The Dominant Sequence Types of Vancomycin-Resistant Enterococcus faecium Among Transplantation Ward Patients

Młynarczyk, A; Szymanek-Majchrzak, Ksenia; Kosykowska, E.; Grzybowska, Wanda; Tyski, Stefan; Mrówka, Agnieszka; Bączkowska, Teresa; Durlik, M.; Pacholczyk, Marek; Chmura, A.; Ciszek, Michał; Pączek, Leszek; Młynarczyk, G.

doi:10.1016/j.transproceed.2011.08.005

Cited by 5 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All over the world, strains of E faecium resistant to beta-lactam antibiotics and fluoroquinolones were noted, which can be explained by the clonal spread of isolates with a mutation in key genes for resistance, as well as the horizontal transfer of the mutated gene among the strains. The literature describes the spread in a hospital environment of the clonal complex CC17 of E faecium (typed on the basis of the MLST technique), which appeared in the early 1980s of the 20th century all over the world [2,20]. These isolates were distinguished by resistance to ampicillin, fluoroquinolones, and to high concentrations of streptomycin and glycopeptides.…”

Section: Discussionmentioning

confidence: 99%

“…Enterococci due to natural resistance to many classes of antibiotics and easy acquisition of new resistances achieved an evolutionary success in the hospital environment and have become one of the most important agents of hospitalassociated infections and hospital outbreaks [1]. Most of hospital strains of vancomycin-resistant enterococci (VRE) Enterococcus faecium belong to the hospital-associated clonal complex e described initially in multilocus sequence typing (MLST) technique as clonal complex 17 (CC17) [2,3]. Moreover, strains resistant to high concentrations of ampicillin and ciprofloxacin simultaneously possess genes encoding virulence factors essential for the process of colonization [4,5].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the Prevalence of Insertion Element IS16 in Vancomycin-resistant Enterococci Strains of Enterococcus faecium Isolated From Transplantology Patients From a Warsaw Hospital Between 2010 and 2012

Chabros¹,

Szymanek-Majchrzak²,

Młynarczyk

et al. 2014

Transplantation Proceedings

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of the Prevalence of Insertion Element IS16 in Vancomycin-resistant Enterococci Strains of Enterococcus faecium Isolated From Transplantology Patients From a Warsaw Hospital Between 2010 and 2012

Chabros¹,

Szymanek-Majchrzak²,

Młynarczyk

et al. 2014

Transplantation Proceedings

Self Cite

View full text Add to dashboard Cite

“…Little is known about the molecular epidemiology of VRE and VRE transmission during the peritransplant setting. Although prior studies have evaluated the rates and clinical epidemiology of VRE colonization among liver transplant candidates as well as the molecular epidemiology of VRE isolates among transplant recipients , there are limited data available regarding the clinical and molecular epidemiology of VRE colonization among the liver transplant candidates who subsequently undergo transplantation, including the impact of pre‐transplantation VRE colonization on post‐transplant outcomes.…”

mentioning

confidence: 99%

The clinical and molecular epidemiology of pre‐transplant vancomycin‐resistant enterococci colonization among liver transplant recipients

Banach

Peaper

Fortune

et al. 2016

Clinical Transplantation

View full text Add to dashboard Cite

Vancomycin-resistant enterococci (VRE) infections cause significant morbidity in liver transplant recipients. The epidemiology and impact of pre-transplant colonization with VRE among patients who undergo liver transplantation are poorly understood. We conducted an observational cohort study to identify risk factors and outcomes associated with pre-transplant VRE colonization and described the molecular diversity among VRE strains colonizing patients who undergo liver transplantation. Perirectal VRE surveillance cultures were performed prior to transplantation. Repetitive sequence-based polymerase chain reaction (rep-PCR) testing was used to identify clonality among VRE isolates. Of 61 patients who underwent pre-transplant VRE surveillance and subsequent liver transplantation, 27 (44%) were colonized with VRE. In multivariate analysis, pre-transplant VRE colonization was associated with central venous catheterization (OR 9.4, 95% confidence interval [CI]= 1.3-70.2, p = 0.03) and rifaximin use (OR 15.4, 95% CI 1.5-159.7, p = 0.02). Pre-transplant VRE colonization was associated with more hospital days post-transplant (26.6 vs. 16.1 d, p = 0.04). Of VRE-colonized patients analyzed with rep-PCR, 68% were colonized with the same strain as another patient in the cohort. Active surveillance identifies VRE-colonized patients who may benefit from targeted antimicrobial prophylaxis and enhanced infection prevention measures to prevent VRE spread. The relationship between rifaximin receipt and VRE colonization warrants further study. The identification of similar VRE isolates may suggest linked transmission during pre-transplant hospitalizations, which should be further investigated in prospective studies.

