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



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


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


A tertiary-care teaching hospital in Taiwan.


Patients with VRE isolated from any body site.


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.


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.


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.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 1999

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