Vancomycin-resistant enterococci from nosocomial, community, and animal sources in the United States

The presence of vancomycin-resistant enterococci (VRE) was looked for in fecal samples from 104 healthy volunteers (3 with hospital exposure), 100 selected hospitalized patients, and various environmental sources (44 commercial chickens, 5 farm-raised chickens, 3 turkeys, and 2 chicken farm lagoon slurries). Five probiotic preparations were also studied. No VRE with vanA or vanB genes were isolated from the healthy volunteers without hospital exposure, environmental sources, or probiotic preparations. VRE with vanB were found in the stools of 16% of the high-risk hospitalized patients and in one volunteer with hospital contact. All VRE examined could be classified into one of two clones by pulsed-field gel electrophoresis. VRE from 11 of the colonized patients were quantified and ranged from 10(3) to 10(6) CFU/g of stool. This study, in contrast to findings in Europe, failed to find evidence of VanA- or VanB-type VRE in the community or environmental sources in Houston, Texas, and suggests that these settings are not a likely source of VRE in hospitals in this geographic area.

[1]  M. Zervos,et al.  Characterization of antimicrobial resistance in enterococci of animal origin , 1995, Antimicrobial agents and chemotherapy.

[2]  F. Baquero,et al.  vanA-mediated vancomycin-resistant Enterococcus spp. in sewage. , 1994, The Journal of antimicrobial chemotherapy.

[3]  F M Aarestrup,et al.  Occurrence of glycopeptide resistance among Enterococcus faecium isolates from conventional and ecological poultry farms. , 1995, Microbial drug resistance.

[4]  J. Bates,et al.  Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium. , 1994, The Journal of antimicrobial chemotherapy.

[5]  H. Claus,et al.  Environmental strains of Enterococcus faecium with inducible high-level resistance to glycopeptides. , 1993, FEMS microbiology letters.

[6]  P. Murray,et al.  In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis , 1989, Antimicrobial Agents and Chemotherapy.

[7]  R. Arduino,et al.  High-level resistance to aminoglycosides: comparison of community and nosocomial fecal isolates of enterococci. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  P. Courvalin,et al.  Analysis of genes encoding D-alanine-D-alanine ligase-related enzymes in Enterococcus casseliflavus and Enterococcus flavescens , 1994, Antimicrobial Agents and Chemotherapy.

[9]  J. Duval,et al.  Characterization of the chromosomal aac(6')-Ii gene specific for Enterococcus faecium , 1993, Antimicrobial Agents and Chemotherapy.

[10]  B. Murray.  What can we do about vancomycin-resistant enterococci? , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  K. Singh,et al.  Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  P. Courvalin,et al.  Emergence of high-level resistance to glycopeptides in Enterococcus gallinarum and Enterococcus casseliflavus , 1994, Antimicrobial Agents and Chemotherapy.

[13]  N Woodford,et al.  Vancomycin-resistant enterococci , 1993, The Lancet.

[14]  M. Arthur,et al.  Genetics and mechanisms of glycopeptide resistance in enterococci , 1993, Antimicrobial Agents and Chemotherapy.

[15]  J. Tokars,et al.  Ability of Clinical Laboratories To Detect Antimicrobial Agent-Resistant Enterococci , 1993, Journal of clinical microbiology.

[16]  D. Shlaes,et al.  Inducible, transferable resistance to vancomycin in Enterococcus faecium, D399. , 1989, The Journal of antimicrobial chemotherapy.

[17]  J. Duval,et al.  Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. , 1988, The New England journal of medicine.

[18]  J. Sambrook,et al.  Molecular Cloning: A Laboratory Manual , 2001 .

[19]  R. Hakenbeck,et al.  Enterococcus faecium strains with vanA-mediated high-level glycopeptide resistance isolated from animal foodstuffs and fecal samples of humans in the community. , 1995, Microbial drug resistance.

[20]  G. Weinstock,et al.  Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites , 1990, Journal of clinical microbiology.

