher VRE prevalence than that reported in previous European or U.S. studies. A partial explanation is the use of an enrichment broth step which enabled detection of strains which would otherwise have been missed, but the fact that subjects and patients were recruited from a predominantly agricultural area where vancomycin-related antibiotics have recently been used in animal husbandry could also contribute to the high levels of VRE in patients and subjects alike.

Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci

“…This study investigated the clinical characteristics, antibiotic use, microbiological factors and clinical outcome of patients colonised with VRE. The overall prevalence of VRE of 14.4% was somewhat higher than those reported previously by other investigators in Europe (1.5-8.6%) [11][12][13] or specifically in Greece (3.9-7.5%) [25,26]. The PFGE results, showing that most isolates belonged to two major clones, with the remainder belonging to six additional clones, suggest an endemic situation, combined with an acute nosocomial outbreak.…”

Characterization and risk factors of vancomycin-resistantEnterococci(VRE) among animal-affiliated workers in Malaysia

“…), respectively, and the VRE prevalence rate among communities living in cattle‐rearing areas was 11·8% (Gambarotto et al . ). In our study, VRE were detected in 13·5% (95% CI: 8·1–20·9) of the poultry workers, which appeared to be lower than those reported in the two former studies.…”

“…; Gambarotto et al . ), although the rates differ considerably between countries. The highly variable rates observed among countries indicate the possibility of a confounding effect of the environmental and other factors not accounted for in these studies.…”

Enterococci from foods

“…Conversely, no PFGE-deduced genetic overlap was found when VREF from humans were compared with VREF from poultry [57]. Molecular typing by PFGE carried out on VRE isolated from hospitalised patients and non-hospitalised controls in France revealed a di¡erent pattern for each VRE that originated from an individual subject [65]. Similarly, di¡erent PFGE patterns between strain 686B, a VRE causing nosocomial outbreaks in three hospitals located in the Northern Italy, and various VRE isolated from food were observed (Fontana, Goglio and Scagnelli, personal communication).…”