title: High-level vancomycin-resistant enterococci causing hospital infections.
abstract: Nosocomial infection or colonization due to enterococci with high-level resistance to vancomycin (minimal inhibitory concentrations [MICs] between 64 and greater than 2000 mg/L) has occurred in 41 patients with renal disease. These vancomycin-resistant enterococci were cultured from many sources including blood. All but one strain contained one or more plasmids ranging in molecular weight from 1.0 to 40 Megadaltons (MDa). Vancomycin resistance was transferable by conjugation to a susceptible recipient strain of Enterococcus faecalis but this was not always associated with plasmid DNA. The emergence of transferable high-level vancomycin resistance in enterococci causing significant clinical infections is of particular importance since vancomycin is widely regarded as a reserve drug for the management of infections with multi-resistant Gram-positive organisms.
authors.affiliation: Public Health Laboratory, Dulwich Hospital, London.
authors.forename: A H
authors.initials: AH
authors.lastname: Uttley
authors.forename: R C
authors.initials: RC
authors.lastname: George
authors.forename: J
authors.initials: J
authors.lastname: Naidoo
authors.forename: N
authors.initials: N
authors.lastname: Woodford
authors.forename: A P
authors.initials: AP
authors.lastname: Johnson
authors.forename: C H
authors.initials: CH
authors.lastname: Collins
authors.forename: D
authors.initials: D
authors.lastname: Morrison
authors.forename: A J
authors.initials: AJ
authors.lastname: Gilfillan
authors.forename: L E
authors.initials: LE
authors.lastname: Fitch
authors.forename: J
authors.initials: J
authors.lastname: Heptonstall
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D003227:Conjugation, Genetic; D003428:Cross Infection / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D004352:Drug Resistance, Microbial; D013293:Enterococcus faecalis / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D011815:R Factors; D013290:Streptococcal Infections / Q000382:microbiology*; D013291:Streptococcus / Q000187:drug effects / Q000235:genetics; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D004269:DNA, Bacterial; D014640:Vancomycin