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PubMedDate not supplied

Antimicrobial susceptibility patterns and high-level gentamicin resistance among enterococci isolated in a Mexican tertiary care center.

AIM: To describe the antimicrobial susceptibility pattern of enterococcal clinical isolates. SETTING: A 200-bed tertiary-care center in Mexico City. STUDY DESIGN: Prospective surveillance of enterococcal clinical isolates identified according to Facklam's method since 1990. Susceptibility tests were performed by a commercial micromethod, agar diffusion and microbroth dilution. We present data from 1990 to 1992. RESULTS: A total of 407 enterococci were recovered during the study period: 245 from inpatients and 162 from outpatients; 325 of the isolates were Enterococcus faecalis, 61 E. faecium, seven E. avium, four each for E. raffinosus and, E. hirae; two, E. pseudoavium; and one each E. gallinarum, E. durans; E. mundtii, and E. faecales var asacharolyticus. Resistance to ampicillin and imipenem among E. faecium was 59%. Among E. faecalis, 0.3% were resistant to ampicillin and 2% to imipenem; no beta-lactamase production was detected. All were susceptible to vancomycin. Overall, a 12% high-level gentamicin resistance (HLGR) was found without a difference between species; 25% of bloodstream clinical isolates were HLGR enterococci. More than half (63%) of the HLGR clinical isolates were susceptible to streptomycin; a-hemolysis in human blood agar as well as nitrofurantoin resistance were observed in all E. faecium isolates and in two E. avium. CONCLUSIONS: In our center, HLGR has a prevalence of 12%. Streptomycin may be a therapeutic alternative in 63% of the HLGR cases. The pattern of hemolysis in human blood agar plus the susceptibility to nitrofurantoin could be used as an initial screening to identify enterococci.

Anti-Bacterial Agents↗
PubMed1996

[Use of the Streptotest kit for identification of enterococci isolated from human clinical material].

Enterococci are part of the common microflora of man and are isolated in large numbers also from the environment. Recently their presence in clinical material is increasing and they have become an important causal agent of nosocomial infections. From human clinical material (urine, vaginal smears, wounds) a total of 164 strains of enterococci was isolated. Identification of these isolates by means of the commercial STREPTOtest kit was not very successful (71.3%). The use of several supplementary tests and evaluation by the TNW programme improved successful identification (98.8%). The dominating species in clinical material was E. faecalis (94.5%), the second most frequent isolated species was E. faecium (3%). To achieve better identification of enterococci the authors recommend to supplement the kit by further tests (acidification of arabinose, ribose and pyruvate assimilation).

Bacteriological Techniques↗
PubMed1997

[Vancomycin resistant enterococci in Austria].

This study reports pheno- and genotypical analysis of 9 isolates of vancomycin-resistant enterococci (VRE) and 5 vancomycin-sensitive enterococci (VSE) in Austria: 5 E, faecium isolates of 4 patients (the sole patients demonstrating VRE at the University Hospital of Innsbruck in 1994 and 1995), 3 glycopeptide-sensitive isolates collected in Innsbruck in February 1996 for epidemiological analysis, and 6 enterococcus isolates from the University Hospitals of Vienna and Graz. The pheno- and genotypical analyses of all glycopeptide highly resistant E. faecium and E. faecalis isolates indicated the presence of VanA type resistance. One E. casseliflavus strain with intrinsic VanC-1 resistance showed a characteristic constitutive low-level resistance to vancomycin and susceptibility to teicoplanin. Genotyping with macro-restriction analysis demonstrated that 3 VRE isolates of the 5 E. faecium specimens were identical; the same applied to 2 VSE isolates. The two patients with VRE had been cared for at the same time in a surgical ICU and likewise, the two patients with VSE were simultaneously treated at a neurological ICU. The genotyping of E. faecalis strains showed that two strains of the three VRE isolates exhibited identical patterns. Epidemiological investigation did not reveal a mode of transmission for this cluster. Two of the 8 patients with VRE died within 60 days after isolation of the bacteria; the doctors in charge did not consider that the enterococci had been the cause of death. The results of our study indicate that oral vancomycin administration to humans is a primary cause of VRE in Austrian hospitals. In Austria approximately 66 kg vancomycin, 20% of it given orally, are administered to patients per year. Approx. 18-20 tons Avotan (active ingredient Avoparcin-10%)/year were used in Austria; as of April 1, 1997 the use of this animal foodstuff supplement is prohibited by the European Commission.

