title: Emergence of vancomycin-resistant Enterococcus faecium at a tertiary care hospital in Karachi, Pakistan.
abstract: Vancomycin-resistant enterococcus (VRE) has not been reported previously in Pakistan. This is the first report where in vancomycin-resistant Enterococcus faecium was isolated from the clinical specimens of six patients admitted to the intensive care unit (ICU) and neonatal intensive care unit (NICU) of the Aga Khan University Hospital, Karachi. To identify the extent of the outbreak, rectal swabs were obtained from all the patients admitted to the ICU and NICU at that time. A total of 10 strains of vancomycin-resistant Enterococcus faecium were isolated. All the strains showed high-level resistance to both glycopeptides (vancomycin and teicoplanin) with a vancomycin minimum inhibitory concentration greater than 256 mg/L. All isolates had the vanA gene detected by polymerase chain reaction. The contour-clamped homogeneous electric field (CHEF) pattern demonstrated that all but one of the isolates were of a single clone, suggesting that they were derived from common source. Use of vancomycin and prolonged hospitalization were common features in all cases investigated.
authors.affiliation: Dept of Pathology, The Aga Khan University Hospital, Karachi, Pakistan. erum.khan@aku.edu
authors.forename: E
authors.initials: E
authors.lastname: Khan
authors.forename: A
authors.initials: A
authors.lastname: Sarwari
authors.forename: R
authors.initials: R
authors.lastname: Hasan
authors.forename: S
authors.initials: S
authors.lastname: Ghori
authors.forename: I
authors.initials: I
authors.lastname: Babar
authors.forename: F
authors.initials: F
authors.lastname: O'Brien
authors.forename: W
authors.initials: W
authors.lastname: Grubb
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques / Q000379:methods; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000145:classification / Q000235:genetics; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests; D010154:Pakistan / Q000453:epidemiology; D016133:Polymerase Chain Reaction / Q000379:methods; D020713:Vancomycin Resistance
chemical_list: D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases