Risk Factors for New Detection of Vancomycin-Resistant Enterococci in Acute-Care Hospitals That Employ Strict Infection Control Procedures

Padiglione, Alexander A; Wolfe, Rory; Grabsch, Elizabeth A; Olden, D.; Pearson, Stephen; Franklin, Clare; Spelman, Denis; Mayall, Barrie C.; Johnson, Paul; Grayson, M. Lindsay

doi:10.1128/aac.47.8.2492-2498.2003

Cited by 66 publications

(73 citation statements)

References 32 publications

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“…This isolate was an E. faecium strain with vanA-type glycopeptide resistance. In contrast, the majority of VRE isolates in Australia today, in particular, E. faecium, possess vanB-type resistance (8,43). Following the first Australian case in 1994, VRE was soon reported in other Australian health care facilities, with outbreaks involving VRE colonization of the hospital environment.…”

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confidence: 99%

“…Following the first Australian case in 1994, VRE was soon reported in other Australian health care facilities, with outbreaks involving VRE colonization of the hospital environment. In the past decade, the rates of VRE and vancomycin-susceptible E. faecium (VSE) colonization and, to a lesser extent, infection have increased dramatically Australia-wide (32,33,43). A recent molecular epidemiological analysis of E. faecium bacteremia isolates at one Australian institution demonstrated that ST17 was the predominant MLST clone prior to 2005; however, this was subsequently replaced by a new clone, ST203, which was associated with a significant increase in episodes of bacteremia (32).…”

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Comparative Analysis of the First Complete Enterococcus faecium Genome

et al. 2012

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Vancomycin-resistant enterococci (VRE) are one of the leading causes of nosocomial infections in health care facilities around the globe. In particular, infections caused by vancomycin-resistant Enterococcus faecium are becoming increasingly common. Comparative and functional genomic studies of E. faecium isolates have so far been limited owing to the lack of a fully assembled E. faecium genome sequence. Here we address this issue and report the complete 3.0-Mb genome sequence of the multilocus sequence type 17 vancomycin-resistant Enterococcus faecium strain Aus0004, isolated from the bloodstream of a patient in Melbourne, Australia, in 1998. The genome comprises a 2.9-Mb circular chromosome and three circular plasmids. The chromosome harbors putative E. faecium virulence factors such as enterococcal surface protein, hemolysin, and collagen-binding adhesin. Aus0004 has a very large accessory genome (38%) that includes three prophage and two genomic islands absent among 22 other E. faecium genomes. One of the prophage was present as inverted 50-kb repeats that appear to have facilitated a 683-kb chromosomal inversion across the replication terminus, resulting in a striking replichore imbalance. Other distinctive features include 76 insertion sequence elements and a single chromosomal copy of Tn 1549 containing the vanB vancomycin resistance element. A complete E. faecium genome will be a useful resource to assist our understanding of this emerging nosocomial pathogen.

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Comparative Analysis of the First Complete Enterococcus faecium Genome

et al. 2012

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“…The emergence of resistance to glycopeptide antibiotics (vancomycin and teicoplanin) in enterococci is one of the most serious infection control issues currently facing large hospitals in Australia, as elsewhere (13,20,24). There are currently six different vancomycin resistance (van) gene operons (vanA, -B, -C, -D, -E, and -G) mediating glycopeptide resistance.…”

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Molecular Characterization of vanB Elements in Naturally Occurring Gut Anaerobes

Ballard

Pertile

Lim

et al. 2005

Antimicrob Agents Chemother

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Sequence analysis of the integration site revealed distinct sequences: the Tn1549/5382 element within E. faecium was inserted within the host chromosome, whereas nucleotide sequences surrounding the Tn1549/5382 element in the 10 anaerobes showed no significant homology to sequences in the GenBank database. We demonstrate considerable similarity between the Tn1549/5382 element identified in 10 anaerobe isolates with that found in enterococci. The homology and potential to transpose suggest a recent horizontal transfer event may have occurred. However, the original direction of transposition and the mechanism involved remains unknown.