show abstract

“…Ζ πεξηγξαθή ζηειερώλ Enterococcus πνπ θέξνπλ ην γνλίδην vanB κε MIC ζε βαλθνκπθίλε ≤4 mg/L έρεη γίλεη θαη από άιινπο εξεπλεηέο, νη νπνίνη ππνγξακκίδνπλ όηη ηα ζηειέρε απηά κπνξεί λα κελ αληρλεπζνύλ εάλ ν έιεγρνο ησλ ζηειερώλ Enterococcus γηα αληνρή ζηε βαλθνκπθίλε γίλεηαη κόλν κε ηνλ θαζνξηζκό ηεο MIC θαη ζπζηήλνπλ ηε αλίρλεπζε ηνπ γνληδίνπ vanB κε PCR [381, 385, 389]. πιεηνλόηεηα ησλ αλζεθηηθώλ ζε βαλθνκπθίλε E. faecium αλήθνπλ ζην θισληθό ζύκπινθν CC17 όπσο ε πιεηνλόηεηα ησλ ζηειερώλ πνπ απνκνλώλνληαη πιένλ από θιηληθά δείγκαηα ζηελ Δπξώπε θαζώο θαη παγθνζκίσο[115,116,128,129,133,393,404,[413][414][415][416][417][418][419][420]. Ζ δηαζπνξά ηνπ CC17 εμεγεί θαη ηελ πςειή αληνρή ησλ ζηειερώλ E. faecium ζε ακπηθηιιίλε θαη ζηπξνθινμαζίλε[115,116,128,129,133,393,404,[413][414][415][416][417][418][419][420].…”

unclassified

“…πιεηνλόηεηα ησλ αλζεθηηθώλ ζε βαλθνκπθίλε E. faecium αλήθνπλ ζην θισληθό ζύκπινθν CC17 όπσο ε πιεηνλόηεηα ησλ ζηειερώλ πνπ απνκνλώλνληαη πιένλ από θιηληθά δείγκαηα ζηελ Δπξώπε θαζώο θαη παγθνζκίσο[115,116,128,129,133,393,404,[413][414][415][416][417][418][419][420]. Ζ δηαζπνξά ηνπ CC17 εμεγεί θαη ηελ πςειή αληνρή ησλ ζηειερώλ E. faecium ζε ακπηθηιιίλε θαη ζηπξνθινμαζίλε[115,116,128,129,133,393,404,[413][414][415][416][417][418][419][420]. Πέληε ζηειέρε αλήθνπλ ζην CC94 ην νπνίν είρε αλαθεξζεί ζε ζηειέρε πνπ απνκνλώζεθαλ ζηελ Πνξηνγαιία, ελώ 5 αθόκα ζηειέρε αλήθνπλ ζε έλαλ θαηλνύξγην θιώλν, ηνλ ST786[421].…”

unclassified

Κλινικοεργαστηριακή Διερεύνηση Της Φορείας Και Των Λοιμώξεων Από Πολυανθεκτικά Στελέχη Σε Ασθενείς Της Μονάδας Εντατικής Θεραπείας Και Των Μονάδων Αυξημένης Φροντίδας

