Glycopeptide-resistant Enterococci Research Articles

Retrospective evidence for a biological cost of vancomycin resistance determinants in the absence of glycopeptide selective pressures

ObjectivesTo estimate the relative fitness differences between glycopeptide-resistant Enterococcus faecium (GREF) and glycopeptide-susceptible E. faecium (GSEF) from yearly surveillance data on the occurrence of GREF in Danish poultry farm environments.MethodsA population genetic model was adapted to retrospectively estimate the biological fitness cost of acquired resistance. Maximization of a likelihood function was used to predict the longitudinal persistence of acquired resistance.ResultsOur analysis suggests strong selection against GREF following the 1995 ban on the glycopeptide growth promoter avoparcin. However, parameterizing the model with two selection coefficients suggesting a reduced negative effect of the acquired resistance on bacterial fitness over time significantly improved the fit of the model. Our analyses suggest that the acquired glycopeptide resistance will persist for >25 years.ConclusionsAcquired resistance determinants in commensal E. faecium populations in Danish farm environments are likely to persist for decades, even in the absence of glycopeptide use.

VanM , a New Glycopeptide Resistance Gene Cluster Found in Enterococcus faecium

Since glycopeptide-resistant enterococci (GRE) were reported in 1988, they have appeared in hospitals worldwide. Seven van gene cluster types (vanA, vanB, vanC, vanD, vanE, vanG, and vanL) are currently known. We investigated a clinical strain of Enterococcus faecium Efm-HS0661 that was isolated in 2006 from an inpatient with intra-abdominal infection in Shanghai. It was resistant to most antimicrobials, including vancomycin (MIC, >256 μg/ml) and teicoplanin (MIC, 96 μg/ml). Glycopeptide resistance could be transferred to E. faecium BM4105RF by conjugation. The donor and its transconjugant were negative by PCR for the known van genes. By cloning and primer walk sequencing, we discovered a novel van gene cluster, designated vanM. The vanM ligase gene was 1,032-bp in length and encoded a 343-amino-acid protein that shared 79.9, 70.8, 66.3, and 78.8% amino acid identity with VanA, VanB, VanD, and VanF, respectively. Although the vanM DNA sequence was closest to vanA, the organization of the vanM gene cluster was most similar to that of vanD. Upstream from the vanM cluster was an IS1216-like element, which may play a role in the dissemination of this resistance determinant. Liquid chromatography-mass spectrometry analysis of peptidoglycan precursors extracted from the VanM-type strain Efm-HS0661 treated with vancomycin or teicoplanin revealed a modified precursor (UDP-N-acetylmuramic acid [MurNAc]-tetrapeptide-D-Lac), indicating that VanM, like VanA, confers glycopeptide resistance by the inducible synthesis of precursor ending in D-Ala-D-Lac.

Biocidal Efficacy of Copper Alloys against Pathogenic Enterococci Involves Degradation of Genomic and Plasmid DNAs

The increasing incidence of nosocomial infections caused by glycopeptide-resistant enterococci is a global concern. Enterococcal species are also difficult to eradicate with existing cleaning regimens; they can survive for long periods on surfaces, thus contributing to cases of reinfection and spread of antibiotic-resistant strains. We have investigated the potential use of copper alloys as bactericidal surfaces. Clinical isolates of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium were inoculated onto copper alloy and stainless steel surfaces. Samples were assessed for the presence of viable cells by conventional culture, detection of actively respiring cells, and assessment of cell membrane integrity. Both species survived for up to several weeks on stainless steel. However, no viable cells were detected on any alloys following exposure for 1 h at an inoculum concentration of <or=10(4) CFU/cm(2). Analysis of genomic and plasmid DNA from bacterial cells recovered from metal surfaces indicates substantial disintegration of the DNA following exposure to copper surfaces that is not evident in cells recovered from stainless steel. The DNA fragmentation is so extensive, and coupled with the rapid cell death which occurs on copper surfaces, that it suggests that mutation is less likely to occur. It is therefore highly unlikely that genetic information can be transferred to receptive organisms recontaminating the same area. A combination of effective cleaning regimens and contact surfaces containing copper could be useful not only to prevent the spread of viable pathogenic enterococci but also to mitigate against the occurrence of potential resistance to copper, biocides, or antibiotics and the spread of genetic determinants of resistance to other species.

