Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-12-01T01:39:33.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Molecular Typing and Antimicrobial Susceptibility of Vancomycin-Resistant Enterococcus faecium in Brazil

Published online by Cambridge University Press:  02 January 2015

Rosangela F. Cereda ,
Ana C. Gales ,
Suzane Silbert ,
Ronald N. Jones  and
Helio S. Sader
Rosangela F. Cereda
Affiliation:
Division of Infectious Diseases, Universidade Federal Sao Paulo, Brazil
Ana C. Gales
Affiliation:
Division of Infectious Diseases, Universidade Federal Sao Paulo, Brazil
Suzane Silbert
Affiliation:
Division of Infectious Diseases, Universidade Federal Sao Paulo, Brazil
Ronald N. Jones
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Helio S. Sader*
Affiliation:
Division of Infectious Diseases, Universidade Federal Sao Paulo, Brazil
*
Laboratório Especial de Microbiologia Clínica, Infectious Disease Division, Federal University of Sao Paulo, Rua Botucatu, 740. Sao Paulo, SP- CEP 04023-063 – Brazil
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To characterize vancomycin-resistant enterococci (VRE) isolates and to evaluate the mode of dissemination of this pathogen in Brazil.

Design:

We collected 22 vancomycin-resistant Enterococcus faecium isolates from 6 medical centers in Sao Paulo, Brazil, and 1 isolate from a medical center in Curitiba, Brazil.

Participants:

All Brazilian hospitals that had identified vancomycin-resistant E. faecium up to the beginning of this study (late 1999) contributed isolates to the study.

Methods:

The isolates were susceptibility tested using the broth microdilution method and the E-test. The presence of vancomycin resistance genes (vanA, vanB, vanC1, vanC2-3, and vanD) was evaluated by polymerase chain reaction; molecular typing was performed by pulsed-field gel electrophoresis (PFGE).

Results:

The vanA gene was demonstrated in all vancomycin-resistant E. faecium, except for 1 isolate. None of the vancomycin resistance genes cited above was detected in the isolate from Curitiba, which was the first vancomycin-resistant E. faecium described in Brazil. All isolates were resistant to ampicillin and teicoplanin. The main clone remains susceptible to doxycycline and chloramphenicol, but intermediate to quinupristin-dalfopristin. PFGE analysis demonstrated 7 major PFGE patterns. A unique PFGE pattern with 4 subtypes was detected in 17 isolates from 4 different hospitals.

Conclusion:

