title: vanA-containing E. faecium isolates of clonal complex CC17 in clinical and environmental samples in a Tunisian hospital.
abstract: Twenty-eight vancomycin (VA)-resistant enterococci isolated from different patients (n = 16) and also from the environment (n = 12) were recovered in a Tunisian military hospital during 2012-2013. The mechanisms of resistance to VA and to other antibiotics as well as the presence of esp and hyl virulence genes were determined in these isolates by PCR, being their clonal relationship analyzed by pulsed-field gel electrophoresis (PFGE). VA resistance mechanisms detected were as follows (species-patient/environment): vanA (Enterococcus faecium, 13/5), vanC1 (Enterococcus gallinarum, 3/0), and vanC2 (Enterococcus casseliflavus, 0/7). Most of the VA-resistant enterococci presented a multiresistance phenotype and harbored different resistance genes (erm(B), tet(M), tet(L), ant(6)-Ia, aac(6')-aph(2"), aph(3')-IIIa, and catA). The PFGE revealed the presence of 3 clones (A, B, C) and 1 closely related pattern (A1) among the 13 vanA-containing E. faecium isolates of patients showing 11 of them the A-A1 patterns. The clone A was also detected in all 5 environmental vanA-containing E. faecium isolates. Strains did not contain esp or hyl virulence genes. Multilocus sequence typing was performed in 4 E. faecium isolates representative of the 4 detected pulsotypes (A, A1, B, and C), and 2 different sequence types were identified (ST18 and ST80), both of them included in clonal complex CC17. These strains contained the IS16 element and showed ampicillin and ciprofloxacin resistance. VA resistance could be an emerging problem in Tunisia, and this is one of the first cases described so far in this country.
authors.affiliation: Laboratoire des Maladies transmissibles et substances biologiquement actives, Faculté de Pharmacie, Monastir, Tunisia.
authors.forename: Dalèle
authors.initials: D
authors.lastname: Elhani
authors.affiliation: Laboratoire MBA, Université de Tunis El Manar, Faculté des Sciences de Tunis, 2092, Tunis, Tunisia.
authors.forename: Naouel
authors.initials: N
authors.lastname: Klibi
authors.affiliation: Laboratoire MBA, Université de Tunis El Manar, Faculté des Sciences de Tunis, 2092, Tunis, Tunisia.
authors.forename: Raoudha
authors.initials: R
authors.lastname: Dziri
authors.affiliation: Laboratoire de Microbiologie, Hôpital Militaire de Tunis, Tunis, Tunisia.
authors.forename: Meriem
authors.initials: M
authors.lastname: Ben Hassan
authors.affiliation: Laboratoire de Microbiologie, Hôpital Militaire de Tunis, Tunis, Tunisia.
authors.forename: Selim
authors.initials: S
authors.lastname: Asli Mohamed
authors.affiliation: Laboratoire MBA, Université de Tunis El Manar, Faculté des Sciences de Tunis, 2092, Tunis, Tunisia.
authors.forename: Laila
authors.initials: L
authors.lastname: Ben Said
authors.affiliation: Laboratoire des Maladies transmissibles et substances biologiquement actives, Faculté de Pharmacie, Monastir, Tunisia.
authors.forename: Aouini
authors.initials: A
authors.lastname: Mahjoub
authors.affiliation: Laboratoire MBA, Université de Tunis El Manar, Faculté des Sciences de Tunis, 2092, Tunis, Tunisia.
authors.forename: Karim
authors.initials: K
authors.lastname: Ben Slama
authors.affiliation: Service de Parasitologie, Hôpital militaire de Tunis et Unité de recherche Epidémiologie moléculaire des infections fongiques nosocomiales (UR09DN03), Tunis, Tunisia.
authors.forename: Boutheina
authors.initials: B
authors.lastname: Jemli
authors.affiliation: Service d'hygiène hospitalière et de protection de l'environnement, HMPIT, Tunis, Tunisia.
authors.forename: Ridha
authors.initials: R
authors.lastname: Bellaj
authors.affiliation: Laboratoire de Microbiologie, Hôpital Militaire de Tunis, Tunis, Tunisia.
authors.forename: Farouk
authors.initials: F
authors.lastname: Barguellil
authors.affiliation: Area de Bioquímica y Biología Molecular, Universidad de La Rioja, 26006 Logroño, Spain. Electronic address: carmen.torres@unirioja.es.
authors.forename: Carmen
authors.initials: C
authors.lastname: Torres
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics; D019729:Carbon-Oxygen Ligases / Q000235:genetics; D003428:Cross Infection / Q000382:microbiology*; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D004783:Environmental Microbiology; D004865:Equipment and Supplies, Hospital / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D014416:Tunisia; D020713:Vancomycin Resistance / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; C071437:VanA ligase, Bacteria; D019729:Carbon-Oxygen Ligases
keywords: CC17; Hospital-environment; Tunisia; Vancomycin resistant Enterococcus faecium; vanA