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The Use of Molecular Typing Techniques in the Epidemiologic Investigation of Resistant Enterococci

  • Barbara M. Willey (a1), Allison J. McGeer (a1), Mario A. Ostrowski (a2), Barry N. Kreiswirth (a3) and Donald E. Low (a1)...

Extract

The Enterococcus has become an important nosocomial pathogen despite its low virulence. From 1986 to 1989, the National Nosocomial Infections Surveillance System (NNIS) reported enterococci to be the third most common pathogen associated with bloodstream infections and the second most commonly isolated pathogen overall. This is due in part to the organism's ubiquitous nature and inherent antimicrobial resistance.

Enterococcus faecalis is found in the stool of virtually all adults at concentrations in excess of 106 colony-forming units/g. Enterococcus faecium, the second most common species causing human infection, is found at lesser concentrations in the stool of approximately 25% of healthy adults. Enterococci also can be isolated from the mouth, anterior urethra, groin, and vagina.

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Department of Microbiology, Room 1487, Mount Sinai and Princess Margaret Hospitals, 600 University Ave., Toronto, Ontario, Canada M5G 1X5

References

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1.Moellering, RC Jr. Emergence of enterococcus: a significant pathogen. Clin Infect Dis 1992;14:11731178.
2.Spera, KV, Farber, BEMultiply-resistant Enterococcus fueciuvn. The nosocomial pathogen of the 1990s. JAMA 1992;268:25632564.
3.Steady increase in resistant enterococcus poses new threat. Hospital Infection Control 1993;20:15. Editorial.
4.Schaberg, DR, Culver, DH, Gaynes, RI? Major trends in the microbial etiology of nosocomial infections. Am J Med 1991;91:72S75s.
5.Murray, BE. The life and times of the enterococcus. Clin Microbiol Rev 1990;3:4665.
6.Moellering, RC Jr, Weinberg, AN. Studies on antibiotic synergism against enterococci, II: effect of various antibiotics on the uptake of C14-labelled streptomycin by enterococci. J Clin Invest 1971;50:25802584.
7.Geraci, JE, Martin, WJ. Antibiotic therapy of bacterial endocarditis, VI: subacute enterococcal endocarditis: clinical pathologic and therapeutic considerations of 33 cases. Circulation 1954:10:173194.
8.Boyce, JM, Opal, SM, Potter-Bynoe, G, et al. Emergence and nosocomial transmission of anrpicillin-resistant enterococci. Anti-microb Agents Chemother 1992;36:10321039.
9.Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus fuecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112116.
10.Zervos, MJ, Bacon, AE III, Patterson, JE, et al. Enterococcal superinfections in patients treated with ciprofloxacin. Antimi-crob Chemother 1988;21:113115.
11.Jones, RN. Gram-positive superinfections following beta-lactam chemotherapy: the significance of the enterococcus. Infection 1985;13:581588.
12.Wells, VD, Wong, ES, Murray, BE, et al. Infections due to beta-lactamase-producing, high-levelgentamicin-resistant Enterro-coccusfueculis. Ann Intern Med 1992;116:285292.
13.Chirurgi, VA, Oster, SE, Goldberg, AA, et al. Nosocomial acquisition of beta-lactamase-negative, ampicillin-resistant enterococcus. Arch Intern Med 1992;152:14571461.
14.Pallares, RPujol, M, Pena, C, et al. Cephalosporins as a risk factor for nosocomial Enterococcus fueculis bacteremia. A matched case-control study. Arch Intern Med 1993:153:15811586.
15.Dougherty, SH. Role of enterococcus in intraabdominal sepsis. Am J Surg 1984;148:308312.
