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PubMed2006

Case report vancomycin -resistant Enterococcus faecium VanA phenotype: first documented isolation in India.

In recent years, vancomycin-resistant enterococci, especially Enterococcus faecium has emerged as an important nososcomial pathogen and represents a serious threat to patients with impaired host defences. We report infection with vancomycin-resistant Enterococcus faecium in a 3-year-old child with patent ductus arteriosus. The organism, isolated from a central venous catheter tip, exhibited a high-level resistance to vancomycin (minimum inhibitory concentration > or = 256 microg/ ml) and was also resistant to teicoplanin. The child probably died due to sepsis from this highly resistant organism. To the best of our knowledge, this is the first reported isolation of VanA phenotype Enterococcus faecium in India.

Bacterial Proteins↗
PubMed1991

[Study of the host factors in the occurrence of the postoperative infections--special reference to the pathogenicity of the Enterococcus and MRSA].

A study of the pathogenicity of the Enterococcus and Methicillin resistant S. aureus (MRSA) was made of 781 cases with gastroenterological surgery. The results obtained were summarized as follows. In this study 215 strains were isolated from clinical specimens. In these strains 13% was isolated from the postoperative mixed infection and only 7% occurred in single infection. Most of the single infections by the Enterococcus occurred in the cases with changes in host resistance, such as terminal cancer, disorder of the glucose tolerance, malnutrition and/or organ failures. Seventy-three strains were isolated from clinical specimens. In these strains 10% were the postoperative mixed infection and 40% were single infection. Incidence of the infection by the MRSA was significantly high compared with that by the Enterococcus. Single infection by the MRSA occurred even in the cases with normal host resistance. Strains producing enterotoxin C (single or plus A) were frequently isolated in MRSA enteritis or pneumonia. However, 60 percent of the patients in whom MRSA were detected in their abdominal drains had no signs of infection. These results suggest that the occurrence and severity of the MRSA infection relate with site of the infection and production of the exotoxin.

Enterococcus↗
PubMedDate not supplied

[Study of the susceptibility of Staphylococcus sp. and Enterococcus sp. to teicoplanin and vancomycin].

PURPOSE: The study was performed in order to evaluate the susceptibility of Enterococcus and Staphylococcus to teicoplanin and vancomycin. METHODS: 150 Enterococcus strains and 450 Staphylococcus strains (298 Staphylococcus aureus and 152 negative coagulase strains) isolated in three Brazilian hospitals were studied. The MICs were determined using teicoplanin and vancomycin E Test strips. The range of the antimicrobial concentration in each strip went from 256 mcg/mL to 0.016 mcg/mL. Diffusion tests using disks impregnated with 10 mcg of teicoplanin and 30 mcg of vancomycin were also performed. RESULTS: All the 298 Staphylococcus aureus strains were susceptible to the two antimicrobials. Three of the 152 negative coagulase strains presented intermediate susceptibility to teicoplanin (MICs between 8 and 16 mcg/mL). Four of the 150 Enterococcus strains presented intermediate susceptibility to vancomycin but were totally susceptible to teicoplanin. CONCLUSION: According to these results teicoplanin and vancomycin are good therapeutical options in the treatment of staphylococcal and enterococcal infections.

Anti-Bacterial Agents↗
PubMed1998

Molecular epidemiology by ribotyping and PCR-ribotyping of Enterococcus faecium strains isolated from intercontinental areas.

In this study classical ribotyping based on hybridization of an enteroccocal ribosomal operon previously cloned from Enterococcus hirae (Sechi and Daneo-Moore, 1993) with XbaI cut chromosomal DNA and PCR-ribotyping were used to characterize the molecular epidemiology of 131 Enterococcus faecium, with high-level resistance to gentamicin, isolated from different hospitals in Italy and the United States. The ribotyping was able to differentiate all 131 clinical isolates into 96 family patterns. These family patterns appeared to be useful in establishing epidemiological spread. The results obtained were in agreement with those previously published, suggesting the presence of five to six operons in the Enterococcus genus (Sechi et al., 1994). We performed PCR-ribotyping, based on conserved sequences at the 3' end of the enterococcal 16S rrn and the 5' end of the 23S rrn, on 131 clinical isolates as well as on several enterococcal ATCC strains tested. The results were then compared with those obtained with the classical ribotyping method. The results suggest the presence of at least four classes of intergenic spacers among enterococci, but these classes are not helpful in differentiating between Enterococci or among Enterococcal isolates.

