Abstract
Geographic spread of vancomycin-resistant enterococci (VRE) clones in cities, countries, or even continents has been identified by molecular techniques. This study aimed at characterizing virulent genes and determining genetic relatedness of 45 VRE isolates from Trinidad and Tobago using molecular tools, including polymerase chain reaction, pulsed-field gel electrophoresis (PFGE), and Random Amplification Polymorphic DNA (RAPD). The majority (84%) of the isolates were Enterococcus faecium possessing vanA gene while the rest (16%) were Enterococcus faecalis possessing vanB. The esp gene was found in all 45 VRE isolates while hyl genes were found only in E. faecium species. The E. faecium species expressed five distinct PFGE patterns. The predominant clones with similar or common patterns belonged to clones one and three, and each had 11 (29%) of the VRE isolates. Plasmid content was identified in representative isolates from each clonal group. By contrast, the E. faecalis species had one PFGE pattern suggesting the presence of an occult and limited clonal spread. The emergence of VRE in the country seems to be related to intra/interhospital dissemination of an epidemic clone carrying the vanA element. Therefore, infection control measures will be warranted to prevent any potential outbreak and spread of VRE in the country.
Highlights
Vancomycin-resistant enterococci (VRE) were first described in Great Britain in 1988 and shortly afterwards were reported in other European countries and the USA [1, 2]
All 45 VRE isolates used for this analysis and their hospital and facility distribution were from work previously reported [6]
The genetic characteristics of all vancomycin-resistant enterococci were investigated by pulsed-field gel electrophoresis (PFGE), Random Amplification Polymorphic DNA (RAPD), Rep-Polymerase Chain Reaction (PCR), and esp repeat profiles
Summary
Vancomycin-resistant enterococci (VRE) were first described in Great Britain in 1988 and shortly afterwards were reported in other European countries and the USA [1, 2]. Several reports of outbreaks and spread in hospitals, communities, nursing homes, and long term care institutions have been documented [3]. Epidemiologic links of VRE clones occurring in different hospitals, countries, and regions have been demonstrated in several places [3]. The presence of the variant esp gene in E. faecium was reported to be associated with in-hospital spread whereas the hyaluronidase (hyl) gene was regarded as a potential virulence gene associated with invasive disease [4, 5]. The prevalence rate of VRE in Trinidad and Tobago is low, 3.9% [6], there are no molecular analysis or epidemiologic reports of VRE isolates available in the country
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