Administration, Oral↗
PubMed1998

[Enterococci as uropathogens. Frequency of isolation and sensitivity to antibacterial agents].

221 clinically significant enterococcal strains (191: E. faecalis, 27: E. faecium, 3 others) were isolated from the urine of patients hospitalised with UTI over an 18-month period (1995-1996). The susceptibility of the isolates to 8 antimicrobial agents was determined by agar dilution method (NCCLS). All enterococci were sensitive to vancomycin and most of them (over 92%) to penicillin and ampicillin. Only 3.14% of E. faecalis and 3.70% of E. faecium were resistant to ciprofloxacin. A relatively high incidence of resistance of enterococci to aminoglycosides was observed: 46.07% and 51.85% to streptomycin, 42.41% and 44.44% to gentamicin, 70.68% and 77.78% to amikacin for E. faecalis and E. faecium, respectively. Among the resistant to penicillin and amino glycosides enterococci of the two species was found a great percent "high level" resistance. There were no beta-lactamase producers among our strains. The established multiresistance accompanied by "high level" resistance requires careful consideration of antimicrobial therapy of enterococcal UTI.

Adult↗
PubMed1998

[First infection with vancomycin resistant type VanA enterococci in a Norwegian hospital].

Enterococci are part of the normal human and animal bowel flora. They are considered bacteria of relatively low virulence, but are important nosocomial pathogens. In the context of their intrinsic resistance to a number of antimicrobial agents, the rapid emergence of multiresistant enterococci is alarming. As inhabitants of the gastrointestinal tract, they come into close contact with other bacteria and may pass antibiotic resistance genes to them. We report the first case of infection with a VanA vancomycin-resistant. Enterococcus in Norway. The strain was identified as Enterococcus faccium with high level resistance to aminoglycosides, ampicillin, teicoplanin and vancomycin. The VanA phenotype was confirmed by PCR detection of the vanA gene. Transmission, treatment, prevention, and control of infections with vancomycin-resistant enterococci is discussed.

Aged↗
PubMed1998

[Vancomycin resistant enterococci].

Enterococci are normal intestinal flora in humans. Among enterococci, Enterococcus faecalis and Enterococcus faecium are frequently isolated and can become nosocomial pathogens in hospitals, especially in intensive care units and oncology wards. Recently, vancomycin-resistant enterococci (VRE) such as E. faecalis and E. faecium have caused a serious problem of hospital-acquired infections in Europe and the USA. VRE also has another aspect as a cause of community-acquired infections. Especially, avoparcin which had been used to enhance growth of food animals is documented as associated with the spread of VRE in European countries. In Japan, there have only been a few of reports about VRE so far. However, there evidence that VRE might become prevalent in many hospitals in Japan. In fact, we have already isolated another highly vancomycin-resistant E. faecium (VCM:MIC > 128 micrograms/ml) from a hospitalized diabetic patient. We should pay a careful attention to VRE and perform the following control measures: 1)re-education and re-training about hospital infection control procedures, 2) prudent use of vancomycin in clinical settings, 3)accurate report of VRE in clinical laboratories, and 4) good communications and collaborations among physicians, nurses and other health care personnel and laboratory technicians. We should learn more from countries in which VRE are already prevalent, and pursue further investigations, to prevent the spread of VRE in Japan.

Animals↗
PubMed1998

Prevalence of high level aminoglycoside and vancomycin resistance among enterococci in Turkey.