DNA, Bacterial↗
PubMed1995

Characterisation and antimicrobial susceptibility of Enterococcus species from the intestines of ducks in Assam.

The Enterococcus flora of duck intestines consisted of E faecalis and E faecium in ducklings less than eight weeks old and E faecalis, E faecium and E gallinarum in ducks more than eight weeks old. The enterococci were resistant to several antibiotics; chloramphenicol and gentamycin sulphate were the only antibiotics of those tested which were moderately effective. All the Enterococcus species isolates were resistant to the macrolide and lincosamide antibiotics.

Age Factors↗
PubMed2001

Differentiation of Enterococcus spp. by cell membrane fatty acid methyl ester profiling, biotyping and ribotyping.

AIMS: Gas chromatographic analysis of cell membrane fatty acid methyl esters (FAME), biochemical profiling (biotyping) and EcoRI restriction endonuclease profiling of DNA containing ribosomal RNA sequences (ribotyping) were compared for differentiation of Enterococcus spp. METHODS AND RESULTS: FAME profiling, biotype profiling and ribotyping of 41 strains from retail Swiss-type cheeses and five strains from culture collections resulted in 17, 25 and 26 groups, respectively, with only two pairs of strains having the same FAME group, biotype profile and ribogroup. CONCLUSION: Substantial overlap occurred in groupings assigned by the three methods. SIGNIFICANCE AND IMPACT OF THE STUDY: Differentiation of Enterococcus spp. strains increases if multiple methods are used.

Bacterial Typing Techniques↗
PubMed2006

Transfer of vancomycin resistance transposon Tn1549 from Clostridium symbiosum to Enterococcus spp. in the gut of gnotobiotic mice.

The vancomycin resistance vanB2 gene cluster is disseminated worldwide and has been found in phylogenetically remote bacterial genera. The vanB2 operon is part of conjugative transposons Tn1549/Tn5382, but conjugative transposition of these elements has not been demonstrated. We have obtained transfer of a Tn1549-like element (referred to herein as "Tn1549-like") from Clostridium symbiosum MLG101 to Enterococcus faecium 64/3 and Enterococcus faecalis JH2-2 in the digestive tract of gnotobiotic mice and to E. faecium 64/3 in vitro. Retransfer of Tn1549-like from an E. faecium transconjugant also containing Tn916 to E. faecium BM77 was obtained in vitro, albeit at a very low frequency. Transfer efficiency was found to be both donor and recipient dependent. Pulsed-field gel electrophoresis analysis of total SmaI-digested DNA of 48 transconjugants indicated in 27 instances the acquisition of ca. 34 kb of DNA. Two transconjugants harbored two copies of the transposon. Sequencing of the flanking regions of Tn1549-like in 48 transconjugants revealed 29 integration events in 26 loci in the E. faecium genome, and two hot spots for insertion were identified. Integration of the transposon was associated with the acquisition of 5 (n = 18) or 6 (n = 7) bp of donor DNA or with 5-bp duplications of target DNA in the remaining transconjugants. These data demonstrate functionality of the Tn1549-like element and attest that the transfer of the vanB operon between enterococci and human commensal anaerobes occurs in the intestinal environment.

Animals↗
PubMed2004

Prevalence and molecular characterization of tetracycline resistance in Enterococcus isolates from food.

