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Phenotypic and genetic diversity of Lactococcus lactis and Enterococcus spp. strains isolated from Northern Spain starter-free farmhouse cheeses.

To evaluate a previous phenotypic classification of lactococci, 39 presumed lactococcal strains were classified by molecular techniques. The strains were also subjected to several typing techniques to estimate the phenotypic and genetic diversity present in original populations from starter-free farmhouse cheeses. Partial Amplified rDNA Restriction Analysis (partial ARDRA) with either restriction enzyme MboII or HhaI divided these isolates into four distinctive groups. Sequencing of representative amplicons identified 29 isolates as belonging to Lactococcus lactis subsp. lactis (24) and Lactococcus lactis subsp. cremoris (5). The remaining 10 isolates were shown to be Enterococcus durans (8) and Enterococcus faecalis (2), which were misclassified by the traditional tests. Thus, partial ARDRA was successfully used to classify wild Lactococcus-like strains into Lactococcus and Enterococcus species. The technique also allowed differentiation of L. lactis strains at subspecies level. The 29 strains of L. lactis showed five different fermentation profiles, four distinct Random Amplification of Polymorphic DNA (RAPD) profiles, and 14 unrelated profiles by both Restriction Fragment Length Polymorphism analyzed by Pulsed Field Gel Electrophoresis (RFLP-PFGE) and Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE). Using the same techniques, the 10 enterococcal strains showed four fermentation profiles, four RADP, and six by RFLP-PFGE and SDS-PAGE, respectively. Several typing techniques, especially RFLP-PFGE and SDS-PAGE, revealed wide phenotypic and genetic variability in both the lactococcal and enterococcal isolates. Two simple, rapid and cheap techniques (partial ARDRA and SDS-PAGE) are proposed as reliable tools for the classification and typing of new lactococcal-like isolates.

Bacterial Typing Techniques↗

[Post operative Enterococcus faecalis endophthalmitis: three case report].

We report three cases of endophthalmitis following cataract extraction. Enterococcus faecalis was the causative organism in all of them. Initial visual acuity was only light perception in all cases, final visual acuity was negative light perception in two cases, and light perception in one case. After initial improvement, inflammation was exacerbated in one patient and evisceration realized. The capsular bag was examined using scanning electron microscopy and it was shown that enterococci were adherent to the capsular bag, four months after the onset of the infection. Enterococcus faecalis can be the causative agent both of an acute and a chronic form of post operative endophthalmitis. Experimental studies on rabbit eyes could explain the poor prognosis of these endophtalmitis and focused on bacterial toxins. The contamination appears to be post operative, because Enterococcus faecalis is not a commensal agent of the conjunctiva. So we have to inform our patients about some hygienic habits, to prevent from this devastating complication of cataract surgery.

Aged↗

Antimicrobial resistance from enterococci in a pediatric hospital. Plasmids in Enterococcus faecalis isolates with high-level gentamicin and streptomycin resistance.

BACKGROUND: Enterococcus spp. is an important nosocomial and community-acquired pathogen. Recent studies have documented the increasing importance of this pathogen in children, particularly in the hospital setting. Our objective in this study was to report the frequency of antimicrobial resistance in enterococci and to determine the characteristics of high-level gentamicin resistance (HLGR) plasmids in Enterococcus faecalis clinical isolates. METHODS: Two hundred eighty-nine enterococcal isolates were collected during an 18-month period from a tertiary-care pediatric hospital in Mexico City. Isolates were screened for antibiotic resistance, including HLGR. High-level, gentamicin-resistant E. faecalis strains were selected for pulsed-field electrophoresis (PFGE) typing and plasmid analysis. Transferability of resistance markers was carried out using filter matings. RESULTS: Seventy-six percent of isolates were E. faecalis, 10% were E. avium, 5.2% E. faecium, 5.2% E. raffinossus, 1.38% E. malodoratus, 0.6% E. hirae, and 0.6% E. casseliflavus. Antimicrobial resistance was ampicillin and penicillin 29%, imipenem 17%, and vancomycin 3%, HLGR 5%. The following 15 high-level, gentamicin-resistant isolates were identified: six E. faecalis; four E. avium; three E. faecium, and two E. casseliflavus. Five of the six E. faecalis isolates were different by PFGE and transferred gentamicin and streptomycin resistance on filter membranes. Transfer frequencies ranged from 8.2 x 10(-4) to 6.92 x 10(-5) transconjugants/recipient cell. The plasmid content of donors and transconjugants were homogeneous (one plasmid of 47 kb). CONCLUSIONS: In this pediatric hospital, antimicrobial resistance in Enterococcus spp. is common. Frequency of high-level, gentamicin-resistant strains is low. Mechanism of HLGR appears to be due to a single plasmid dissemination.

Drug Resistance, Microbial↗

Isolation and epidemiological study of vancomycin-resistant Enterococcus faecium from patients of a haematological unit in Poland.

Enterococcus faecium has recently emerged as a serious nosocomial pathogen. Vancomycin resistant enterococci (VRE) have been isolated in Europe and the USA since 1988. This is the first report on isolation of vancomycin resistant E. faecium (VREM) strains in Poland, from Haematological Unit patients in the Clinical Hospital in Gdańsk. In total, 6412 samples were examined between December 1996 and October 1997. Five hundred and five isolates of Enterococcus spp. were collected. One hundred and one were classified as Enterococcus faecium of which 49 were resistant to vancomycin (MIC > 256 mg/L) and teicoplanin (MIC > 256 mg/L), characteristic of the VanA phenotype. Twenty-nine patients were infected or colonized. A PCR-based specific diagnostic assay confirmed the phenotype. The multiplex PCR-restriction fragment length polymorphism patterns were consistent with VanA-type of vancomycin-resistant E. faecium for all isolates examined. These isolates were epidemiologically-related as shown by PCR-fingerprinting.

Adult↗

In vitro activities of six fluoroquinolones against Canadian isolates of vancomycin-sensitive and vancomycin-resistant Enterococcus species.

The in vitro activities of six fluoroquinolones were determined against 1482 Enterococcus species isolates collected as part of a 1996 Canadian surveillance study. Clinafloxacin MIC90s were 4 or 8 microg/mL, trovafloxacin and BAY 12-8039 MIC90s were 8 or 16 microg/mL, sparfloxacin MIC90s were 32 microg/mL, and ciprofloxacin and ofloxacin MIC90s were >32 microg/mL for the vancomycin-sensitive Enterococcus faecalis, vancomycin-sensitive Enterococcus faecium, and vancomycin-resistant E. faecium isolates collected.

Anti-Bacterial Agents↗

Aminoglycoside-modifying enzymes in high-level streptomycin and gentamicin resistant Enterococcus spp. in Spain.

Aminoglycoside resistance was evaluated in 690 enterococcus strains isolated from different clinical sources originating from patients at the University Clinic Hospital of Zaragoza (Spain). The enterococci obtained from clinically significant samples (blood, urine, or exudates) showed more high-level resistance to gentamicin and streptomycin (65 and 42%, respectively) than those isolated from faecal samples (49 and 23%, respectively). Aminoglycoside-modifying enzymes (AME) from 119 of these high-level gentamicin and streptomycin resistant enterococcus strains were studied. The most frequent AMEs found were APH(3') and AAC(6')-APH(2"). More than one enzyme was detected in 71% of the strains (four different enzymes in 5% of the strains). Three Enterococcus faecalis strains had ANT(4')(4") enzymatic activity. Different enzymatic expressions of the bifunctional enzyme AAC(6')-APH(2") were demonstrated in strains in which the complete aac(6')-aph(2") gene was detected by PCR and hybridization: (i) AAC(6') + APH(2") activity; (ii) AAC(6') only; (iii) APH(2") only; and (iv) no activity of AAC(6') or APH(2").

Anti-Bacterial Agents↗

Interaction of fibronectin and aggregation substance promotes adherence of Enterococcus faecalis to human colon.

This in vitro study investigates the interaction between aggregation substance (AS), a virulence factor of Enterococcus faecalis, and colonic mucosal fibronectin in normal colon and colon from patients with Crohn's disease. Fibronectin was found to be overexpressed in Crohn's disease compared to normal colon. Compared to E. faecalis OG1X:pAM944 (AS-negative), E. faecalis OG1X:pAM721 (expressing AS) showed a significantly enhanced adhesion to human colonic mucosa in normal colon and in colon from patients with Crohn's disease. Double-staining of fibronectin and AS-positive enterococci showed that colocalization of bacteria and fibronectin was significantly more frequent in Crohn's disease than in normal colon. Preincubation of bacteria with soluble fibronectin caused a significant reduction in the adherence to fibronectin. In conclusion, the interaction between AS and fibronectin plays is an important factor that mediates adhesion of Enterococcus faecalis to colonic mucosa. This might be one of the mechanisms responsible for bacterial translocation of Enterococcus faecalis.

