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Emergence of Vancomycin-Resistant Enterococci at a University Hospital in Taiwan: Persistence of Multiple Species and Multiple Clones

Published online by Cambridge University Press:  02 January 2015

Po-Ren Hsueh ,
Lee-Jene Teng ,
Hui-Ju Pan ,
Yu-Chi Chen ,
Li-Hua Wang ,
Shan-Chwen Chang ,
Shen-Wu Ho  and
Kwen-Tay Luh
Po-Ren Hsueh
Affiliation:
National Taiwan University College of Medicine, Taipei, Taiwan
Lee-Jene Teng
Affiliation:
National Taiwan University College of Medicine, Taipei, Taiwan
Hui-Ju Pan
Affiliation:
National Taiwan University Hospital, Taipei, Taiwan
Yu-Chi Chen
Affiliation:
National Taiwan University Hospital, Taipei, Taiwan
Li-Hua Wang
Affiliation:
National Taiwan University Hospital, Taipei, Taiwan
Shan-Chwen Chang
Affiliation:
National Taiwan University College of Medicine, Taipei, Taiwan
Shen-Wu Ho
Affiliation:
National Taiwan University College of Medicine, Taipei, Taiwan
Kwen-Tay Luh*
Affiliation:
National Taiwan University College of Medicine, Taipei, Taiwan
*
Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan
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Abstract

Objectives:

To describe the epidemiology of vancomycin-resistant enterococci (VRE) in a university hospital in Taipei, Taiwan.

Design:

Retrospective review over a 27-month period, from March 1996 to May 1998.

Setting:

A tertiary-care teaching hospital in Taiwan.

Participants:

Patients with VRE isolated from any body site.

Methods:

Patients were identified through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiology data, including age, gender, previous hospital admissions, underlying diseases, types of infection, and recent antibiotic use. VRE isolates were characterized by their typical biochemical reactions, cellular fatty acid profiles, and the presence of van genes. Antibiotypes using the E-test and randomly amplified polymorphic DNA (RAPD) patterns of these isolates were used to determine the clonality.

Results:

Twenty-five isolates of VRE recovered from 12 patients were identified. One patient with a perianal abscess had 12 isolates of VRE (4 Enterococcus faecalis, 7 Enterococcus faecium, and 1 Enterococcus casseliflavus) recovered from perianal lesions. Among 3 patients who were hospitalized in the same room, 1 had a community-acquired cellulitis over the left leg caused by E faecalis, and the other 2 patients both had anal colonization with 2 isolates of E faecalis. The other 8 patients had 1 E faecalis isolate each from various clinical specimens. All isolates possessed vanA resistance phenotype and vanA genes. Different antibiotypes and RAPD patterns of the isolates from different patients excluded the possibility of nosocomial spread at the hospital.

Conclusions:

Multiple species of VRE (E faecalis, E faecium, and E casseliflavus) and multiple clones of E faecium could colonize or infect hospitalized patients. In addition, clones of VRE can persist long-term in patients' lower gastrointestinal tracts. These results extend our knowledge of the coexistence and the persistence of multiple species and multiple clones of VRE in hospitalized patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 12 , December 1999 , pp. 828 - 833
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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References