The results of our study indicate the occurrence of intra- and interhospital dissemination of VRE in Sao Paulo, Brazil.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 1 , January 2002 , pp. 19 - 22
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Sastry, V, Brennan, PJ, Levy, MM, et al. Vancomycin-resistant enterococci: an emerging pathogen in immunosuppressed transplant recipients. Transplant Proc 1995;27:954–955.Google ScholarPubMed
2.Leclerq, R, Courvalin, P. Resistance to glycopeptides in enterococci. Clin Infect Dis 1997;24:545–546.CrossRefGoogle Scholar
3.Cereda, RF, Pignatari, AC, Hashimoto, A, Sader, HS. In vitro antimicrobial activity against enterococci isolated in a university hospital in São Paulo, Brazil. Brazilian Journal of Infectious Diseases 1997;1:83–90.Google Scholar
4.Pfaller, MA, Jones, RN, Doern, GV, Kugler, K, SENTRY Participants Group. Bacterial pathogens isolated from patients with bloodstream infection: frequencies of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997). Antimicrob Agents Chemother 1998;42:1762–1770.CrossRefGoogle Scholar
5.Pfaller, MA, Jones, RN, Doern, GV, et al. Survey of blood stream infections attributable to gram-positive cocci: frequency of occurrence and antimicrobial susceptibility of isolates collected in 1997 in the United States, Canada, and Latin America from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis 1999;33:283–297.CrossRefGoogle ScholarPubMed
6.Sader, HS, Sampaio, JLM, Zoccoli, C, Jones, RN. Results of the SENTRY Antimicrobial Surveillance Program in three Brazilian medical centers for 1997. Brazilian Journal of Infectious Diseases 1999;3:63–79.Google ScholarPubMed
7.Dalla-Costa, LM, Souza, DC, Martins, LTF, et al. Vancomycin-resistant Enterococcus faecium: first case in Brazil. Brazilian Journal of Infectious Diseases 1998;2:160–163.Google Scholar
8.Sader, HS, Jones, RN, Ballow, CH, Biedenbach, DJ, Cereda, RF. Antimicrobial susceptibility of quinupristin-dalfopristin tested against gram positive cocci from Latin America: results from the Global SMART (GSMART) Surveillance Study. Brazilian Journal of Infectious Diseases 2001;5:21–30.CrossRefGoogle ScholarPubMed
9.Facklam, R, Sahm, DA, Teixeira, LM. Enterococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology, 7th ed. Washington, DC: American Society for Microbiology; 1999:297–305.Google Scholar
10.National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 5th ed. Approved Standard, M7-A5. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000.Google Scholar
11.National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing: Tenth Informational Supplement M100-S10. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000.Google Scholar
12.National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing: Eighth Informational Supplement M100-S8. Wayne, PA: National Committee for Clinical Laboratory Standards; 1998.Google Scholar
13.Dutka-Malen, S, Evers, S, Courvalin, P. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR. J Clin Microbiol 1995;30:1621–1624.Google Scholar
14.Soltani, M, Beighton, D, Philpott-Howard, J, Woodford, N. Mechanisms of resistance to quinupristin-dalfopristin among isolates of Enterococcus faecium from animals, raw meat, and hospital patients in Western Europe. Antimicrob Agents Chemother 2000;44:433–436.CrossRefGoogle ScholarPubMed
15.Werner, G, Witte, W. Characterization of a new enterococcal gene, satG, encoding a putative acetyltransferase conferring resistance to streptogramin A compounds. Antimicrob Agents Chemother 1999;43:1813–1814.CrossRefGoogle ScholarPubMed
16.Pfaller, MA, Sader, HS, Hollis, RJ. Chromosomal restriction fragment analysis by pulsed-field gel electrophoresis. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1992:1–12.Google Scholar
17.Jones, RN, Ballow, CH, Biedenbach, DJ, Deinhart, JA, Schentag, JJ. Antimicrobial activity of quinupristin-dalfopristin (RP 59500, Synercid) tested against over 28,000 recent clinical isolates from 200 medical centers in the United States and Canada. Diagn Microbiol Infect Dis 1998;31:437–451.CrossRefGoogle Scholar
18.Dalla-Costa, LM, Reynolds, PE, Souza, AHM, Souza, DC, Palepou, MPI, Woodford, N. Characterization of a divergent vanD-type resistance element from the first glycopeptide-resistant strain of Enterococcus faecium in Brazil. Antimicrob Agents Chemother 2000;44:3444–3446.CrossRefGoogle ScholarPubMed
19.Vannuffel, P, Cocito, C. Mechanism of action of streptogramins and macrolides. Drugs 1996;51(suppl 1):20–30.CrossRefGoogle ScholarPubMed
20.Sader, HS, Pignatari, AC, Hollis, RJ, Jones, RN. Evaluation of interhospital spread of methicillin-resistant Staphylococcus aureus in São Paulo, Brazil, using pulsed-field gel electrophoresis of chromosomal DNA. Infect Control Hosp Epidemiol 1994;15:320–323.CrossRefGoogle Scholar
21.Cereda, RF, Vinagre, A, Hashimoto, A, et al. Low prevalence of patients colonized with vancomycin-resistant enterococci in spite of high use of vancomycin. Presented at the 98th General Meeting of the American Society for Microbiology; May 17-21, 1998; Atlanta, GA, Abstract C-356.Google Scholar
22.Centers for Disease Control and Prevention (CDC). Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Clinical Practices Advisory Committee (HICPAC), United States, 1995. MMWR 1995;44(RR-12):1–13.Google Scholar
23.Sader, HS, Pfaller, MA, Tenover, FC, Hollis, RJ, Jones, RN. Evaluation and characterization of multiresistant Enterococcus faecium from twelve U.S. medical centers. J Clin Microbiol 1994;32:2840–2842.CrossRefGoogle Scholar