title: [Microbiological and epidemiological characteristics of vancomycin-dependent enterococci].
abstract: BACKGROUND
  Vancomycin-dependent enterococci (VDE) are clinically equivalent to vancomycin-resistant enterococci (VRE), but more difficult to detect. This study was purposed to characterize VDE microbiologically and epidemiologically.
  
  
  METHODS
  The patients from whom VDE were detected from April 2007 to March 2008 were investigated. For available isolates, minimal inhibitory concentrations (MICs) of and the levels of dependence on vancomycin and teicoplanin were measured by E test (AB Biodisk, Sweden), and a test for reversion of VDE to non-dependent VRE (NDVRE) and pulsed field gel electrophoresis (PFGE) were performed. Patients' demographic and clinical findings were reviewed via electronic medical records.
  
  
  RESULTS
  VDE were recovered from 6 (2.2%) of 272 patients carrying VRE during this study period. All patients were already colonized or infected by VRE and treated with vancomycin for 13 to 107 days. VDE were isolated from pleural fluid (one), urine (four), and stool (one). All isolates carried vanA with vancomycin MICs of >256 microg/mL, but two of them had intermediate susceptibilities to teicoplanin. Because 4 VDE isolates were reverted to NDVRE with single passage, vancomycin dependence was measurable for only two isolates as equal and above 0.064 and 0.5 microg/mL respectively, and was reverted after 5 and 7 passages, respectively. Six VDE isolates showed no related clones in PFGE analysis, and 3 of 4 available pairs of initial VRE isolates and subsequent VDE isolates were identical clones.
  
  
  CONCLUSIONS
  VDE were not rare and seemed to emerge independently from VRE with a prolonged use of vancomycin. Vancomycin-dependence was reverted within several passages.
authors.affiliation: Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Keumrock
authors.initials: K
authors.lastname: Hwang
authors.forename: Heungsup
authors.initials: H
authors.lastname: Sung
authors.forename: Seung
authors.initials: S
authors.lastname: Namgoong
authors.forename: Nam Surp
authors.initials: NS
authors.lastname: Yoon
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016521:Electrophoresis, Gel, Pulsed-Field; D016983:Enterococcus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000382:microbiology; D014640:Vancomycin / Q000494:pharmacology*; D020713:Vancomycin Resistance
chemical_list: D014640:Vancomycin