Molecular Characterization of Glycopeptide-Resistant Enterococci from Hospitals of the Picardy Region (France)

We studied 138 glycopeptide-resistant enterococci (GRE) strains, consisting of 131 glycopeptide-resistant Enterococcus faecium (GREfm) and 7 glycopeptide-resistant Enterococcus faecalis (GREfs). The GREfm strains were resistant to penicillin, ampicillin, vancomycin, and teicoplanin, while the GREfs strains were only resistant to vancomycin and teicoplanin. The van A gene was the only glycopeptide determinant present in all GRE isolates investigated. Genes coding for Hyl and Hyl+ Esp were detected in 39 (29.8%) and 92 (70.2%) of the 131 GREfm isolates, respectively. Three of the 7 GREfs were positive for gelE+asa 1 genes, 3 for gel E gene, and 1 for asa 1 gene. The genetic relationship between the 138 GRE was analyzed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). GREfm isolates were clustered in a single genogroup (pulsotype A), and GREfs were clustered in six genogroups (pulsotypes B-G). Among the isolates investigated by MLST, only 18 PCR products were sequenced (12 E. faecium and 6 E. faecalis), and 9 sequence types (STs) were identified.

Glycopeptide resistant enterococci: What's the problem?

Enterococci are cocci gram-positive bacteria belonging to the bowel flora. Since the end of the 80s, glycopeptide resistant enterococci (GRE) have emerged in healthcare facilities. It has become a major public health issue in several countries. In USA, the rate of GRE was in 2003 about 30% of Enterococci isolated in intensive care units. In UK, 910 GRE bacteraemia has been reported by hospitals during 2007 with a majority of Enterococcus faecium owning the vanA phenotype. The emergence of the resistance to glycopeptides has increased difficulties in treating infected patients. Collectively, the potential transfer of the resistance gene to others pathogens like meticillin resistant Staphylococcus aureus is feared. The application of infection control guidelines and an appropriate use of antimicrobial agents could allow avoiding infections. This article had the aim to give an overview on problems associated to the spread of GRE and to provide some recommendation about the management of infected or colonized patients.

A prospective study of the impact of colonization following hospital admission by glycopeptide-resistant Enterococci on mortality during a hospital outbreak

This study was designed to investigate the impact on mortality of colonization by glycopeptide-resistant Enterococci (GRE) during hospitalization. Between 2004 and 2006, a hospital in Nancy, France, was subject to a GRE van A outbreak. Some 113 patients who had acquired GRE after hospital admission were matched with 113 controls. Basic demographic data, such as sex, age, principal pathology, history of surgery, and presence of associated pathology, were obtained for each case and control. Information on whether or not the case subject was still alive was obtained by searching the hospital mortality database and the civil death register and by phoning the patient's home. Statistical analysis used the Cox proportional hazards model for calculating survival function with SPSS software version 9.1 (SPSS Inc., Chicago, IL). The mean age was 71.2 in the GRE+ group and 70.8 in the control group (P = .80). There was a significant difference between the groups for severity status health (P = .035). The mortality rate was 30.1% in the case group and 19.5% in the control group. Single predictor variable analysis showed a hazard ratio of death in the case group of 4.61 (95% confidence interval [CI]: 2.58-8.28], P = 2 x 10(-7)). The final Cox regression model with multiple predictor variables showed that only GRE presence (OR, 1.63 [95% CI: 1.04-2.57], P = .035) and severity of comorbidity (P = .013) were independently significant predictors of mortality. This study shows that the GRE acquisition has a poor prognosis and that this is independent of the other prognostic factors such as age and severity of underlying disease. Survival in GRE+ patients was significantly shorter.

Portage d’entérocoques résistants aux glycopeptides : les techniques d’isolement et d’identification actuelles sont-elles suffisantes ?

The monitoring of infection by glycopeptide-resistant enterococci (GRE) is one of the main elements of hospital hygiene policy. It involves systematic rectal swabs in clinics at risk (asymptomatic carriage). Aim We compare two GRE screening methods and evaluate a new kit associating multiplex PCR and hybridization (Génotype ® Enterococcus, Hain Lifescience) on a panel of 448 samples collected over a 4-month period. Patients and methods The first method is based on direct inoculation of the sample; the second one involves a preliminary enrichment phase followed by molecular diagnosis allowing the identification of species of enterococci as well as glycopeptide resistance genes. Results All the resistant strains were isolated using the enrichment technique. The incidence of GRE (VanA) carriage was 0,55% (two out of 362 patients, two out of 448 isolates) with two Enterococcus faecium VanA. Six Enterococcus gallinarum VanC1 and two Enterococcus casseliflavus VanC2/C3 were also isolated and identified. The main clinics concerned are intensive care and hematology. The two patients with E. faecium VanA had been previously given glycopeptides for 10 days. For three strains, the molecular method allowed to correct prior erroneous results based on rapid identification (RapidID32Strep V2.0). Conclusion The method using direct samples inoculation underestimates real incidence of GRE carriage. The performances of Génotype ® Enterococcus molecular method, evaluated for other parameters using reference strains and DNA sequencing, offer new possibilities applicable to routine laboratory.

