Abstract
Cases of bacteremia caused by vancomycin-resistant E. faecium (VRE-fm) increased significantly in Taiwan. The present multicenter surveillance study was performed to reveal the associated epidemiological characteristics. In 2012, 134 non-repetitive VRE-fm isolates were prospectively collected from 12 hospitals in Taiwan. Antimicrobial susceptibility, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and analysis of van genes and Tn1546 structures were investigated. Two isolates carried vanB genes, while all the remaining isolates carried vanA genes. Three isolates demonstrated a specific vanA genotype - vanB phenotype. Nine (6.7%) isolates demonstrated tigecycline resistance, and all were susceptible to daptomycin and linezolid. Molecular typing revealed 58 pulsotypes and 13 sequence types (STs), all belonged to three major lineages 17, 18, and 78. The most frequent STs were ST17 (n = 48, 35.8%), ST414 (n = 22, 16.4%), and ST78 (n = 16, 11.9%). Among the vanA harboring isolates, eight structure types of the Tn1546-like element were demonstrated. Type I (a partial deletion in the orf1 and insertion of IS1251-like between the vanS - vanH genes) and Type II (Type I with an additional insertion of IS1678 between orf2 - vanS genes) were the most predominant, consisted of 60 (45.5%) and 62 (47.0%) isolates, respectively. The increase of VRE-fm bacteremia in Taiwan may be associated with the inter- and intra-hospital spread of some major STs and horizontal transfer of vanA genes mostly carried on two efficient Tn1546-like elements. The prevailing ST414 and widespread of the Type II Tn1546-like elements are an emerging problem that requires continuous monitoring.
Highlights
Enterococci are a part of the normal intestinal flora in human and animals
In addition to glycopeptides resistant, the vancomycin-resistant enterococci (VRE)-fm isolates were all resistant to ampicillin and ciprofloxacin
All of them belonged to clonal complex 17 (CC17), the most frequently identified clonal complex globally [28]
Summary
Enterococci are a part of the normal intestinal flora in human and animals. They may colonize many body sites of healthy individuals and cause opportunistic infection in immunocompromised patients. These organisms are a common cause of hospital-acquired infection (HAI) and are associated with a substantial proportion of bloodstream and urinary tract infections. Enterococci are intrinsically resistant to a variety of antibiotics. Vancomycin is usually required for treatment, especially for invasive infections. Treatment of infections caused by vancomycin-resistant enterococci (VRE) may be difficult
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