1. Moellering, RC Jr. Vancomycin-resistant enterococci. Clin Infect Dis 1998;26:1196–1199.CrossRefGoogle ScholarPubMed
2. Morris, JG Jr, Shay, DK, Hebden, JN, McCarter, RJ Jr, Perdue, BE, Jarvis, W, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.CrossRefGoogle Scholar
3. Murray, BE. Vancomycin-resistant enterococci. Am J Med 1997;102:284–293.Google Scholar
4. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
5. Uttley, AH, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet 1988;1:57–58.Google Scholar
6. Boyle, JF, Soumakis, SA, Rendo, A, Herrington, JA, Gianarkis, DG, Thurberg, BE, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993;1:1280–1285.Google Scholar
7. Montecalvo, MA, Horowitz, H, Gedris, C, Carbonaro, C, Tenover, FC, Issah, A, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resis-tant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.Google Scholar
8. Pegues, DA, Pegues, CF, Hibberd, PL, Ford, DS, Hooper, DC. Emergence and dissemination of highly vancomycin-resistant vanA strain of Enterococcus faecium at a large teaching hospital. J Clin Microbiol 1997;35:1565–1570.Google Scholar
9. Perlada, DE, Smulian, AG, Cushion, MT. Molecular epidemiology and antibiotic susceptibility of enterococci in Cincinnati, Ohio: a prospective citywide survey. J Clin Microbiol 1997;35:2342–2347.Google Scholar
10. Wells, CL, Juni, BA, Cameron, SB, Mason, KR, Dunn, DL, Ferrieri, P, et al. Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients. Clin Infect Dis 1995;21:45–50.Google Scholar
11. Montecalvo, MA, de Lencastre, H, Carraher, M, Gedris, C, Chung, M, VanHorn, K, et al. Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1995;16:680–685.Google Scholar
12. Noskin, GA, Cooper, I, Peterson, LR. Vancomycin-resistant Enterococcus faecium sepsis following persistent colonization. Arch Intern Med 1995;155:1445–1447.Google Scholar
13. Roghmann, MC, Qaiyumi, S, Johnson, JA, Schwalbe, R, Morris, JG Jr. Recurrent vancomycin-resistant Enterococcus faecium bacteremia in a leukemia patient who was persistently colonized with vancomycin-resistant enterococci for two years. Clin Infect Dis 1997;24:514–515.Google Scholar
14. Roghmann, MC, Qaiyumi, S, Schwalbe, R, Morris, JG Jr. Natural history of colonization with vancomycin-resistant Enterococcus faecium. Infect Control Hosp Epidemiol 1997;18:679–680. Letter.Google Scholar
15. Beezhold, DW, Slaughter, S, Hayden, MK, Matushek, M, Nathan, C, Trenholme, GM, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis 1997;24:704–706.CrossRefGoogle ScholarPubMed
16. Schoonmaker, DJ, Bopp, LH, Baltch, AL, Smith, RP, Rafferty, E, George, M. Genetic analysis of multiple vancomycin-resistant Enterococcus isolates obtained serially from two long-term-care patients. J Clin Microbiol 1998;36:2105–2108.Google Scholar
17. Weinstein, JW, Roe, M, Towns, M, Sanders, L, Thorpe, JJ, Corey, GR, et al. Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital. Infect Control Hosp Epidemiol 1996;17:36–41.CrossRefGoogle ScholarPubMed
18. Facklam, RR, Sahm, DF. Enterococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: American Society for Microbiology; 1995:308–314.Google Scholar
19. Garner, JS, Jarvis, WR, Emori, TG, Horan, TG, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
20. Hsueh, PR, Teng, LJ, Lee, LN, Yang, PC, Chen, YC, Ho, SW, et al. Indwelling device-related and recurrent infections due to Aeromonas species. Clin Infect Dis 1998;26:651–658.Google Scholar
21. National Committee for Clinical Laboratory Standards. Performance Standard for Antimicrobial Susceptibility Testing: Eighth Informational Supplement. NCCLS document M100-S9. Villanova, PA: NCCLS; 1999.Google Scholar
22. Hsueh, PR, Teng, LJ, Yang, PC, Chen, YC, Ho, SW, Luh, KT. Persistence of a multidrug-resistant Pseudomonas aeruginosa clone in an intensive care burn unit. J Clin Microbiol 1998;36:1347–1351.Google Scholar
23. Clark, NC, Cooksey, RC, Hill, BC, Swenson, JM, Tenover, FC. Characterization of glycopeptide-resistant enterococci from US hospitals. Antimkrob Agents Chemother 1993;37:2311–2317.Google Scholar
24. Livornese, LL Jr, Dias, S, Samel, C, Romanowski, B, Taylor, S, May, P, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.Google Scholar
25. Collins, LAMalanoski, GJ, Eliopoulos, GM, Wennersten, CB, Ferraro, MJ, Moellering, RC Jr. In vitro activity of RP59500, an injectable strep-togramin antibiotic, against vancomycin-resistant gram-positive organisms. Antimkrob Agents Chemother 1993;37:598–601.Google Scholar
26. Evans, PA, Norden, CW, Rhoads, S, Deobaldia, J, Silber, JL. In vitro susceptibilities of clinical isolates of vancomycin-resistant enterococci. Antimkrob Agents Chemother 1997;41:1406.CrossRefGoogle ScholarPubMed
27. Freeman, C, Robinson, A, Cooper, B, Mazens-Sullivan, M, Quintiliani, R, Nightingale, C. In vitro antimicrobial susceptibility of glycopeptide-resistant enterococci. Diagn Microbiol Infect Dis 1995;21:47–50.CrossRefGoogle ScholarPubMed
28. Lucas, GM, Lechtzin, N, Puryear, DW, Yau, LL, Flexner, CW, Moore, RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis 1998;26:1127–1133.Google Scholar