Comparative Analysis on Antibiotic Resistance Characteristics ofListeriaspp. andEnterococcusspp. Isolated From Laying Hens and Eggs in Conventional and Organic Keeping Systems in Bavaria, Germany

By investigating the prevalence and antimicrobial resistance characteristics of Gram-positive bacteria from organic and conventional keeping systems of laying hens, it was to be determined to what extent these properties are influenced by the different systems. For this purpose, a total of 799 cloacal swabs and 800 egg samples were examined. Prevalences for all selected bacteria from cloacal swabs were much the same for both organic and caged birds: Listeria spp.1.3%[org] versus 1.6%[con]; Enterococcus spp. 95.5%[org] versus 97.5%[con]. Egg contents and eggshells were generally contaminated to a lesser extent, primarily with Enterococcus spp. Listeria isolates were susceptible to almost all tested antibiotics, only three Listeria innocua from conventional keepings were resistant to clindamycin; one isolate additionally to imipenem. High percentages of Enterococcus faecalis were resistant to doxycycline and macrolides. Enterococcus faecium proved to have high resistance rates to clindamycin, fosfomycin and erythromycin; 9.1% were even resistant to the reserve antibiotic synercid. Further, Enterococcus spp. showed higher resistance rates to doxycycline, erythromycin, fosfomycin and rifampicin. No glycopeptide resistant enterococci were detected. A correlation between keeping system and resistance/susceptibility rates could be demonstrated. In detail, E. faecalis from organic laying hen husbandries showed significant lower resistance prevalences to tylosin, streptomycin and doxycycline; susceptibility rates were higher for enrofloxacin and ciprofloxacin. Rifampicin and imipenem were more effective in isolates from conventional keepings (P < 0.05). The amounts of resistant isolates of the Enterococcus raffinosus from organic farms were significantly lower, the amounts of sensitive isolates were significantly higher than from conventional farms concerning eight antibiotics (P < 0.05). When comparing the susceptibility/resistance rates, as well as the mean minimum inhibitory concentrations values, the consistent tendency is that bacteria from organic layer flocks are more susceptible to antimicrobials. These results show that organic livestock farming plays a part in contributing to reduced antibiotic resistance.

The role of telavancin in the treatment of MRSA infections in hospital

Background: Serious infections caused by Gram-positive bacteria, particularly multi-drug resistant, are an important cause of morbidity and mortality in patients admitted to intensive care units. Thus, new antibiotics covering these pathogens are urgently needed. Objective: To review characteristics of telavancin, a novel antibiotic intended to use for treating infections caused by difficult Gram-positive bacteria, such as Staphylococcus aureus, resistant to meticillin or vancomycin, multi-drug-resistant Streptococcus pneumoniae or glycopeptide-resistant enterococci. Methods: The studies on microbiological activity, clinical efficacy and safety of telavancin were reviewed. Results/conclusion: Telavancin is a lipoglycopeptide administered intravenously once-daily and excreted with urine. It proved to be microbiologically active against numerous Gram-positive pathogens including drug-resistant staphylococci, enterococci and pneumococci. Large randomized Phase II and III clinical trials on efficacy and safety of telavancin in treating complicated skin and skin structure infections reported telavancin to be non-inferior to standard treatment (mostly vancomycin). Preliminary data on telavancin in hospital-acquired pneumonia, including ventilator-associated pneumonia, documented that telavancin was efficacious for this indication. Overall incidence of adverse events was similar for telavancin and the comparator arms. Mild and transient disgeusia, nausea and vomiting resulted to be more frequent in telavancin group. Increase in creatinine values was also observed in telavancin arm.