In the present study, a collection of 187 Enterococcus food isolates mainly originating from European cheeses were studied for the phenotypic and genotypic assessment of tetracycline (TC) resistance. A total of 45 isolates (24%) encompassing the species Enterococcus faecalis (n = 33), E. durans (n = 7), E. faecium (n = 3), E. casseliflavus (n = 1), and E. gallinarum (n = 1) displayed phenotypic resistance to TC with MIC ranges of 16 to 256 microg/ml. Eight of these strains exhibited multiresistance to TC, erythromycin, and chloramphenicol. By PCR detection, TC resistance could be linked to the presence of the tet(M) (n = 43), tet(L) (n = 16), and tet(S) (n = 1) genes. In 15 isolates, including all of those for which the MIC was 256 micro g/ml, both tet(M) and tet(L) were found. Furthermore, all tet(M)-containing enterococci also harbored a member of the Tn916-Tn1545 conjugative transposon family, of which 12 erythromycin-resistant isolates also contained the erm(B) gene. Filter mating experiments revealed that 10 E. faecalis isolates, 3 E. durans isolates, and 1 E. faecium isolate could transfer either tet(M), tet(L), or both of these genes to E. faecalis recipient strain JH2-2. In most cases in which only tet(M) was transferred, no detectable plasmids were acquired by JH2-2 but instead all transconjugants contained a member of the Tn916-Tn1545 family. Sequencing analysis of PCR amplicons and evolutionary modeling showed that a subset of the transferable tet(M) genes belonged to four sequence homology groups (SHGs) showing an internal homology of > or = 99.6%. Two of these SHGs contained tet(M) mosaic structures previously found in Tn916 elements and on Lactobacillus and Neisseria plasmids, respectively, whereas the other two SHGs probably represent new phylogenetic lineages of this gene.

Cheese↗
PubMed1999

Proficiency of clinical laboratories in Spain in detecting vancomycin-resistant Enterococcus spp. The Spanish VRE Study Group.

Studies in a variety of U.S. clinical laboratories have demonstrated difficulty in detecting intermediate and low-level vancomycin-resistant enterococci (VRE). The misclassification of "at least intermediate resistant isolates" as vancomycin susceptible may have both clinical implications and a negative impact on measures to control the spread of VRE. No published study has assessed the ability of clinical laboratories in Europe to detect VRE. So, the apparent low prevalence of VRE in European hospitals may be, in part, secondary to the inability of these laboratories to detect all VRE. In an effort to assess European laboratories' proficiency in detecting VRE, we identified 22 laboratories in Spain and asked them to test four VRE strains and one susceptible enterococcal strain from the Centers for Disease Control and Prevention collection. Each organism was tested by the routine antimicrobial susceptibility testing method used by each laboratory. Overall, VRE were correctly identified in 61 of 88 (69.1%) instances. The accuracy of VRE detection varied with the level of resistance and the antimicrobial susceptibility method. The high-level-resistant strain (Enterococcus faecium; MIC, 512 microg/ml) was accurately detected in 20 of 22 (91. 3%) instances, whereas the intermediate-resistant isolate (Enterococcus gallinarum; MIC, 8 microg/ml) was accurately detected in only 11 of 22 (50%) instances. Classification errors occurred in 27 of 88 (30.9%) instances. Misclassification as vancomycin susceptible was the most common error (16 of 27 [59.3%] instances). Our study shows that the participating Spanish laboratories had an overall acceptable proficiency in detecting VRE but that a substantial proportion of VRE isolates with low or intermediate levels of resistance were not detected. We recommend that studies be conducted to validate laboratory proficiency testing as an important step in the prevention and control of the spread of antimicrobial resistance.

Centers for Disease Control and Prevention, U.S.↗
PubMed1990

Enterococcus columbae, a species from pigeon intestines.

Gram-positive cocci which dominate in the intestinal flora of domestic pigeons were found to constitute a new species of the genus Enterococcus. The strains were most closely related to Enterococcus cecorum, originally described as Streptococcus cecorum, a carboxyphilic species from chicken intestines, and to Enterococcus avium. The pigeon strains resemble E. cecorum and also many E. avium strains in their lack of group D antigen and in being more sensitive to NaCl than other enterococci. The type strain is strain STR 345 (= NCIMB 13013).

Amino Acid Sequence↗
PubMed2006

Epidemiology of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in a rural state.

