Journal Article

Molecular and clinical epidemiology of vancomycin-resistant <i>Enterococcus faecalis</i>

Simona F. Oprea, Najam Zaidi, Susan M. Donabedian, Mamtha Balasubramaniam, Ellie Hershberger and Marcus J. Zervos

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 53, issue 4, pages 626-630
Published in print April 2004 | ISSN: 0305-7453
Published online April 2004 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh138
Molecular and clinical epidemiology of vancomycin-resistant Enterococcus faecalis

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Objectives: With the recent emergence of vancomycin-resistant (VR) Staphylococcus aureus, subsequent to the suggested transfer of the vanA resistance gene from Enterococcus faecalis, we sought to determine risk factors for acquisition of VR E. faecalis and to evaluate the molecular epidemiology of this less-prevalent and less-studied species of VR enterococcus.

Methods: We compared clinical isolates of VR E. faecalis from 71 patients, collected over 12 years in a large community teaching hospital, with isolates from 126 patients with vancomycin-susceptible E. faecalis.

Results: Risk factors for VR E. faecalis acquisition by multivariate analysis were nursing home residence (P = 0.0005), haemodialysis (P = 0.009), decubitus ulcers (P = 0.03) and receipt of parenteral vancomycin (P = 0.0002). Twenty-one percent of VR E. faecalis demonstrated vanA and 79% vanB resistance. The number of VanA isolates increased over time. Molecular analysis showed vanA or vanB in multiple PFGE groups.

Conclusions: The results of this study suggest gene dissemination among some isolates and intra-hospital spread of other isolates. The risk factors identified clearly suggest that VR E. faecalis is a nosocomial pathogen and should be considered in infection control practices. Further surveillance of VR E. faecalis is warranted, due to the potential spread of vancomycin resistance among enterococci and staphylococci.

Keywords: Keywords: risk factors, pulse-field gel electrophoresis, E. faecalis

Journal Article.  4080 words. 

Subjects: Medical Oncology ; Critical Care

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