[21]  J. Boyce,et al.  Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance , 1994, Journal of clinical microbiology.

[22]  B. Murray,et al.  Identification of Enterococcus faecalis strains by DNA hybridization and pulsed-field gel electrophoresis , 1995, Journal of clinical microbiology.

[23]  Nosocomial enterococci resistant to vancomycin--United States, 1989-1993. , 1993, MMWR. Morbidity and mortality weekly report.

[24]  Ellen Jo Baron,et al.  Manual of clinical microbiology , 1975 .

[25]  D. Shlaes,et al.  Vancomycin susceptibility and identification of motile enterococci , 1991, Journal of clinical microbiology.

[26]  J. Elion,et al.  Evidence for the genetic unrelatedness of nosocomial vancomycin-resistant Enterococcus faecium strains in a pediatric hospital , 1991, Journal of clinical microbiology.

[27]  J. Bates,et al.  Farm animals as a putative reservoir for vancomycin-resistant enterococcal infection in man. , 1994, The Journal of antimicrobial chemotherapy.

[28]  R. Leclercq,et al.  Influence of oral glycopeptides on the fecal flora of human volunteers: selection of highly glycopeptide-resistant enterococci. , 1996, The Journal of infectious diseases.

[29]  B. Murray.  Editorial Response: What Can We Do About Vancomycin-Resistant Enterococci? , 1995 .

[30]  H. Claus,et al.  vanA-mediated high-level glycopeptide resistance in Enterococcus faecium from animal husbandry. , 1995, FEMS microbiology letters.

[31]  M. Zervos,et al.  Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states , 1993, Journal of clinical microbiology.

[32]  D. Shlaes,et al.  Inducible, transferable resistance to vancomycin in Enterococcus faecalis A256 , 1989, Antimicrobial Agents and Chemotherapy.

[33]  F. Tenover,et al.  Characterization of glycopeptide-resistant enterococci from U.S. hospitals , 1993, Antimicrobial Agents and Chemotherapy.

[34]  P. Hartman,et al.  Antibiotic Resistance Among Enterococcal Isolates from Environmental and Clinical Sources. , 1993, Journal of food protection.

[35]  P. Courvalin,et al.  The vanB gene of vancomycin-resistant Enterococcus faecalis V583 is structurally related to genes encoding D-Ala:D-Ala ligases and glycopeptide-resistance proteins VanA and VanC. , 1993, Gene.

[36]  B. Murray,et al.  Analysis by PCR and direct DNA sequencing of gyrA mutations associated with fluoroquinolone resistance in Enterococcus faecalis , 1994, Antimicrobial Agents and Chemotherapy.

[37]  M. Arthur,et al.  Sequence of the vanC gene of Enterococcus gallinarum BM4174 encoding a D-alanine:D-alanine ligase-related protein necessary for vancomycin resistance. , 1992, Gene.

[38]  J. Waitz.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically , 1990 .

[39]  G. Woods,et al.  Hospital-acquired Infection with Vancomycin-resistant Enterococcus faecium Transmitted by Electronic Thermometers , 1992, Annals of Internal Medicine.

[40]  N. Woodford,et al.  High-level vancomycin-resistant enterococci causing hospital infections , 1989, Epidemiology and Infection.

[41]  C. Thornsberry,et al.  Problems with the disk diffusion test for detection of vancomycin resistance in enterococci , 1989, Journal of clinical microbiology.

[42]  C. Thornsberry,et al.  Problems with the disk diffusion test for detection of vancomycin resistance in enterococci , 1989 .

[43]  J. Duval,et al.  Vancomycin resistance gene vanC is specific to Enterococcus gallinarum , 1992, Antimicrobial Agents and Chemotherapy.

[44]  D. Shlaes,et al.  Inducible resistance to vancomycin in Enterococcus faecium D366. , 1989, The Journal of infectious diseases.

[45]  W. Witte,et al.  Glycopeptide-resistant Enterococcus faecium outside Hospitals: a commentary. , 1995, Microbial drug resistance.