Assessment of high-level gentamicin and glycopeptide-resistant Enterococcus faecalis and E. faecium clonal structure in a Portuguese hospital over a 3-year period

This study focussed on the clonal structure and temporal distribution of E. faecalis and E. faecium with high-level resistance to gentamicin (HLGR) and glycopeptides (GR) collected from clinical samples during 2004 to 2006 at a Portuguese Hospital. The findings were an E. faecalis-dominant and epidemic clone (PFGE-AO), the maintenance of a major epidemic E. faecium clone (PFGE-c) and a high prevalence of putative virulence genes--asa1 (aggregation substances), gelE (gelatinase), cylA (cytolysin), esp (enterococcal surface protein), and hyl (hyaluronidase)--most of them significantly associated with the major clones of both species. The E. faecalis GR isolates ST6 and the E. faecium GR isolates ST17, ST18 and ST280 belong to the clonal complexes E. faecalis-CC2 and E. faecium-CC17, which are well adapted to the nosocomial setting and are disseminated worldwide. This study highlights the need for continuous and active surveillance in this Portuguese hospital in order to follow the evolution of these epidemic and persistent clones.

In vitro inhibition of vancomycin-susceptible and vancomycin-resistant Enterococcus faecium and E. faecalis in the presence of citrus essential oils

Glycopeptide-resistant Enterococcus (GRE) is an important healthcare-acquired infection (HCAI) which costs the healthcare service many millions of pounds worldwide. In this study, lemon (Citrus limon), sweet orange (Citrus sinensis) or bergamot (Citrus bergamia) essential oils (EO) and their vapours, alone and in combination, are tested for their antimicrobial activity against vancomycin-resistant and vancomycin-sensitive strains of E. faecium and E. faecalis. A blend of 1:1 (v/v) orange and bergamot EO was the most effective of the oils and/or blends tested with a minimum inhibitory concentration (MIC), at 25˚C and pH 5.5, of 0.25–0.5% (v/v) and a minimum inhibitory dose (MID) of 50 mg/L, at 50˚C at pH 7.5, when viable counts reduced by 5.5–10 log10 colony forming units (cfu)/mL, suggesting that this blend of citrus oils is effective under a range of conditions for inhibiting the growth and survival of E. faecalis, E. faecium and VRE.

Tackling antibiotic resistance: a dose of common antisense?

Resistance to antimicrobial agents undermines our ability to treat bacterial infections. It attracts intense media and political interest and impacts on personal health and costs to health infrastructures. Bacteria have developed resistance to all licensed antibacterial agents, and their ability to become resistant to unlicensed agents is often demonstrated during the development process. Conventional approaches to antimicrobial development, involving modification of existing agents or production of synthetic derivatives, are unlikely to deliver the range or type of drugs that will be needed to meet all future requirements. Although many companies are seeking novel targets, further radical approaches to both antimicrobial design and the reversal of resistance are now urgently required. In this article, we discuss 'antisense' (or 'antigene') strategies to inhibit resistance mechanisms at the genetic level. These offer an innovative approach to a global problem and could be used to restore the efficacy of clinically proven agents. Moreover, this strategy has the potential to overcome critical resistances, not only in the so-called 'superbugs' (methicillin-resistant Staphylococcus aureus, glycopeptide-resistant enterococci and multidrug-resistant strains of Acinetobacter baumannii, and Pseudomonas aeruginosa), but in resistant strains of any bacterial species.

Épidémie en réanimation médicochirurgicale d’Enterococcus faecium résistants aux glycopeptides (ERG) avec cocirculation de deux clones différents

To describe specific difficulties to control a glycopeptide-resistant Enterococcus (GRE) outbreak occurring in an intensive care unit (ICU) during a regional epidemy. Following identification of a GRE clinical isolate in ICU, systematic screening was performed on admission and then weekly, by anal swabs. GRE carriers were isolated according to two processes: first (week [W] 2-W8), cohorting of carriers in a dedicated sector of the ICU, with dedicated HCW; this required closing four of the 16 ICU beds. Second (W8-W29), a specific unit was created outside the ICU. VanA-genotypes and pulsed-field gel electrophoresis (PFGE) profiles were analyzed. During the first outbreak period (102 rectal swabs), two patients were found colonized at admission: the index case transferred from Nancy hospital, carrier of the Nancy epidemy PFGE profile strain, and one patient from the haemodialysis unit, carrier of a GRE strain presenting a different PFGE profile called the Thionville strain. Seven patients were newly identified as GRE colonized (2 by the Nancy strain and 5 by the Thionville strain). Defective running of the ICU was noted. During the second period (442 samples), six ICU patients were found colonized, including four at admission. No other case was identified in 16 weeks. Outbreak extension to other hospital units was checked at W19. The Thionville strain was not found in other regional hospitals. ICUs concentrate GRE colonization risk. This study demonstrates interest of PFGE. These low virulence bacteria have few direct pathological consequences, but they cause organizational problems in ICUs.

