Discrimination between epidemic and non-epidemic glycopeptide-resistant E. faecium in a post-outbreak situation.
Vancomycin-resistant enterococci (VRE) have been isolated in increasing numbers. Hospital-adapted VRE exhibit relatively high pathogenicity by expressing factors like enterococcal surface protein (Esp), which facilitates epidemic spread. By contrast, 'community-acquired' VRE show low pathogenicity and non-epidemic features. In 2004 and 2005 an extended outbreak of VRE occurred at a university hospital in Southwestern Germany and an infection control programme was implemented to confine the outbreak. Pulsed-field gel electrophoresis (PFGE), esp PCR, multiple-locus variable number of tandem repeat analysis (MLVA), purK1 typing and multiple-locus sequence typing (MLST) were performed on representative VRE isolates. Twenty-six non-epidemic and two epidemic VRE types (MLST203, MLST280) were identified by PFGE. Seven of the non-outbreak VRE types were esp gene negative, whereas 19 non-outbreak and both epidemic VRE types were esp positive. Eight MLVA types were identified. MLVA type 1 included five PFGE types and MLVA type 159 included 16 PFGE types. Currently there is no efficient method available to identify non-epidemic VRE and avoid unnecessary isolation of patients. More than 50% non-epidemic clones were esp positive; nevertheless, esp PCR appears to be the most promising approach to identify non-epidemic VRE.
Institute for Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany. synlab@gmx.de
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Borgmann
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Schulte
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Wolz
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Gruber
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Werner
C
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Goerke
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Klare
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K
Beyser
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Heeg
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Autenrieth
D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics*; D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks / Q000145:classification*; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000145:classification* / Q000235:genetics / Q000472:pathogenicity; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000145:classification* / Q000453:epidemiology / Q000235:genetics; D006785:Hospitals, University; D006801:Humans; D008565:Membrane Proteins / Q000145:classification / Q000235:genetics*; D020713:Vancomycin Resistance / Q000235:genetics*
D001426:Bacterial Proteins; D008565:Membrane Proteins; C116707:enterococcal surface protein, esp