BACKGROUND: Most data on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) isolates come from large tertiary care centers. Infection control personnel need to understand the epidemiology of MRSA and VRE across the continuum of care, including small rural hospitals, to develop effective control strategies. OBJECTIVE: To describe the epidemiology of MRSA and VRE in Iowa. SETTING: Fifteen hospitals in Iowa. Methods Between July 1998 and June 2001, a total of 1,968 S. aureus isolates and 1,845 Enterococcus isolates from patients infected with these pathogens were examined. Multivariate models were developed to evaluate patient and institutional risk factors for MRSA infection and VRE infection. RESULTS: The proportion of S. aureus isolates resistant to methicillin was 31%, and the proportion of Enterococcus isolates resistant to vancomycin was 6%. Independent risk factors for MRSA infection included residence in a long-term care facility, age of more than 60 years, hospitalization in a hospital with less than 200 short-term care beds, and acquiring the infection in the hospital. Independent risk factors for VRE infection included use of a central venous catheter, residence in a long-term care facility, acquisition of infection in the hospital, and hospitalization in a hospital with more than 200 short-term care beds. CONCLUSIONS: In Iowa, the epidemiology of MRSA differ from those of VRE. MRSA has become established in small rural hospitals. Effective MRSA control strategies may require inclusion of all hospitals in a state or region.

Aged↗
PubMed2006

Descriptive epidemiology and case-control study of patients colonized with vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus.

BACKGROUND: Patients colonized or infected with vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus may be at risk of acquiring vancomycin-resistant S. aureus if the vanA gene is transferred from vancomycin-resistant enterococcus to methicillin-resistant S. aureus. OBJECTIVE: Our goal was to identify risk factors for cocolonization or coinfection (CC/CI) with vancomycin-resistant enterococcus and methicillin-resistant S. aureus. DESIGN: We conducted a descriptive, epidemiologic study of all patients with CC/CI identified from January 1998 to May 2003 and a nested case-control study of a cohort of patients hospitalized in the burn and wound unit. SETTING: We conducted our study in a 813-bed tertiary care university teaching hospital. POPULATION: The study population consisted of patients found to have CC/CI during the study period. METHODS: Descriptive epidemiologic data were collected from hospital records of all patients identified as having CC/CI. A subset of patients hospitalized in the burn and wound unit were included in a case-control study. RESULTS: CC/CI was detected in 71% of the patients during a single hospital stay. The burn and wound unit, which does active surveillance for both organisms, and the general medicine unit, which does not do active surveillance for either organism, cared for more than one-half of these patients. Among patients being cared for in the burn and wound unit, having exposure to 2 or more invasive devices (central venous catheters, indwelling urinary catheters, and enteral feeding tubes) and renal insufficiency were independent risk factors for CC/CI. CONCLUSIONS: Patients with CC/CI are the population at greatest risk for vancomycin-resistant S. aureus colonization or infection. The number of invasive devices to which patients are exposed and, thus, possibly the patients' underlying severity of illness, as well as renal insufficiency, appear to be risk factors for CC/CI.

Adult↗
PubMed1990

Pathogenicity of the enterococcus in surgical infections.

The enterococcus has been relegated to a position of unimportance in the pathogenesis of surgical infections. However the increasing prevalence and virulence of these bacteria prompt reconsideration of this view, particularly because the surgical patient has become increasingly vulnerable to infectious morbidity due to debility, immunosuppression, and therapy with increasingly potent antibiotics. The enterococcus is a versatile opportunistic nosocomial pathogen, causing such diverse infections as wound, intra-abdominal, and urinary tract infections; catheter-associated infection; suppurative thrombophlebitis; endocarditis; and pneumonia. Although surgical drainage remains the cornerstone of therapy for enterococcal infections involving a discrete focus, in the circumstances typified by the compromised surgical patient, specific antibacterial therapy directed against the enterococcus is warranted. Recent evidence indicates that parenteral antibiotic therapy for enterococcal bacteremia is mandatory and that appropriate therapy clearly reduces the number of deaths.

Cross Infection↗
PubMed1991

Enterococcus seriolicida sp. nov., a fish pathogen.

The properties and taxonomic position of bacterial strains isolated from diseased specimens of cultured yellowtail and eels were examined. The isolates were gram-positive, short-chain-forming, catalase-negative, facultatively anaerobic cocci. Growth at 10 and 45 degrees C in 6.5% NaCl (pH 9.6) with 40% bile and in 0.1% methylene blue-milk were both positive. The isolates could be distinguished from other species of the genus Enterococcus by several biochemical characteristics and by Lancefield's group antigen. Guanine-plus-cytosine content of DNA was 44 mol% as determined by the thermal melting temperature. The value for DNA-DNA hybridization was sufficiently low to warrant distinguishing this species from reported. Enterococcus species. The name Enterococcus seriolicida is proposed. The type strain is YT-3 (=ATCC 49156).

Animals↗
PubMed1988

Occurrence of the Campylobacter resistance gene tetO in Enterococcus and Streptococcus spp.

The distribution of nucleotide sequences related to tetK, tetL, tetM, and tetO was studied by dot blot hybridization in 178 strains of Streptococcus and Enterococcus spp. that were resistant to tetracycline. The tetO gene, which is responsible for tetracycline resistance in Campylobacter spp., was detected in six Streptococcus strains and two Enterococcus strains, in which it was borne by similar plasmids. This observation confirms our previous proposal that tetO originated in gram-positive cocci. tetM, the most prevalent resistance gene, was present alone in 109 strains and associated with tetL in 33 strains in which the two genes contributed cooperatively to high-level tetracycline resistance. tetL was present alone in five Enterococcus strains, and tetK was detected in a single Streptococcus strain. The existence of 22 strains that did not hybridize to the probes suggest that tetracycline resistance in streptococci and enterococci involves additional gene classes as well.

Campylobacter↗
PubMed1986

New test system for identification of Aerococcus, Enterococcus, and Streptococcus species.

A total of 244 strains of Aerococcus, Enterococcus, and Streptococcus species were tested by the RapID STR system (Innovative Diagnostic Systems Inc., Atlanta, Ga.) for identification. Strains were identified without additional tests or with additional conventional tests suggested by the IDS compendium manual. Our data indicate that the RapID STR system identifies 89% of the beta-hemolytic Streptococcus species if serological procedures are used in conjunction with the rapid physiological procedures. Of the group D streptococci, 98% of the Enterococcus species and 100% of the group D non-Enterococcus species were correctly identified. Of the commonly occurring viridans group Streptococcus species, 93% were correctly identified, and 79% of the less frequently occurring viridans group Streptococcus species were correctly identified. All of the Streptococcus pneumoniae and Aerococcus strains tested were correctly identified.

Humans↗
PubMed1989

[In vitro effects of combinations of teicoplanin and ceftriaxone against Staphylococcus aureus and Enterococcus].

The in vitro activity of antibiotic combinations of teicoplanin (T) and ceftriaxone (C) was evaluated on 10 methicillin sensitive S. aureus (MSSA), 10 methicillin resistant S. aureus (MRSA), 4 Enterococcus and 2 E. coli. By the checkerboard method the combination T + C showed synergism against 9 MRSA, 2 MSSA, 4 Enterococcus, indifferent effect against the other strains. By the time-kill-curves method synergism was found for the combinations T + C at 1/2 CMI against MRSA, MSSA and Enterococcus, and indifference with the combinations at 1 X CMI, 2 X CMI, 4 X CMI against all the strains. Antagonistic effect was never found. These results suggest that teicoplanin in combination with ceftriaxone can be tested in in vivo study to demonstrate the possible benefits of the synergism particularly in the therapy of the nosocomial infections.

Ceftriaxone↗
PubMed2001

Characteristics and glycerol metabolism of fumarate-reducing Enterococcus faecalis RKY1.

Enterococcus faecalis RKY1, which converts fumarate to succinate with a high yield, was identified on the basis of a phylogenetic analysis of the 16S rDNA gene sequence. The strain was incubated at 38 degrees C for 18 h to examine the possible diversion of glucose or glycerol fermentation by fumarate. The products of glucose and glycerol fermentation with fumarate were quite different from those of normal fermentation, which ultimately produces lactate, in that mainly succinate is produced. Metabolic pathway stoichiometry was used to analyze the oxidation of glycerol to succinate by Enterococcus faecalis RKY1. The stoichiometric relationship between glycerol and fumarate was used as a guideline to accumulate succinate more efficiently.

DNA, Ribosomal↗