Novel Rapid Culture-Based Detection Method for Methicillin-Resistant Streptococcus aureus

In the May 2008 issue of Journal of Clinical Microbiology, Malhotra-Kumar et al. (2) provided an excellent minireview of current trends in rapid diagnostics for methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-resistant enterococci. In this article, the authors describe a novel rapid culture-based assay, the 3M BacLite rapid MRSA test, which detects MRSA without the need for macroscopic growth of bacterial colonies, allowing the presence or absence of MRSA to be determined within 5 h. The article states the assay detects ciprofloxacin-resistant MRSA and comments that this may lead to the possibility of the assay not detecting community-acquired MRSA strains, as well as some hospital-acquired MRSA strains, that are sensitive to ciprofloxacin. The authors are correct in their statements but refer to an assay formulation that has not been available since February 2007, when ciprofloxacin was replaced by cefoxitin as a selective agent.

Relevance of hot spots in the evolution and transmission of Tn1546 in glycopeptide-resistant Enterococcus faecium (GREF) from broiler origin

Glycopeptide-resistant enterococci are still present within the broiler sector, despite the EU ban of avoparcin more than a decade ago. In the present study, we have developed a rapid method for screening the flanking regions at the integration point of Tn1546 in glycopeptide-resistant Enterococcus faecium isolated from broiler farms. Total DNA was digested, ligated and amplified using primers from inside Tn1546. The resulting amplicons were purified and sequenced. Two new primers were designed based on obtained sequences. Two main insertion points have been repeatedly found in isolates from the UK (n = 150). The first insertion point revealed that 25 isolates harboured Tn1546 positioned in a sequence with 96% homology to a streptomycin adenyltransferase gene (AY604739) from a Staphylococcus intermedius plasmid. At this insertion point, a direct repeat (GTCCT) was duplicated as previously described, indicating transposition at the target site. Furthermore, this 'hot spot' was also detected in isolates from Norway (2/8) and Denmark (17/20). The second insertion point detected in 45 isolates from the UK revealed integration into an Inc18-like plasmid, most likely by a process of target site recombination. The presence of a common insertion point for isolates from different geographical areas could suggest the insertion of Tn1546 by transposition in a plasmid-specific site, followed by genetic rearrangement both inside the transposon and in the flanking regions.

Complete sequence of Enterococcus faecium pVEF3 and the detection of an ω-ε-ζ toxin–antitoxin module and an ABC transporter

Glycopeptide resistant Enterococcus faecium (GREF) persists on Norwegian poultry farms despite the ban on the growth promoter avoparcin. The biological basis for long-term persistence of avoparcin resistance is not fully understood. This study presents the complete DNA sequence of the E. faecium R-plasmid pVEF3 and functional studies of some plasmid-encoded traits (a toxin–antitoxin (TA) system and an ABC transporter) that may be of importance for plasmid persistence. The pVEF3 (63.1 kbp), isolated from an E. faecium strain of poultry origin sampled in Norway in 1999, has 71 coding sequences including the vanA avoparcin/vancomycin resistance encoding gene cluster. pVEF3 encodes the TA system ω-ε-ζ, and plasmid stability tests and transcription analysis show that ω-ε-ζ is functional in Enterococcus faecalis OGIX, although with decreasing effect over time. The predicted ABC transporter was not found to confer reduced susceptibility to any of the 28 substances tested. The TA system identified in the pVEF-type plasmids may contribute to vanA plasmid persistence on Norwegian poultry farms. However, size and compositional heterogeneity among E. faecium vanA plasmids suggest that additional plasmid maintenance systems in combination with host specific factors and frequent horizontal gene transfer and rearrangement causes the observed plasmid composition and distribution patterns.

Opinion on Millar et al., ‘Are meticillin-resistant Staphylococcus aureus bloodstream infection targets fair to those with other types of healthcare-associated infection or cost-effective?’

