title: Emergence of vancomycin-resistant enterococci at a university hospital in Taiwan: persistence of multiple species and multiple clones.
abstract: OBJECTIVE
  To describe the epidemiology of vancomycin-resistant enterococci (VRE) in a university hospital in Taipei, Taiwan.
  
  
  METHODS
  Retrospective review over a 27-month period, from March 1996 to May 1998.
  
  
  METHODS
  A tertiary-care teaching hospital in Taiwan.
  
  
  METHODS
  Patients with VRE isolated from any body site.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Taiwan University College of Medicine, Taipei.
authors.forename: P R
authors.initials: PR
authors.lastname: Hsueh
authors.forename: L J
authors.initials: LJ
authors.lastname: Teng
authors.forename: H J
authors.initials: HJ
authors.lastname: Pan
authors.forename: Y C
authors.initials: YC
authors.lastname: Chen
authors.forename: L H
authors.initials: LH
authors.lastname: Wang
authors.forename: S C
authors.initials: SC
authors.lastname: Chang
authors.forename: S W
authors.initials: SW
authors.lastname: Ho
authors.forename: K T
authors.initials: KT
authors.lastname: Luh
mesh_terms: D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D016983:Enterococcus / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006785:Hospitals, University; D006801:Humans; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013624:Taiwan; D014640:Vancomycin / Q000627:therapeutic use; D020713:Vancomycin Resistance / Q000235:genetics
chemical_list: D014640:Vancomycin