Bacterial Adhesion↗

Potential of the enterocin regulatory system to control expression of heterologous genes in Enterococcus.

AIMS: To exploit the enterocin regulatory system for regulated expression of genes in Enterococcus. METHODS AND RESULTS: Production of some pediocin-like bacteriocins such as enterocin A in Enterococcus is regulated by a three-component system comprising a histidine kinase (entK ), a response regulator (entR) and an induction factor (entF ). Exposure to the induction factor results in the transcription of gene(s) under the control of the enterocin A promoter, including entA which encodes the bacteriocin. In an effort to exploit this system for expression of genes in Enterococcus, a number of vectors were constructed which contain the entA promoter followed by convenient cloning sites to introduce gene(s) of interest. These vectors were used in an enterococcal background which does not produce induction factor but does produce both the kinase and regulator proteins. The system was tested using the reporter genes ltnI (lacticin 3147 immunity) and gusA (beta-glucuronidase) under the control of the entA promoter. CONCLUSIONS: Upon addition of the induction factor, the beta-glucuronidase activity increased 20-fold when compared with uninduced cells. In addition, concentrations of as little as 0.2 nm synthetic EntF were sufficient to give maximal expression. SIGNIFICANCE AND IMPACT OF THE STUDY: The potential benefit of having an expression system based on EntF is that gene expression can be finely controlled upon addition of low concentrations of a peptide that can easily be artificially synthesized.

Anti-Bacterial Agents↗

Emergence of vancomycin-resistant Enterococcus faecium at a tertiary care hospital in Karachi, Pakistan.

Vancomycin-resistant enterococcus (VRE) has not been reported previously in Pakistan. This is the first report where in vancomycin-resistant Enterococcus faecium was isolated from the clinical specimens of six patients admitted to the intensive care unit (ICU) and neonatal intensive care unit (NICU) of the Aga Khan University Hospital, Karachi. To identify the extent of the outbreak, rectal swabs were obtained from all the patients admitted to the ICU and NICU at that time. A total of 10 strains of vancomycin-resistant Enterococcus faecium were isolated. All the strains showed high-level resistance to both glycopeptides (vancomycin and teicoplanin) with a vancomycin minimum inhibitory concentration greater than 256 mg/L. All isolates had the vanA gene detected by polymerase chain reaction. The contour-clamped homogeneous electric field (CHEF) pattern demonstrated that all but one of the isolates were of a single clone, suggesting that they were derived from common source. Use of vancomycin and prolonged hospitalization were common features in all cases investigated.

Adult↗

Quinupristin/dalfopristin (RP 59500) therapy for vancomycin-resistant Enterococcus faecium aortic graft infection: case report.

A 46-year-old woman was admitted to the hospital with severe peripheral vascular disease, requiring multiple vascular surgical procedures. During the sixth hospital week, after prior therapy with multiple antibiotics, Enterococcus faecium was isolated as the only organism from an operating room culture of an infected aortic graft. Histological examination of the graft showed infiltration with polymorphonuclear leukocytes. Subsequently, cultures of an infected inguinal wound yielded Enterococcus faecium with mixed bacterial growth. Both isolates of Enterococcus faecium were resistant to all available antimicrobials, including ampicillin, vancomycin, tetracycline, chloramphenicol, and ciprofloxacin. Compassionate use therapy with quinupristin/dalfopristin (RP59500) was administered for 25 days, the patient's clinical condition improved, and wound healing occurred. Transient elevation of serum alkaline phosphatase was noted. This case demonstrates successful eradication of deep VREF infection by quinupristin/dalfopristin with good tolerance of prolonged therapy.

Anti-Bacterial Agents↗

Enterococcus species in urinary tract infection.

Significant urinary isolates have been prospectively recorded since 1971. Enterococcus species, a common cause of nosocomial urinary tract infection, have been identified, and susceptibilities to a range of antibiotics have been determined. In addition, isolates in 1988 were tested for breakpoint susceptibility to vancomycin and teicoplanin. Despite changes in the hospitals covered, isolation of Enterococcus species rose steadily from 4% in 1971 to 12.6% in 1990 in hospital patients and from 2% to 5.6% in general-practice patients (P less than .01). All isolates of Enterococcus species were sensitive to ampicillin. Teicoplanin inhibited all 526 strains tested at a concentration of 2 micrograms/mL, but the same concentration of vancomycin inhibited only 370 (70%). The increased prevalence of enterococcal urinary tract infection is probably the result of increasing use of catheterization and broad-spectrum antibiotics. Glycopeptides reach high levels in the urine, and teicoplanin might be an alternative for the treatment of urinary tract infections due to enterococci.