Enterococcus spp. have become the third most common cause of nosocomial infections. High-level aminoglycoside resistance (HLAR), an important clinical concern, has been associated with some species of enterococci. The synergistic effect obtained by the combination of aminoglycosides with penicillin or vancomycin disappears in strains that show high-level resistance (HLR) to the aminoglycosides. We evaluated the agar dilution and high content disk diffusion tests for the detection of HLAR for 60 isolated enterococci. In our study 4 strains of Enterococcus faecalis (6.6%) and 8 strains of Enterococcus faecium (13.3%), totally 20% were found to be highly resistant to gentamicin; 2 strains of E. faecalis (13.3%), 8 strains of E. faecium (3.3%), totally 16.6% showed HLR to streptomycin by agar dilution method and the same rates were found by high-content disk diffusion method. 2 strains of E. faecalis (3.3%), 4 strains of E. faecium (6.6%), totally 10% showed vancomycin resistance by agar dilution method. The ratio for beta lactamase activity was found to be 26.6% for E. faecalis and 3.3% for E. faecium. Our results demonstrate that high-content disk diffusion test should be performed by using both gentamicin and streptomycin in routine screening of HLAR among enterococci and the determination of beta lactamase activity at the same time is also useful for detecting resistance to a beta lactam agent.

Anti-Bacterial Agents↗
PubMed2005

[Prevalence of vancomycin-resistant enterococci in hospital and community environment.].

AIM OF THE STUDY: The presented study aimed at determining the prevalence of vancomycin-resistant enterococci (VRE) in rectal swabs taken from both patients in the Teaching Hospital in Olomouc (THO), Czech Republic, and subjects from the community setting of the hospital's catchment area. MATERIALS AND METHODS: Between July 1, 2002 and July 1, 2003, rectal swabs were taken from the THO patients as well as individuals from the community catchment area to be utilized for isolating and identifying enterococci and their suscetibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in VanA Enterococcus faecium strains. To determine the relationship of strains, macrorestriction analysis of the total chromosomal DNA digested with SmaI restriction endonuclease was used. RESULTS: During the observed period, 2,157 rectal swabs from the hospitalized patients and 4,874 rectal swabs from the subjects in community setting were examined. In total, 27 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 2.3 % in the hospitalized patients and 0.6 % in the community subjects. The prevailing strains were Enterococcus faecium VanA (70.4 %) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2 %) in the community VRE. Mutual comparison between the hospital and community VRE showed no similarity. CONCLUSION: In the Czech Republic, VRE were proved both in community and hospital settings. Their prevalence in rectal swabs is low and does not exceed the values reported in other European countries. The author describes the chief characteristics of the most important quinolone antibiotics, including preparations either in their development stage or whose development has been prematurely interrupted because of adverse side-effects. The list includes all preparations that are or were temporarily registered in the Czech Republic.

Anti-Bacterial Agents↗
PubMed1999

The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis.

BACKGROUND: The association between vancomycin hydrochloride treatment and vancomycin-resistant enterococci (VRE) has been investigated in numerous studies with variable results. OBJECTIVES: To conduct a meta-analysis to estimate the magnitude of the association between vancomycin treatment and individual risk of VRE and to identify study characteristics that accounted for heterogeneity in study results. METHODS: Studies were identified using MEDLINE with index terms "Enterococcus," "Enterococcus faecalis," or "Enterococcus faecium" and "vancomycin," "drug resistance," "drug resistance, microbial," or "drug resistance, multiple or risk factors." Reports from conferences and reference lists of recent reviews were used. A total of 420 published reports and 98 conference reports were reviewed; 20 studies described in 15 published reports were included in the analysis. We recorded study period, hospital setting, case and control definitions, length of hospital stay, method of adjustment for differences in length of stay, and data on treatment with vancomycin. The odds ratio (OR) of vancomycin treatment provided the measure of association analyzed. A random-effects model was used to estimate the pooled OR. RESULTS: When results from all 20 studies were combined, the pooled OR was 4.5 (95% confidence interval, 3.0-6.9), but the test for heterogeneity was highly significant (P<.001). The 5 studies that used patients with vancomycin-susceptible enterococci as controls found a stronger association (pooled OR, 10.7; 95% confidence interval, 4.8-23.8) than the 15 studies that used controls who had no VRE isolated (pooled OR, 2.7; 95% confidence interval, 2.0-3.8). After restricting the analysis to the latter studies only, no heterogeneity was evident in the unadjusted study results. Patients with VRE had stayed in the hospital much longer than control patients. Studies that adjusted for this difference found only a small and nonsignificant association between vancomycin treatment and VRE (pooled OR, 1.4; 95% confidence interval, 0.74-2.60). We also detected publication bias, favoring report of studies that found a large measure of association. CONCLUSIONS: The reported strong association between vancomycin treatment and hospital-acquired VRE results from the selection of the reference group, confounding by duration of hospitalization, and publication bias. Studies that accounted for these factors found only a small and nonsignificant association.

