Abstract
BackgroundIn 2003, nosocomial infections caused by vancomycin-resistant enterococci (VRE) occurred rarely in Taiwan. Between 2003 and 2010, however, the average prevalence of vancomycin resistance among enterococci spp. increased from 2% to 16% in community hospitals and from 3% to 21% in medical centers of Taiwan. We used molecular methods to investigate the epidemiology of VRE in a tertiary teaching hospital in Taiwan.MethodsBetween February 2009 and February 2011, rectal samples and infection site specimens were collected from all inpatients in the nephrology ward after patient consent was obtained. VRE strain types were determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).ResultsA total of 59 vanA gene-containing VRE isolates (1 per patient) were obtained; 24 originated from rectal sample surveillance of patients who exhibited no symptoms (22 Enterococcus faecium and 2 Enterococcus faecalis), and 35 had developed infections over 3 days after admission (32 E. faecium, 2 E. faecalis, and 1 Enterococcus durans). The 59 VRE isolates demonstrated vancomycin minimum inhibitory concentrations (MICs) of ≥256 μg/m. The MIC range for linezolid, tigecycline, and daptomycin was 0.25–1.5 μg/mL, 0.032–0.25 and 1–4 μg/mL, respectively. For 56 isolates, the MIC for teicoplanin was >8 μg/mL. The predominant types in the nephrology ward were MLST types 414, 78, and18 as well as PFGE types A, C, and D.ConclusionVREs are endemic in nephrology wards. MLST 414 is the most predominant strain. The increase VRE prevalence is due to cross-transmission of VRE clones ST 414,78,18 by undetected VRE carriers. Because similar VRE STs had been reported in a different hospital of Taiwan, this finding may indicate inter-hospital VRE spread in Taiwan. Active surveillance and effective infection control policies are important controlling the spread of VRE in high risk hospital zones. All endemic VRE strains are resistant to teicoplanin but are sensitive to daptomycin, linezolid, and tigecycline.
Highlights
In 2003, nosocomial infections caused by vancomycin-resistant enterococci (VRE) occurred rarely in Taiwan
These 24 VRE isolates were indicative of colonization without any clinical symptoms or signs of VRE infection and all carried the vanA gene (22 E. faecium and 2 E. faecalis isolates)
The pulsed-field gel electrophoresis (PFGE) types of remaining ST types of E. faecium isolates belonged to types B through F: 3 B1, 1 C1, 2 C2, 1 C3, 2 E1, and 1 F1 (Table 1)
Summary
In 2003, nosocomial infections caused by vancomycin-resistant enterococci (VRE) occurred rarely in Taiwan. Between 2003 and 2010, the average prevalence of vancomycin resistance among enterococci spp. increased from 2% to 16% in community hospitals and from 3% to 21% in medical centers of Taiwan. We used molecular methods to investigate the epidemiology of VRE in a tertiary teaching hospital in Taiwan. In 2003, nosocomial infections caused by VRE occurred rarely in Taiwan [5]. Between 2003 and 2010, the prevalence of vancomycin resistance among enterococci spp. in community-hospitals and medical centers has increased from 2% to 16% and from 3% to 21%, respectively [5]. Taiwan’s current management guidelines for VRE colonization and infection mimic those of the United States, which involve reasonably strict isolation measures [3,6]. We investigated the in-vitro susceptibilities of VRE to current antimicrobial agents
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