Abstract
BackgroundEnterococcus faecium has recently emerged as a multidrug-resistant nosocomial pathogen involved in outbreaks worldwide. A high rate of resistance to different antibiotics has been associated with virulent clonal complex 17 isolates carrying the esp and hyl genes and the purK1 allele.ResultsTwelve clinical vancomycin-resistant Enterococcus faecium (VREF) isolates were obtained from pediatric patients at the Hospital Infantil de México Federico Gómez (HIMFG). Among these VREF isolates, 58.3% (7/12) were recovered from urine, while 41.7% (5/12) were recovered from the bloodstream. The VREF isolates showed a 100% rate of resistance to ampicillin, amoxicillin-clavulanate, ciprofloxacin, clindamycin, chloramphenicol, streptomycin, gentamicin, rifampicin, erythromycin and teicoplanin. In addition, 16.7% (2/12) of the isolates were resistant to linezolid, and 66.7% (8/12) were resistant to tetracycline and doxycycline. PCR analysis revealed the presence of the vanA gene in all 12 VREF isolates, esp in 83.3% (10/12) of the isolates and hyl in 50% (6/12) of the isolates. Phylogenetic analysis via molecular typing was performed using pulsed-field gel electrophoresis (PFGE) and demonstrated 44% similarity among the VREF isolates. MLST analysis identified four different sequence types (ST412, ST757, ST203 and ST612).ConclusionThis study provides the first report of multidrug-resistant VREF isolates belonging to clonal complex 17 from a tertiary care center in Mexico City. Multidrug resistance and genetic determinants of virulence confer advantages among VREF in the colonization of their host. Therefore, the prevention and control of the spread of nosocomial infections caused by VREF is crucial for identifying new emergent subclones that could be challenging to treat in subsequent years.
Highlights
Enterococcus faecium has recently emerged as a multidrug-resistant nosocomial pathogen involved in outbreaks worldwide
Origin of the strains A total of 12 Vancomycin-resistant Enterococcus faecium (VREF) clinical isolates obtained during the period from July 2009 to April 2011 were included in this study
Detection of susceptibility patterns and glycopeptide resistance in the VREF isolates The results obtained for the 12 VREF clinical isolates showed a 100% rate of resistance to ampicillin, amoxicillin-clavulanate, ciprofloxacin, clindamycin, chlorampheni col, streptomycin, gentamicin, rifampicin, erythromycin and teicoplanin
Summary
Enterococcus faecium has recently emerged as a multidrug-resistant nosocomial pathogen involved in outbreaks worldwide. The most common species of Enterococcus involved in nosocomial infections is Enterococcus faecium (E. faecium) [1,2]. This pathogen is associated with hospitalacquired infections such as UTIs (urinary tract infections), wounds, bacteremia, endocarditis and meningitis [1,2]. Due to increased resistance to aminoglycosides, vancomycin is currently the antibiotic employed to treat these infections. In the last several decades, the number of vancomycin-resistant enterococci (VRE) has increased. Vancomycin-resistant Enterococcus faecium (VREF) has been associated with outbreaks in hospitals worldwide [2]. The rates of VREF colonization and infection have risen steadily, with most cases being caused by strains displaying glycopeptide resistance to VanA and VanB [8,9,10,11]
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