Adult↗
PubMed2005

Transfer of vancomycin-resistant enterococci via health care worker hands.

BACKGROUND: The roles of the contaminated hospital environment and of patient skin carriage in the spread of vancomycin-resistant enterococci (VRE) are uncertain. Transfer of VRE via health care worker (HCW) hands is assumed but unproved. We sought to determine the frequency of VRE transmission from sites in the environment or on patients' intact skin to clean environmental or skin sites via contaminated hands of HCWs during routine care. METHODS: We cultured sites on the intact skin of 22 patients colonized by VRE, as well as sites in the patients' rooms, before and after routine care by 98 HCWs. Observers recorded sites touched by HCWs. Cultures were obtained from HCW hands and/or gloves before and after care. All isolates underwent pulsed-field gel electrophoresis. We defined a transfer to have occurred when a culture-negative site became positive with a VRE pulsotype after being touched by an HCW who had the same pulsotype on his or her hands or gloves and who had previously touched a colonized or contaminated site. RESULTS: Health care workers touched 151 negative sites after touching a site that was positive for VRE. Sixteen negative sites (10.6%) became positive after contact. The percentage of times that contact with a site led to a transfer was highest for antecubital fossae and blood pressure cuffs. CONCLUSIONS: Vancomycin-resistant enterococci were transferred from contaminated sites in the environment or on patients' intact skin to clean sites via HCW hands or gloves in 10.6% of opportunities. Controlling VRE by decontaminating the environment and patients' intact skin may be an important adjunctive infection control measure.

Cross Infection↗
PubMed1999

Direct detection of vanA and vanB genes in clinical specimens for rapid identification of vancomycin resistant enterococci (VRE) using multiplex PCR.

Surveillance for vancomycin resistant enterococci (VRE) by culture can be labour intensive and time consuming. We have developed a multiplex polymerase chain reaction (MPCR) which can be performed directly on the clinical specimen. The assay allows sensitive detection of enterococci with vanA - and vanB -mediated resistance to vancomycin. DNA was purified from stool and rectal specimens using the XTRAX(TM)DNA Extraction Kit (Gull Labs). Multiplex PCR amplified vanA and vanB targets were detected using a microtiter plate EIA. Two-hundred specimens were tested by routine culture and MPCR. Culture identified 44 VRE isolates and MPCR detected 38 of the 44 culture positives. Multiplex PCR detected three additional positive VRE specimens missed by culture for a sensitivity and specificity of 86.4 and 98.1%, respectively. When the presence of PCR inhibitors was addressed in the six culture positive/MPCR negative specimens, four additional VRE positive specimens were detected. Performing MPCR on the original specimens and on a 1:10 dilution of all specimens to minimize the effect of inhibitors gave a sensitivity and specificity of 95.5 and 98.1%, respectively. Multiplex PCR with confirmation by microtiter plate hybridization could be completed in 8 h compared with 24-48 h required for culture.

Bacterial Proteins↗
PubMed1980

Clinical significance of enterococci in blood cultures from adult patients.