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“…Inoculation of the media was in the reverse order for even-numbered specimens. The cultures were incubated at 35°C in ambient air and were examined daily, with cIDVRE incubated for 48 h, according to the manufacturer's recommendations (cIDVRE product insert; bioMérieux), and EVA plates were incubated for 72 h, as reported previously (13). Strains producing ␤-galactosidase (violet color) and ␤-glucosidase (blue-green color) on cIDVRE and esculin-positive isolates (black color) on EVA were considered possible E. faecium or E. faecalis isolates.…”

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Comparative Study of Selective Chromogenic (chromID VRE) and Bile Esculin Agars for Isolation and Identification of vanB -Containing Vancomycin-Resistant Enterococci from Feces and Rectal Swabs

Grabsch¹,

Ghaly-Derias²,

Gao³

et al. 2008

J Clin Microbiol

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The new chromogenic agar chromID VRE (cIDVRE; bioMérieux) was compared with bile esculin agar (BD) containing 6 mg/liter vancomycin for the detection of colonization with vanB-containing vancomycin-resistant enterococci (VRE). At 48 h of incubation, the results obtained with both media were comparable. However, cIDVRE detected significantly more VRE at 24 h (39.3% versus 21.3%, P ‫؍‬ 0.003), and its use may facilitate the timely implementation of infection control procedures.Vancomycin-resistant enterococci (VRE) are significant nosocomial pathogens, and both vanA-and vanB-containing strains of VRE may cause serious infections, including bacteremia (10, 17). In Australia, unlike the United States and Europe, vanB-containing VRE strains predominate (2, 6). The early detection of VRE may facilitate the timely implementation of infection control measures, and surveillance by examination of fecal and rectal swab specimens has been adopted as a means of reducing outbreaks caused by VRE (16). Recently, it has been reported from Europe and the United States that the use of new chromogenic agars improves the ability to detect VRE isolates from fecal and rectal swab specimens (5,11,12). ChromID VRE agar (cIDVRE; bioMérieux, Marcyl'Etoile, France), which contains 8 mg/liter vancomycin, also has the advantage of differentiating Enterococcus faecalis and Enterococcus faecium, as it detects the ␤-glucosidase and the ␤-galactosidase produced by the two species respectively (5, 11, 12; cIDVRE product insert, reference no. 43 002, 2007; bioMérieux). vanA-containing VRE typically have vancomycin MICs of Ն64 mg/liter (4, 15) and would be expected to grow well in the presence of 8 mg/liter vancomycin. However, vanBcontaining VRE strains, which may exhibit much lower vancomycin MICs, including MICs of Յ4 mg/liter (4, 8), may not be as readily isolated on cIDVRE as they are on bile esculin agar (Enterococcosel; BD, Sparks, MD) containing 6 mg/liter vancomycin (EVA). At Austin Health, where vanB-containing VRE predominate, we compared cIDVRE for the detection of vancomycin-resistant strains of E. faecalis and E. faecium with EVA for the isolation of VRE from fecal and rectal swab specimens.Feces and rectal swabs were inoculated directly onto both cIDVRE and EVA. The media were inoculated with separate cotton-tipped swab sticks for fecal specimens. As only one rectal swab specimen was collected from each patient, rectal swabs with laboratory accession numbers that were an odd number were inoculated onto cIDVRE first and then onto EVA. Inoculation of the media was in the reverse order for even-numbered specimens. The cultures were incubated at 35°C in ambient air and were examined daily, with cIDVRE incubated for 48 h, according to the manufacturer's recommendations (cIDVRE product insert; bioMérieux), and EVA plates were incubated for 72 h, as reported previously (13). Strains producing ␤-galactosidase (violet color) and ␤-glucosidase (blue-green color) on cIDVRE and esculin-positive isolates (black color) on EVA were considered possi...

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Risk Factors for New Detection of Vancomycin-Resistant Enterococci in Acute-Care Hospitals That Employ Strict Infection Control Procedures

Cited by 66 publications

References 32 publications

Comparative Analysis of the First Complete Enterococcus faecium Genome

Comparative Analysis of the First Complete Enterococcus faecium Genome

Molecular Characterization of vanB Elements in Naturally Occurring Gut Anaerobes

Comparative Study of Selective Chromogenic (chromID VRE) and Bile Esculin Agars for Isolation and Identification of vanB -Containing Vancomycin-Resistant Enterococci from Feces and Rectal Swabs

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