Anti-Bacterial Agents↗

Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium.

To determine the differences in outcome in cases of enterococcal bacteremia due to vancomycin-resistant organisms, we compared consecutive patients on a liver transplant service who had clinically significant bacteremia due to vancomycin-resistant Enterococcus faecium (VREF) (n = 54) with a contemporaneous cohort of patients who had vancomycin-susceptible E. faecium (VSEF) bacteremia (n = 48). VREF bacteremia occurred significantly later in the hospitalization than did VSEF bacteremia (43 days vs. 24 days, respectively; P < .01); in addition, VREF was more frequently the sole blood pathogen isolated (91% of patients) than was VSEF (56% of patients) (P = .0002). Invasive interventions for intraabdominal and intrathoracic infection were required more often in the VREF cohort than in the VSEF cohort (34 of 45 patients vs. 20 of 41 patients, respectively; P = .01). Vancomycin resistance more frequently resulted in recurrent bacteremia (22 of 54 patients infected with VREF vs. 7 of 48 patients infected with VSEF; P = .006), persistent isolation of Enterococcus species at the primary site (27 of 33 patients infected with VREF vs. 7 of 18 patients infected with VSEF; P = .005), and endovascular infection (4 patients infected with VREF vs. none infected with VSEF). The decrement in patient survival, as measured from the last bacteremic episode, was greater in the VREF cohort (P = .02). Vancomycin resistance, shock, and liver failure were independent risk factors for Enterococcus-associated mortality. Higher rates of refractory infection, serious morbidity, and attributable death occurred in the VREF cohort and were partially mediated by the lack of effective antimicrobial therapy.

Adult↗

vanA-mediated vancomycin-resistant Enterococcus spp. in sewage.

Three high-level vancomycin-resistant Enterococcus strains (two Enterococcus faecium and one Enterococcus durans) were recovered from three of eight sewage samples taken from the general sewage collector at Logroño (Northern Spain). The strains were present in the sewage samples at estimated concentrations of ten resistant bacteria/mL, corresponding to about 0.4% of the enterococcal population. The VanA protein was detected in each strain by immunoblotting of membrane extracts of the vancomycin-induced cells, and the vanA gene was demonstrated in the wild strains and their transconjugants by DNA-DNA hybridization. This is the first, confirmed report of vanA mediated vancomycin resistance in E. durans.

Bacterial Proteins↗

A survey of antimicrobial susceptibility of clinical isolates of Enterococcus spp. from Irish hospitals.

Nosocomial enterococcal infections are increasing. In order to establish the species distribution and antibiotic resistance patterns of enterococci in clinical specimens from hospitalized patients, we undertook a survey of 23 Irish hospitals. One thousand and five viable enterococcal strains were studied. Nine different species of enterococci were identified, including Enterococcus faecalis (84%); Enterococcus faecium (9%); and Enterococcus hirae (3%). The most common sites of isolation were the urinary tract (66%), wound and soft tissues (23%) and blood stream (3%). Many of the isolates were multiply antibiotic resistant. Ampicillin resistance was detected in 16%. Neither beta-lactamase production, nor high level penicillin resistance was detected. High level gentamicin resistance was evident in 7% of isolates and varied among species, e.g. 4% E. faecalis, 24% E. faecium, and 34% E. hirae. A number of isolates (23%) were also highly resistant to streptomycin. No clinically significant glycopeptide resistance was detected. The species distribution and incidence of multiple resistance was geographically widespread. This emphasizes the need for detailed speciation and in-vitro susceptibility testing along with the evaluation of alternative combination chemotherapeutic regimens for the management of serious enterococcal infection.

Anti-Bacterial Agents↗

Comparative in-vitro activity of quinupristin/dalfopristin against Enterococcus spp.

