title: Clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype.
abstract: OBJECTIVE
  To investigate the clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype (VanD-vanA VRE).
  
  
  METHODS
  We tested in vitro and in vivo efficacies of teicoplanin against VanD-vanA VRE strains. Change in teicoplanin MICs was monitored during incubation with teicoplanin. In vitro and in vivo time-kill assay and survival analysis using a mouse peritonitis model were performed.
  
  
  RESULTS
  Teicoplanin MICs of VanD-vanA VRE strains increased to 128 mg/L within 48 h when they were cultured with 120 mg/L teicoplanin. In vitro and in vivo time-kill assay showed that VanD-vanA VRE strains were not eliminated by 120 mg/L teicoplanin in contrast to vancomycin-susceptible E. faecium and VanD-vanB strains. The survival rate of mice infected with VanD-vanA VRE strains treated with teicoplanin was comparable with that of untreated mice.
  
  
  CONCLUSIONS
  Data suggest that teicoplanin would fail in the treatment of VanD type VRE infections if the strains contained the vanA gene, which cannot be detected in the clinical microbiology laboratory.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhsong@ansorp.org
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Ji Yoeun
authors.initials: JY
authors.lastname: Suh
authors.forename: Won Sup
authors.initials: WS
authors.lastname: Oh
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Wee Gyo
authors.initials: WG
authors.lastname: Lee
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics*; D001769:Blood / Q000382:microbiology; D019729:Carbon-Oxygen Ligases / Q000235:genetics*; D015169:Colony Count, Microbial; D016984:Enterococcus faecium / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D051379:Mice; D008813:Mice, Inbred ICR; D008826:Microbial Sensitivity Tests; D050296:Microbial Viability; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology; D016019:Survival Analysis; D017334:Teicoplanin / Q000494:pharmacology* / Q000627:therapeutic use*; D020713:Vancomycin Resistance / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D017334:Teicoplanin; D019729:Carbon-Oxygen Ligases