The significance of enterococci in the blood cultures of 79 adult patients encountered in a 21-month period was reviewed by means of clinical data. One blood culture consisted of an aerobic and an anaerobic bottle. Patients were divided according to the clinical picture into those with "likely", "possible", and "dubious" septicemia. Those with "likely" septicemia showed significantly more positive sets and more often two positive bottles in a single set taken on the same day than patients in the other categories. They also grew cultures with shorter detection times, with 90% of all cultures eventually yielding enterococci within three days after collection. Finally, probability figures relating positivity in one or two bottles to detection time and category of significance are presented. They may be used prospectively to assess the chances of a blood cultures reflecting any of the three above categories.

Adult↗
PubMed1982

Comparative in vitro antibacterial activity of seven semi-synthetic penicillins against aerobic gram-negative bacteria and enterococci.

The MICs and MBCs of mecillinam, ticarcillin, mezlocillin, azlocillin and piperacillin were determined by the microdilution method in liquid medium using 700 strains of gram-negative bacilli and enterococci isolated from pathological sources and classified as a function of their sensitivity to ampicillin and carbenicillin. The ampicillin and carbenicillin-sensitive strains were generally sensitive to the other penicillins, although there were differences in activity. The ampicillin and carbenicillin-resistant strains of Escherichia coli that produce a TEM-type penicillinase were sensitive to mecillinam. Mezlocillin, piperacillin and azlocillin had MICs of between 32 and 64 mg/l for 40% of these strains. The Klebsiella strains, whose broad-spectrum penicillinase deactivates ampicillin and carbenicillin, remained sensitive to mecillinam. Mezlocillin, azlocillin and piperacillin had MICs of less than 8 mg/l for 50% of these strains. The carbenicillin-resistant strains of Enterobacter and Citrobacter were also resistant to the other penicillins. Piperacillin and mezlocillin displayed some activity against certain strains of carbenicillin-resistant Serratia, Proteus and Acinetobacter. Azlocillin, piperacillin and, to a lesser degree, mezlocillin were active against the strains of Pseudomonas, for which carbenicillin had an MIC of about 512 mg/l. Ampicillin, mezlocillin and azlocillin showed the best activity against the enterococci, against which mecillinam was inactive. The MBC of these antibiotics is greatly influenced by the density of the bacterial inoculum.

Gram-Negative Aerobic Bacteria↗
PubMed1991

Isolation of vancomycin-resistant enterococci in haematologic patients.

After the occurrence of septicaemia with a vancomycin-resistant Enterococcus faecalis strain in a patient, it was decided to determine the number of carriers of vancomycin-resistant cocci among haematologic patients. During a period of six months 135 stool samples from 25 children, and 400 samples from 70 adults were studied. All samples from the children were negative for vancomycin-resistant cocci. Nine of the adult patients had cultures positive for cocci, all identified as enterococci, which were highly resistant to vancomycin (MIC greater than 250 micrograms/ml), sensitive to amoxicillin, moderately resistant to gentamicin, slightly resistant to teicoplanin, and sensitive to daptomycin. None of these patients had been given vancomycin prior to the isolation of the vancomycin-resistant enterococci.

Adult↗
PubMed1998

Control of peptidoglycan synthesis in vancomycin-resistant enterococci: D,D-peptidases and D,D-carboxypeptidases.

Resistance to glycopeptide antibiotics in enterococci results from the synthesis of peptidoglycan precursors with low affinity for these antibiotics. The resistance proteins are encoded on transposons in VanA and VanB type enterococci and are involved in regulation, synthesis of new resistant precursors and elimination of wild-type sensitive precursors by hydrolysis of D-alanyl-D-alanine (D,D-peptidase activity encoded by vanX) and removal of D-alanine from UDP-N-acetylmuramyl (UDP-MurNAc)-pentapeptide (D,D-carboxypept-idase activity encoded by vanY). The substrate specificities of VanX and VanY ensure that essentially only precursors with low affinity for glycopeptide antibiotics are available for peptidoglycan synthesis in strains induced to resistance.

Amino Acid Sequence↗
PubMed1999

Validity of screening procedures for glycopeptide-resistant enterococci.

