title: Genetic relatedness among Enterococcus faecalis with transposon-mediated high-level gentamicin resistance in Swedish intensive care units.
abstract: We studied 45 isolates of Enterococcus faecalis with high-level gentamicin resistance (HLGR), all but one concomitantly resistant to ciprofloxacin, and 25 ciprofloxacin-resistant isolates without HLGR for genetic relatedness using pulsed-field gel electrophoresis (PFGE). E. faecalis were isolated from patients admitted to intensive care units at eight hospitals in southern Sweden from December 1996 through December 1998. Genomic analysis by PFGE resulted in three clusters of genetically related isolates (designated clusters I, II and III) and 23 unique clones. Cluster I was found predominantly in the eastern and central parts of southern Sweden and clusters II and III in south-western Sweden. Among the 45 isolates with HLGR, 69% belonged to cluster I, 20% to cluster II, and 11% had unique PFGE patterns, which suggests that the majority of isolates with HLGR are closely related. Among the 25 ciprofloxacin-resistant isolates without HLGR, 68% had unique PFGE patterns, 12% belonged to cluster I and 20% to cluster III, which suggests the ciprofloxacin-resistant isolates are not related. All isolates with HLGR contained the aac(6')Ie-aph(2")Ia gene, which was carried on a Tn5281-like transposon in all isolates except one. We conclude that HLGR in E. faecalis was mainly due to dissemination of genetically related clones during the time studied, and that HLGR in these isolates was due to the presence of the aac(6')Ie-aph(2")Ia gene.
authors.affiliation: Department of Molecular and Clinical Medicine, Faculty of Health Sciences, S-581 85 Linköping, Sweden. aniha@imk.liu.se
authors.forename: Anita
authors.initials: A
authors.lastname: Hällgren
authors.forename: Baharak
authors.initials: B
authors.lastname: Saeedi
authors.forename: Maud
authors.initials: M
authors.lastname: Nilsson
authors.forename: Hans-Jürg
authors.initials: HJ
authors.lastname: Monstein
authors.forename: Barbro
authors.initials: B
authors.lastname: Isaksson
authors.forename: Håkan
authors.initials: H
authors.lastname: Hanberger
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
mesh_terms: D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics; D004251:DNA Transposable Elements / Q000187:drug effects / Q000502:physiology*; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D013293:Enterococcus faecalis / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D005839:Gentamicins / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
chemical_list: D004251:DNA Transposable Elements; D005839:Gentamicins