16.Garrison, RN, Fry, DE, Berberich, S, et al. Enterococcal bacteremia; clinical implications and determinants of death. Ann Surg 1982;196:4347.
17.Bryan, CS, Reynolds, KL, Brown, JJ. Mortality associated with enterococcal bacteremia. Surg Gynecol Obstet 1985;160:557561.
18.Barral, DT, Kenney, PR, Slotman, GJ, et al. Enterococcal bacteremia in surgical oatients. Arch Surg 1985;120:5763.
19.Gullberg, RM, Homavin, SR, Phair, JP. Enterococcal bacteremia: analysis of 75 episodes. Review of Infectious Diseases 1989;11:7485.
20.Hoge, CW, Adams, J, Buchanan, B, et al. Enterococcal bacteremia: to treat or not to treat, a reappraisal. Review of Infectious Diseases 1991:13:600605.
21.Maki, DG, Agger, WA. Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine 1988:67:248269.
22.Gross, PA, Harkavy, LM, Barden, GE, et al. The epidemiology of nosocomial enterococcal urinary tract infections. Am I Med 1976;272:7581.
23.Carrizosa, J, Kaye, D. Antibiotic synergism in enterococcal endocarditis. J Clin Lab Med 1976;88:132141.
24.Downey, JEWilley, BM, Kreiswirth, BN, et al. Loss of synergy in enterococcal isolates with resistance to ampicillin and vancomycin. Presented at the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-14,1992; Anaheim, California. Abstract 248.
25.Moellering, RC, Wennersten, C, Medrek, T, et al. Prevalence of high-level resistance to aminoglycosides in clinical isolates of enterococci. Antimicrob Agents Chemother 1970;1:335340.
26.Mederski-Samoraj, BD, Murray, BE. High-level resistance to gentamicin in clinical isolates of enterococci. J Infect Dis 1983;147:751757.
27.Murray, BE, Tsao, J, Pomida, J. Enterococci in Bangkok, Thailand, with high-level resistance to currently available aminoglycosides. Antimicrob Agents Chemother 1983;23:799802.
28.Bush, LM, Calmon, J, Cherney, CL, et al. High-level penicillin resistance among isolates of enterococci: implications for treatment of enterococcal infections. Ann Intern Med 1989;110:515520.
29.Grayson, MI, Eliopoulos, GM, Wennersten, CB, et al. Increasing resistance to beta-lactam antibiotics among clinical isolates of Enterococcus fuecium: a 22-year review at one institution. Antimicrob Agents Chemother 1991;35:21802184.
30.Sapico, FL, Canawati, HN, Ginunas, VJ, et al. Enterococci highly resistant to penicillin and ampicillin. An emerging clinical problem? J Clin Microbiol 1989;27:20912095.
31.Fantena, R, Amalfitani, G, Rossi, L, et al. Mechanism of resistance to growth inhibition and killing by beta-lactam antibiotics in enterococci. Clin Infect Dis 1992;15:486489.
32.Murray, BE, Singh, KU, Markowitz, SM, et al. Evidence for clonal spread of a single strain of beta-lactamase producing Enterococcus (Streptococcus) faecalis to six hospitals in five states. J Infect Dis 1971;163:780785.
33.Murray, BE. Beta-lactamase producing enterococci. Antimicrob Agents Chemother 1992;36:23552359.
34.Leclereq, R, Derlot, E, Duval, J, et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988;319:157161.
35.Uttley, AHC, George, RC, Naidoo, J, et al. High-level vancomycin-resistant enterococci causing hospital infection. Epidemiol Infect 1989;103:173181.
36.Freiden, TRMunsiff, SS, Low, DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:7679.
37.Jones, RN, Erwin, ME, Enterococcus Study Group. Emerging multiply resistant enterococci among clinical isolates. Presented at the 33rd Interscience Conference on Antimicrobial Agents and Chemotheranv: October 17-20. 1993: New Orleans, Louisiana. Abstract 1052.
38.Rubin, LG, Tucci, V, Cercenado, E, et al. Vancomycin-resistant Enterococcusfaecium in hospitalized children. Infect Control Hosp Epidemiol 1992;13:700705.
39.Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195200.
40.Clark, NC, Cocksey, RC, Hill, BC, et al. Characterization of glycopeptide-resistant enterococci from U.S. hospitals. Antimicrob Agents Chemother 1993;37:23112317.
41.Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin-United States, 19891993. MMWR 1993;42:597599.
42.Arthur, M, Courvalin, F! Genetics and mechanisms of glycopep tide resistance in enterococci. Antimicrob Agents Chemother 1993;37:15631571.
43.Gold, HS, Unal, S, Cercenado, E, et al. A gene confirming resistance to vancomycin but not teicoplanin in isolates of Enterococcus faecalis and Enterococcus faecium demonstrates homology with van B, van A, and van C genes of enterococci. Antimicrob Agents Chemother 1993;37:16041609.
44.Quintiliani, R Jr, Evans, S, Courvalin, RThe van B gene confers various levels of self-transferable resistance to vancomycin in enterococci. J Infect Dis 1993;167:12201223.
45.Dutka-Malen, S, Molinas, C, Arthur, M, et al. The VAN A glycopeptide resistance protein is related to D-analyl-D-alamine ligase cell wall biosynthesis enzymes. Mol Gen Genet 1990;224:364372.
46.Pallares, R, Dick, RWenzel, RRet al. Trends in antimicrobial utilization at a tertiary teaching hospital during a 15-year period (1978-1992).Infect Control Hosp Epidemiol 1991;12:525534.
47.Ena, J, Dick, RW, Jones, RN, et al. The epidemiology of intravenous vancomycin usage in a university hospital. JAMA 1993;269:598602.
48.Donabedian, SM, Chow, JW, Boyce, JM, et al. Molecular typing of ampicillin-resistant, non-beta-lactamase-producing Enterococcus feacium isolates from diverse geographic areas. J Clin Microbial 1992;30:27572761.
49.Hall, LMC, Duke, B, Guiney, M, et al. Typing of Enterococcus species by DNA fragment analysis. J Clin Microbiol 1992;30:915919.
50.Gordillo, ME, Singh, KV, Murray, BE. Comparison of ribotyping and pulsed-field gel electrophoresis for subspecies differentiation of strains of Enterococcus faecalis. J Clin Microbial 1993;31:15701574.
51.Woodford, N, Morrison, D, Johnson, ARet al. Application of DNA probes for rRNA and van A genes to investigation of a nosocomial cluster of vancomycin-resistant enterococci. J Clin Microbiol 1993;31:653658.
52.Murray, BE, Singh, KV, Heath, JD, et al. Comparison of genomic DNAs of different enterococcal isolates using restriction entonu-cleases with infrequent recognition sites. J Clin Microbiol 1990;28:20592063.
53.Bingen, EH, Denamur, E, Lambert-Zechovsky, NY, et al. Evidence for the genetic unrelatedness of nosocomial vancomycin-resistant Enterococcus faecium strains in a pediatric hospital. J Clin Microbiol 1991;29:18881892.
54.Bovle, JESoumakis, AR, Herrington, JAet al. Epidemiological analysis and genotypic outbreak of vancomycin-resistant enterococci. J Clin Microbiol 1993;31:12801285.
55.Sexton, DJ, Harrell, LJ, Thorpe, JJ, et al. A case-control study of nosocomial ampicillin-resistant enterococcal infection and colonization at a university hospital. Infect Control Hosp Epidemiol 1993;14:629635.
56.Chiragi, VA, Oster, SE, Goldberg, AA, et al. Ampicillin-resistant Enterococcus raffinosis in an acute-care hospital: case-control study and antimicrobial susceptibilities. J Clin Microbiol 1991;29:26632665.
57.Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin and eentamicin. Clin Infect Dis 1993;16:750755.
58.Chow, JW, Kuritza, A, Shlaes, DM, et al. Clonal spread of vancomycin-resistant Enterococcus faecium in three hospitals in two states. J Clin Microbiol 1993;31:16091611.