Screening agars containing different vancomycin concentrations and different susceptibility testing procedures were compared to determine their validity for the detection of glycopeptide-resistant enterococci (GRE). Direct streaking of rectal swabs over the surface of a commercially available agar (Enterococcosel; Becton Dickinson, Germany) containing 4 microg/ml and 16 microg/ml vancomycin was followed by incubation for 24 to 48 h. Susceptibility tests were done by microbroth dilution, disk diffusion, and the E test (AB Biodisk, Sweden). The microbroth dilution method according to National Committee for Clinical Laboratory Standards (NCCLS) was used as the gold standard for detection of GRE. Resistant and intermediately susceptible enterococcal isolates were differentiated to the species level. To detect resistance genes, the polymerase chain reaction was performed on all intermediately resistant isolates, on all isolates of VanB phenotype, and on 30% of isolates of VanA phenotype. Screening agar containing 4 microg/ml vancomycin displayed high sensitivity (97.6%) but only low specificity (35%) for the detection of GRE. Screening agar containing 16 microg/ml vancomycin had a high specificity of 89.3% and only a slightly lower sensitivity (92.7%) than the screening agar containing 4 microg/ml vancomycin. For the disk diffusion test, a breakpoint of < 16 mm yielded the optimal combination of sensitivity (98.8%) and specificity (99.6%). Both sensitivity and specificity of the E test for GRE detection were 100%. However, the E test is too expensive for testing of all enterococci. In conclusion, the combination of an inexpensive screening agar with either the E test or the disk diffusion test constitutes a valid and cost-effective method for the detection of GRE from screening specimens.

Colony Count, Microbial↗
PubMed2000

Cost-effective algorithm for detection and identification of vancomycin-resistant enterococci in surveillance cultures.

A study was undertaken to develop an easy-to-use and cost-effective algorithm for the detection and identification of vancomycin-resistant enterococci (VRE) in surveillance cultures, because the incidence of VRE outbreaks in institutions across Canada has made continuous surveillance a necessity. Enterococcus faecium and Enterococcus faecalis carry transferable resistance genes and hence are a problem for infection control. In laboratory surveillance, however, Enterococcus gallinarum and Enterococcus casseliflavus, which exhibit low-level nontransferable resistance, are also encountered and often create confusion in identification. Included in this study were a total of 218 strains of enterococci and other streptococci isolated from surveillance cultures. Conventional methods were used to determine their biochemical activities, and speciation was attempted in 121 strains using a rapid multiplex polymerase chain reaction (PCR) method that utilized primers for the vanA, B, C1, C2/C3 and ddl genes. The results indicated that by using only a few tests (Gram stain, pyrrolidonyl arylamidase activity, motility, xylose and methyl-alpha-D-glucopyranoside utilization), Enterococcus faecium/faecalis strains could be accurately differentiated from Enterococcus gallinarum/casseliflavus strains. For the 121 strains on which PCR was performed, there was a 100% correlation with the biochemical identification, with the added advantage that the presence of van genes could be determined at the same time. The cost of identification using minimal biochemical testing and PCR was less than that of identification using automated systems or a battery of conventional biochemical methods. The algorithm presented here may be used in the microbiology laboratory.

Algorithms↗
PubMed2002

Low prevalence of vancomycin-resistant enterococci in clinical samples from hospitalized patients of the Canary Islands, Spain.

Over the last decade vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens. The aim of this study was to determine the prevalence of VRE in clinical samples from hospitalized patients in the Canary Islands. From April to November 2000, 437 enterococci were isolated from patients hospitalized at the four main health care centers in those islands. Identification to the species level was performed with the GPS-TA (Vitek 1) or the Wider I system. A PCR assay was used to determine the genotype of glycopeptide resistance ( vanA, vanB, vanC1, and vanC2/C3 genes). Only three (0.7%) VRE were detected: one vanA Enterococcus faecalis, and two vanC1 Enterococcus gallinarum. To our knowledge, this is the first VRE study carried out in the Canary Islands hospitals, and the results showed a low prevalence of VRE.

Enterococcus↗