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Abstract
We identified a novel van gene cluster in a clinical Enterococcus faecium isolate with vancomycin minimum inhibitory concentration (MIC) of 4 µg/mL. The ligase gene, vanP, was part of a van operon cluster of 4,589 bp on a putative novel integrative conjugative element located in a ca 98 kb genomic region presumed to be acquired by horizontal gene transfer from Clostridium scidens and Roseburia sp. 499. Screening for van genes in E. faecium strains with borderline susceptibility to vancomycin is important.
Highlights
We identified a novel van gene cluster in a clinical Enterococcus faecium isolate with vancomycin minimum inhibitory concentration (MIC) of 4 μg/ mL
We present a case infected with a borderline vancomycinsusceptible E. faecium #21122516 with a minimum inhibitory concentration (MIC) of 4 μg/mL, which grew on a chromogenic vancomycin-resistant E. faecium (VRE)-selective agar after a 48 h incubation but was PCR-negative for all known van genes
Because this E. faecium strain grew on a chromogenic selective agar (Chrom ID VRE, bioMérieux, Marcyl’Étoile, France) after 48 h, the isolate was sent as a putative VRE to the Belgian National Reference centre for Enterococci (UZA, Antwerpen, Belgium) for genetic confirmation
Summary
We identified a novel van gene cluster in a clinical Enterococcus faecium isolate with vancomycin minimum inhibitory concentration (MIC) of 4 μg/ mL. After the end of antibiotic therapy (early March 2021), one routine urine specimen yielded a mixed growth of bla NDM-1 carbapenemase-producing Enterobacter cloacae and of E. faecium #21122516, which on BD Phoenix PMIC Panels (New Jersey, United States (US)) was borderline susceptible to vancomycin (MIC 4 μg/mL) and susceptible to teicoplanin (MIC < 1 μg/mL). Because this E. faecium strain grew on a chromogenic selective agar (Chrom ID VRE, bioMérieux, Marcyl’Étoile, France) after 48 h, the isolate was sent as a putative VRE to the Belgian National Reference centre for Enterococci (UZA, Antwerpen, Belgium) for genetic confirmation. The hits containing scaffolds were further analysed using CLC Genomics workbench v.20.1 (clcbio, Aarhus, Denmark) and identified as follows: vanH-vanP-vanX-vanR/walR-vanSG/
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