59.Huycke, MM, Spiegel, CA, Gilmore, MS. Bacteremia caused by hemolytic, high-level gentamicin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 1991;35:16261634.
60.Willey, BM, Chan, A, Kwan, A, et al. Characterization of vancomycin-resistant enterococci (VRE) isolated over a two-year period from a New York City hospital. Presented at the 93rd General Meeting of the American Society for Microbiology; May 1620, 1993; Atlanta, Georgia. Abstract A69.
61.Patterson, JE, Singh, KV, Murray, BE. Epidemiology of an endemic strain of beta-lactamase-producing Enterococcus faecalis. J Clin Microbiol 1991;29:25132516.
62.Murray, BE, Lopardo, HA, Rubeglio, EA, et al. Intrahospital spread of a single gentamicin-resistant, beta-lactamase-producing strain of Enterococcus faecalis in Argentina. Antimicrob Agents Chemother 1992;36:230232.
63.Goering, KV, Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595600.
64.Thal, LA, Chow, JW, Patterson, JE, et al. Molecular characterization of highly gentamicin-resistant Enterococcus faecalis lacking high-level streptomycin resistance. Antimicrob Agents Chemother 1993;37:134137.
65.Hayden, MK, Trenholme, GM, Schultz, JE, et al. In vivo develop ment of teicoplanin resistance in a vanB Enterococcus faecium. J Infect Dis 1993;167:12241227.
66.Schwalbe, R, Almond, D, Jufer, R, et al. Heterogeneity of vancomy-tin-resistant enterococci of the non vanA phenotype. Presented at the 93rd General Meeting of the American Society for Microbiology; May 1620, 1993; Atlanta, Georgia. Abstract A71.
67.Leclercq, R, Derlot, E, Weber, M, et al. Transferable vancomycin and teicoplanin resistance in Enterococcus faecium. Antimicrob Agents Chemother 1989;33:1015.
68.Tyrrell, G, Willey, BM, Kreiswirth, BN, et al. Prevalence of variant enterococcal phenotypes amongst New York City glycopeptide-resistant isolates. Presented at the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy; October 17-20, 1993; New Orleans, Louisiana. Abstract 884.
69.Willey, BM, Kreiswirth, BN, Simor, AE, et al. Detection of vancomycin resistance in enterococcus species. J Clin Microbiol 1992;30:16211624.
70.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 3rd ed. Approved standard M7A3;13(25) Villanova. PANational Committee for Clinical Laboratory Standards; 1993.
71.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Suscebtibilitv Tests. 5th ed. Approved standard M2-A5;13(24) Villanova, PA: National Committee for Clinical Laboratory Standards; 1993.
72.Gray, JW, Pedler, SJ, Kemahan, J, et al. Enterococcal superinfection in paediatric oncology patients treated with imipenem. Lancet 1992;339:14871488.
73.Leoung, GS, Chaisson, RE, Mills, J. Comparison of nosocomial infections due to Staphylococcus aureus and enterococci in a general hospital. Surg Gynecol Obstet 1987;165:339342.
74.Nichols, RE, Muzik, AC. Enterococcal infections in surgical patients: the mystery continues. Clin Infect Dis 1992;15:7276.
75.Luginbuhl, LM, Rotbart, HA, Facklam, RR, et al. Neonatal enterococcal sepsis: case-control study and description of an outbreak. Pediatr Infect Dis J 1987;6:10221030.
76.Rhinehart, E, Smith, NE, Wennersten, C, et al. Rapid dissemination of beta-lactamaseproducing, aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med 1990;323:18141818.
77.Zervos, MJ, Kauffman, CA, Therasse, PM, et al. Nosocomial infection by gentamicin-resistant Streptococcus faecalis. Ann Intern Med 1987;106:687691.
78.Boyce, JM. Should we vigorously try to contain and control MRSA? Infect Control Hosp Epidemiol 1991;12:4654.

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