title: Persistence of a ST6 clone of Enterococcus faecalis genotype vanB2 in two Hospitals in Aragon (Spain).
abstract: BACKGROUND
  In order to study the evolution of the outbreak that occurred between 2009 and 2010 in 3 hospitals in Zaragoza, all vancomycin-resistant clinical Enterococcus faecalis isolates identified between 2011 and 2013 at these hospitals were characterised.
  
  
  METHODS
  Molecular characterisation of the isolates and analysis of their clonal relationships was performed using pulsed field electrophoresis, along with a retrospective review of the patient records.
  
  
  RESULTS
  A total of 79 vancomycin-resistant E.faecalis isolates with genotype vanB2 of 73 patients were recovered in 2 of the 3 hospitals, most of them from urine specimens. About 46% of the cases were nosocomial. Distribution of the isolates among hospital services demonstrated high variability, making it difficult to predict a common source of infection. All the strains were multiresistant (vancomycin, erythromycin, tetracycline, ciprofloxacin, streptomycin, gentamicin, kanamycin) and belonged to lineage ST6. Seventy-four isolates (93.7%) were identical or closely related to the dominant one in the origin of the outbreak.
  
  
  CONCLUSIONS
  The outbreak remains constant over three years after being initially described, indicating the need to implement an active control in order to limit the emergence and spread of vancomycin-resistant clones.
authors.affiliation: Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, España.
authors.forename: Carla Andrea
authors.initials: CA
authors.lastname: Alonso
authors.affiliation: Servicio de Microbiología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rezusta
authors.affiliation: Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, IIS Aragón, Zaragoza, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Seral
authors.affiliation: Servicio de Microbiología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ferrer
authors.affiliation: Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, IIS Aragón, Zaragoza, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Castillo
authors.affiliation: Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, España. Electronic address: carmen.torres@unirioja.es.
authors.forename: Carmen
authors.initials: C
authors.lastname: Torres
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D004196:Disease Outbreaks; D013293:Enterococcus faecalis / Q000145:classification* / Q000235:genetics*; D005260:Female; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013030:Spain; D020713:Vancomycin Resistance / Q000235:genetics
keywords: Brote; Enterococcus faecalis resistente a vancomicina; España; Outbreak; ST6; Spain; Vancomycin-resistant Enterococcus faecalis; vanB2