title: Molecular typing and antimicrobial susceptibility of vancomycin-resistant Enterococcus faecium in Brazil.
abstract: OBJECTIVE
  To characterize vancomycin-resistant enterococci (VRE) isolates and to evaluate the mode of dissemination of this pathogen in Brazil.
  
  
  METHODS
  We collected 22 vancomycin-resistant Enterococcus faecium isolates from 6 medical centers in Sao Paulo, Brazil, and 1 isolate from a medical center in Curitiba, Brazil.
  
  
  METHODS
  All Brazilian hospitals that had identified vancomycin-resistant E. faecium up to the beginning of this study (late 1999) contributed isolates to the study.
  
  
  METHODS
  The isolates were susceptibility tested using the broth microdilution method and the E-test. The presence of vancomycin resistance genes (vanA, vanB, vanC1, vanC2-3, and vanD) was evaluated by polymerase chain reaction; molecular typing was performed by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  The vanA gene was demonstrated in all vancomycin-resistant E. faecium, except for 1 isolate. None of the vancomycin resistance genes cited above was detected in the isolate from Curitiba, which was the first vancomycin-resistant E. faecium described in Brazil. All isolates were resistant to ampicillin and teicoplanin. The main clone remains susceptible to doxycycline and chloramphenicol, but intermediate to quinupristin-dalfopristin. PFGE analysis demonstrated 7 major PFGE patterns. A unique PFGE pattern with 4 subtypes was detected in 17 isolates from 4 different hospitals.
  
  
  CONCLUSIONS
  The results of our study indicate the occurrence of intra- and interhospital dissemination of VRE in Sao Paulo, Brazil.
authors.affiliation: Division of Infectious Diseases, Universidade Federal Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rosangela F
authors.initials: RF
authors.lastname: Cereda
authors.forename: Ana C
authors.initials: AC
authors.lastname: Gales
authors.forename: Suzane
authors.initials: S
authors.lastname: Silbert
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Jones
authors.forename: Helio S
authors.initials: HS
authors.lastname: Sader
mesh_terms: D001938:Brazil; D003428:Cross Infection / Q000517:prevention & control; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008826:Microbial Sensitivity Tests; D020713:Vancomycin Resistance / Q000235:genetics*