The in-vitro activity of quinupristin/dalfopristin against Enterococcus spp. was compared with that of amoxycillin, vancomycin, telcoplanin and erythromycin. The susceptibility of 106 vancomycin-susceptible Enterococcus faecalis, 92 vancomycin-susceptible Enterococcus faecium and 14 vancomycin-resistant enterococci (VRE) was tested. Only one strain of vancomycin-susceptible E. faecium was not susceptible to < or = 0.5 mg/L quinupristin/dalfopristin; this strain required 4 mg/L. All strains of E. faecalis were inhibited by < or = 8 mg/L quinupristin/dalfopristin and all VRE strains were inhibited by < or = 2 mg/L. In contrast, teicoplanin and vancomycin showed inhibitory activity against E. faecalis and E. faecium but not against VRE. Amoxycillin was active against E. faecalis but not usually against E. faecium and showed variable activity against VRE; 38% of E. faecalis, 84% of E. faecium and 80% of VRE strains were resistant to erythromycin. The bactericidal activity of quinupristin/dalfopristin against E. faecium exceeded that of the comparator drugs as judged by MIC:MBC ratios and killing curves. The MBC99 of quinupristin/dalfopristin determined by a microdilution broth technique was < or = 1 mg/L for E. faecium. Four of the five strains of vancomycin-susceptible E. faecium and three of the five VRE strains tested with time-kill curves showed a > or = 2 log reduction in viable count after exposure to quinupristin/dalfopristin for 6 h.

Amoxicillin↗

Successful treatment of vancomycin-resistant enterococcus meningitis with linezolid: case report and review of the literature.

OBJECTIVE: To describe the successful treatment of a case of vancomycin-resistant enterococcus meningitis with linezolid. DESIGN: Case report and review of the literature. PATIENTS: The patient is a 35-yr-old man who suffered a cerebellar hemorrhage after embolization of a cerebellar arteriovenous malformation. The patient underwent ventriculostomy drainage and craniectomy. The patient was on broad-spectrum antibiotics for pneumonia including vancomycin. The patient remained febrile and grew vancomycin-resistant Enterococcus faecium from the cerebrospinal fluid. INTERVENTIONS: The patient was treated with intravenous chloramphenicol without success. On postoperative day 16, the patient was begun on intravenous linezolid. MAIN RESULTS: The patient received 4 wks of intravenous linezolid with complete eradication of the meningitis. CONCLUSIONS: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus meningitis.

Acetamides↗

Intraabdominal vancomycin-resistant enterococcus infections: the new threat.

GOALS: To determine the clinical course and outcome in patients with intraabdominal vancomycin-resistant enterococcus infections (VRE-A) and to identify probable risk factors for VRE-A. BACKGROUND: Vancomycin-resistant enterococcus is one of the most notable nosocomial emerging pathogens. The incidence is increasing, especially in the abdominal surgery setting. STUDY: A comparative study of patients with VRE-A and VRE infection in other sites (VRE-O) who were hospitalized for over 1 year. Fisher exact test and Student t test were used; a two-tailed p value of less than 0.05 was considered to be significant. RESULTS: Of 89 nine patients with VRE, six had VRE-A, 24 had VRE-O, and 59 had VRE colonization. The VRE-A group was comprised of one patient with an inoperable Klatskin tumor and biliary sepsis, one with acquired immune deficiency syndrome and an infected pancreatic pseudocyst, two with fecal peritonitis, and two with biliary sepsis after surgery for common bile duct stones. All six patients with VRE-A had recent surgery before VRE isolation, as compared with three in the VRE-O group (p = 0.0001). Despite adequate treatment with intravenous chloramphenicol, resulting in eradication of VRE in all six VRE-A cases, the mortality rate remained high at 50%. CONCLUSIONS: Vancomycin-resistant enterococcus should be recognized as an emerging nosocomial pathogen that causes potentially fatal intraabdominal infections in the postsurgical setting. However, the impact of treatment on ultimate outcome needs further evaluation.

Abdomen↗

A new approach to use of bacteriolytic enzymes as a tool for species identification: selection of species-specific indicator strains with bacteriolytic activity towards Enterococcus strains.

We describe the bacteriolytic activity of 377 group D Enterococcus isolates expressed towards 25 Enterococcus strains belonging to different species and Micrococcus luteus ATCC 4698. Of the 26 indicator strains used to reveal bacteriolytic activity, 5 were lysed by all of the strains of some species and were not lysed by all of the strains of other species. The use of these indicator strains allowed us to devise a new method to differentiate group D Enterococcus strains, based on qualitative analysis (lysis or no lysis of the indicator strains) of bacteriolytic activity. The bacteriolytic patterns obtained fell into six bacteriolytic groups corresponding (98% agreement) to species or groups of enterococci as determined by a comparison with data from a phenetic similarity study.

Bacterial Typing Techniques↗