Παπαδημητρίου-Ολιβγέρης¹

View full text Add to dashboard Cite

The purpose of this study was to investigate the colonization and infectionscaused by KPC-producing Klebsiella pneumoniae (KPC-Kp), vancomycin-resistantEnterococcus (VRE) and methicillin-resistant Staphylococcus aureus in patientshospitalized in the Intensive Care Units of the University Hospital of Patras (ICU A)and the General Hospital “Saint Andrew” during October 2009 and February 2012.The dissemination of KPC-Kp constitutes the most important issue in GreekICUs, with its percentage rising in medical and surgical wards. During the duration ofthis study, 12.8% of patients admitted in the ICU A (52 from 405 patients) werecolonized upon admission and previous ICU stay, chronic obstructive pulmonarydisease, duration of previous hospitalization and previous usage of carbapenem orcombination of beta-lactamic/lactamase were found to influence colonization. Agradual increase of the percentage of colonized patients admitted at the ICU from3.9% (4 from 102 patients) during the first 6 months to 15.8% (48 from 300 patients)the next 16 months that reflects the dissemination of KPC-Kp in non-ICU wards.Among the 226 non-colonized upon ICU A admission patients, 164 (72.6%)became colonized during their stay with the presence of colonized patients in nearbybeds and the previous colonized occupant in the same bed were associated withcolonization, which did not influence mortality. The high percentage of colonizationin combination with the aforementioned factors indicates the importance of thedissemination of KPC-Kp among patients via the personnel and signifies the value ofa strict implementation of infection control protocols.In total, 53 patients developed KPC-Kp bloodstream infection during ICU Astay with 43.4% mortality. The most important factors that influence mortality werethe resistance of the strain to gentamicin/colistin/tigecycline and septic shock, whilethe treatment with two active antibiotics was associated with better survivalconfirming the results of previous studies favoring combination therapy for thetreatment of KPC-Kp infection.The development of resistance against colistin or tigecycline, which areconsidered the last frontier in the treatment of KPC-Kp infections, is an alarmingphenomenon. In total, 24.4% and 17.9% of ICU A patients became colonized byKPC-Kp resistant to colictin or tigecycline, respectively. As expected, the administration of colistin or tigecycline influenced colonization, while the mostimportant factor favoring colonization was the presence of colonized patients innearby patients, indicating the importance of dissemination of these strains against denovo resistance development.The comparison of the two ICUs, found a higher percentage of patientscolonized during ICU A stay (61.8% vs 34.1%) and in a shorter period (10.6 vs 19.9days). These results may be explained by the higher percentage of patients colonizedupon admission (11.4% vs 1.8%), the lower nurse/patient ration and the highercarbapenem administration.In total, 305 and 100 strains of K. pneumoniae isolated from patientshospitalized in ICU A and B, respectively, were positive for the presence of blaKPCgene while five strains in ICU A were positive for the blaVIM gene also. All strainswere resistant to penicillins, cephalosporins, aztreonam, trimethoprimsulfamethoxazole (30% of ICU B strains were sensitive), amikacin, tombramycin andquinolones. The resistance rates to carbapenems (67.9% vs 60%), colisitn (35.1% vs18%), gentamicin (50.8% vs 24%) and tigecycline (17% vs 18%) among the ICUsstrains were comparable. PFGE of 57 and 20 isolates from ICU A and B, respectively,revealed that ICU A strains belonged in two types, with type A comprising 65.5% ofthe isolates, while all ICU B isolates belonged in type A.The percentage of VRE colonization in both ICUs were lower in comparisonwith those of KPC-Kp. During ICU admission 14.3% (71 from 497 patients) wasalready colonized, while 14.4% (36 from 250 patients) became colonized during stay.The most important factor influencing colonization was the presence of colonizedpatients in nearby beds, indicating that non adherence with hand hygiene may play apredominate role in VRE dissemination.In total 107 VRE strains were isolated (100 E. faecium and 7 E. faecalis).Eighty four were positive for the vanA gene and resistant to vancomycin andteicoplanin, while the rest were vanB positive and were characterized by low levelresistance to vancomycin (12 were in susceptibility range) and susceptible toteicoplanin. All strains were susceptible to linezolid, daptomycin and tigecycline. AsMLST revealed, E. faecium strains belonged in six different Sequencing Types(ST117, ST17, ST203, ST226, ST786, ST125) with 90% among them belonging tothe Clonal Complex CC17. E. faecalis strains were categorized in four STs (ST6,ST41, ST19, ST28). The proportion of colonized patients by MRSA upon admission and duringICU stay was very low (5.3% and 3.7%, respectively). The most important factorassociated with colonization was enteric carriage of vanA-positive Enterococcus.Surveillance cultures revealed 28 mecA-positive S. aureus strains, with the majority(n=19) being PVL-positive, belonging to ST80 and resistant only to kanamycin,tetracycline and fucidic acid, while the remaining were categorized in four STs (6strains in ST239 and one at ST225, ST72 and ST30). The ST30 strain was tstpositive.The comparison of colonization strains from patients (n=67) and personnel(n=23) of the ICUs (Group A) with the strains of colonization (n=53) and bloodstreaminfections (n=75) isolated from non-ICU patients (Group B), revealed a higherpercentage of MRSA and PVL-positive strains in Group B, while Group A wascharacterized by higher percentage of tst-positive strains indicating their silentdissemination between ICU patients and personnel.The present study has identified the risk factors for colonization of infectionby KPC-Kp, VRE and MRSA, in order to guide the future efforts towards containingtheir dissemination in the two ICUs, as well as, to the Greek hospitals, which in totalare plagued by the aforementioned pathogens.

show abstract

The Dominant Sequence Types of Vancomycin-Resistant Enterococcus faecium Among Transplantation Ward Patients

Cited by 5 publications

References 10 publications

Evaluation of the Prevalence of Insertion Element IS16 in Vancomycin-resistant Enterococci Strains of Enterococcus faecium Isolated From Transplantology Patients From a Warsaw Hospital Between 2010 and 2012

Evaluation of the Prevalence of Insertion Element IS16 in Vancomycin-resistant Enterococci Strains of Enterococcus faecium Isolated From Transplantology Patients From a Warsaw Hospital Between 2010 and 2012

The clinical and molecular epidemiology of pre‐transplant vancomycin‐resistant enterococci colonization among liver transplant recipients

Contact Info

Product

Resources

About