Millar et al. 1 Millar M. Coast J. Ashcroft R. Are meticillin-resistant Staphylococcus aureus bloodstream infection targets fair to those with other types of healthcare-associated infection or cost-effective?. J Hosp Infect. 2008; 69: 1-5 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar present the hypothesis that the Department of Health (DoH) target for the National Health Service (NHS) in England to reduce meticillin-resistant Staphyloccus aureus (MRSA) bloodstream infections (BSI) has had a detrimental effect on the control of other healthcare-associated infections (HCAIs). However, their argument is based on a premise that activities focused on reducing MRSA BSI are isolated entities, unique to the prevention and control of MRSA BSI and with no beneficial impact on other HCAIs. Furthermore, they present no evidence that this has in fact happened, whereas there is no doubt that the increased attention to HCAIs and the emphasis on infection prevention and control is having a significant beneficial effect on the delivery of safe healthcare in England. The lead author, Dr Millar, like many of us, has spent much of his professional life as a medical microbiologist in an environment where HCAI and the whole issue of infection prevention and control had a very low priority within the medical establishment and NHS management. Now, however, this issue is at the top of the agenda in all NHS bodies and Trust Boards and their Chief Executives are being held to account for delivering safe healthcare with a zero-tolerance approach to avoidable HCAIs. The authors also suggest that the actions aimed at reducing MRSA BSI would not have any beneficial effect on other HCAIs and might lead to a worsening of the situation. This does not fit with the range of activities that has been put in place in the DoH programme. MRSA BSI is the headline infection, the subject of mandatory reporting since 2001, and represents the most severe end of the spectrum of MRSA infections. It is certainly the focus of performance management within the NHS in England, but the package of guidance and action notes within the DoH programme addresses HCAI issues far wider than MRSA BSI. The increased attention to cleanliness and hygiene is perhaps even more relevant to C. difficile, norovirus and Acinetobacter infection than to MRSA BSI itself. Similarly, the antimicrobial prescribing framework guidance is relevant to C. difficile prevention and control and to all HCAIs that are generally caused by antibiotic-resistant organisms (MRSA, extended-spectrum β-lactamase-producing E. coli, Acinetobacter spp., glycopeptide-resistant enterococci). The Saving Lives High Impact Interventions address all HCAI BSI by attention to aseptic practice and proper intravascular device care, all nosocomial urinary tract infections by attention to urinary catheter insertion and care, ventilator pneumonia due to any bacteria in the ventilator care bundle and all wound infections in the surgical site infection bundle. Furthermore, the basic premises of hand hygiene and aseptic clinical procedures are the right approach to the prevention of any HCAIs. Even the most specific MRSA control measure – the requirement to implement screening for MRSA carriage in all patients admitted to NHS Trusts – is appropriate to the control of all MRSA infections, not just BSI.

Cultivos de vigilancia epidemiológica de bacterias resistentes a los antimicrobianos de interés nosocomial

Implementation of surveillance culture programs and molecular typing are important contributions of Clinical Microbiology to the control of nosocomial infections. This document provides information on collection, transport, preservation, and processing of samples for surveillance culture, as well as the criteria for interpreting and reporting the results of relevant etiologic agents in nosocomial infection. This includes methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant Enterococcus spp., enterobacteria producing extended-spectrum beta -lactamases (ESBLs), multiresistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa. Details on the available methods for rapid diagnosis are also presented. The information in this document attempts to provide a general approach to the problem and may be considered a starting point for laboratories that are developing their own guidelines, according to needs defined by the multidisciplinary nosocomial infection control team.

Enterococcal infection

This article describes enterococci bacteria and the measures related to glycopeptide-resistant enterococci, including screening, treatment and management, antibiotic prescribing and infection control.

Current Trends in Rapid Diagnostics for Methicillin-Resistant Staphylococcus aureus and Glycopeptide-Resistant Enterococcus Species

Hospital-acquired (HA) infections are an increasing global problem. Methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-resistant Enterococcus (GRE) are multidrugresistant organisms and are particularly frequent causes of HA infections that often prove difficult and expensive to treat. Major sources of MRSA and GRE causing infections are either the patient’s own floras (endogenous infection), those acquired from another person (cross-infection), or those from substances recently contaminated by a human source (environmental infection). Active surveillance cultures from patients for carriage of MRSA and GRE facilitate an early contact isolation (and even treatment), thus preventing spread in the hospital and reducing costs (42). However, the time to result with conventional cultures is 2 to 3 days, which allows these organisms a sizeable time window for potential spread prior to the institution of contact precautions. Recently, several “rapid” diagnostic tests have been introduced that would be very beneficial in decreasing the time to detection, therefore reducing the risk of nosocomial transmission and infections, especially in high-risk patients. This review discusses the current state of the art on rapid and direct detection methods for MRSA and GRE from patient material and hopes to facilitate the infectious disease specialist or microbiologist in choosing an appropriate diagnostic test.