title: Emergence and dissemination of a highly vancomycin-resistant vanA strain of Enterococcus faecium at a large teaching hospital.
abstract: We prospectively identified patients at the Massachusetts General Hospital from whom vancomycin-resistant enterococci (VRE) were isolated from a clinical specimen from 1 January 1991 through 31 December 1995. VRE strains were available from 139 (82%) of the 169 patients with clinical cases. Of these, 39 (28%) were identical or closely related by pulsed-field gel electrophoresis (i.e., VRE type A strain), including 38 (43%) of 89 VRE strains in 1995. By multivariate analysis, acquisition of the VRE type A strain was associated with receipt of clindamycin (odds ratio [OR] = 10.5), 15 or more days of hospitalization before the first isolation of VRE (OR = 2.9), and residence on one of the general medical floors (OR = 7.8). The VRE type A strain was a vanA strain of Enterococcus faecium and was highly resistant to all antimicrobial agents tested except chloramphenicol. These findings document the rapid dissemination of a highly resistant strain of E. faecium among patients and among other extant VRE strains at the Massachusetts General Hospital in 1995.
authors.affiliation: Infectious Disease Unit, Massachusetts General Hospital and Harvard Medical School, Boston 02114-2696, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Pegues
authors.forename: C F
authors.initials: CF
authors.lastname: Pegues
authors.forename: P L
authors.initials: PL
authors.lastname: Hibberd
authors.forename: D S
authors.initials: DS
authors.lastname: Ford
authors.forename: D C
authors.initials: DC
authors.lastname: Hooper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D014640:Vancomycin