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CORRESPONDENCE
Year : 2014  |  Volume : 32  |  Issue : 3  |  Page : 345-347
 

Commensal and environmental vancomycin-resistant Enterococcus faecium isolated in hospital settings: Genotypic diversity, antimicrobial resistance and virulence traits


1 Departamento de Microbiologia, Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual de Londrina, PR, Brazil
2 Departamento de Microbiologia do Solo, Instituto Agronômico do Paraná, Londrina, PR, Brazil
3 Departamento de Patologia, Análises Clínicas e Toxicológicas, Laboratório de Microbiologia Clínica, Universidade Estadual de Londrina, PR, Brazil

Date of Submission26-May-2013
Date of Acceptance31-Aug-2013
Date of Web Publication10-Jul-2014

Correspondence Address:
SFY Ogatta
Departamento de Microbiologia, Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual de Londrina, PR
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.136603

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How to cite this article:
Gomes L, Morey A T, Santos J P, Cardoso J D, Oliveira C F, Perugini M, Yamauchi L M, Ogatta S. Commensal and environmental vancomycin-resistant Enterococcus faecium isolated in hospital settings: Genotypic diversity, antimicrobial resistance and virulence traits. Indian J Med Microbiol 2014;32:345-7

How to cite this URL:
Gomes L, Morey A T, Santos J P, Cardoso J D, Oliveira C F, Perugini M, Yamauchi L M, Ogatta S. Commensal and environmental vancomycin-resistant Enterococcus faecium isolated in hospital settings: Genotypic diversity, antimicrobial resistance and virulence traits. Indian J Med Microbiol [serial online] 2014 [cited 2019 Oct 21];32:345-7. Available from: http://www.ijmm.org/text.asp?2014/32/3/345/136603


Dear Editor,

At the University Hospital of Londrina, Paranα, Brazil, cultures of stools are examined weekly for all patients housed in intensive care units and for all patients found to be colonised or infected with vancomycin-resistant enterococci (VRE), as part of the hospital surveillance study for multidrug-resistant microorganisms. A total of 24 non-duplicates vancomycin-resistant Enterococcus faecium (VREfm) isolated in this hospital during 2009 and 2010 were included in this study. Fourteen isolates were recovered from stool cultures of rectal swab specimens. All patients were adults and the underlying clinical conditions at admission were as follows: stroke (6/14, 42.8%), diabetes (3/14, 21.4%), malignancy (2/14, 14.3%) and one patient each had paraplegy, AIDS and Chagas disease. Most of them were hospitalised due to pneumonia (7/14, 50.0%), sepsis (4/14, 28.6%), one patient each had ulcerations in the ankle and sacral region and one underwent eye surgery. Overall, 13 patients (92.9%) received previous broad-spectrum antibiotic therapy and central venous catheters, and mechanical ventilation were used for 10 patients (71.4%). Ten bacterial isolates were obtained by rubbing pre-moistened swabs over the sites in the immediate vicinity of the patient and the general areas in patients' rooms.

All isolates were shown to be resistant to vancomycin and teicoplanin, and the antimicrobial resistance mechanism is mediated by the vanA genes, which is consistent with our previous study with VREfm isolated at the hospital settings during 2002-2007. [1] All isolates also showed resistance to erythromycin that was mediated by ermB gene, which seems to be more widely distributed among VRE isolates. [2] Besides the glycopeptides and erythromycin resistance, all isolates were also resistant to ampicillin and ciprofloxacin that are characteristics of hospital-adapted E. faecium. [3] The Repetitive Extragenic Palindromic elements-PCR [4] detected 13 different clusters among the isolates, and 16 (66.7%) were clustered in five genotypes. The other eight (33.3%) isolates had unique banding profiles. All isolates harboured at least one putative virulence marker and the prevalence was as follows: efaA, 100%; esp, 75%; gelE, 41.7%. The genes acm, cylA and hyl were not detected in this study [Table 1].
Table 1: Putative virulence factors, antimicrobial susceptibility pattern and REP - PCR fingerprinting pattern obtained from 24 vancomycin - resistant Enterococcus faecium isolates from faecal carriage of hospitalised patients and environment of University Hospital of Londrina. Cluster analysis was performed using UPGMA algorithm and Jaccard co - efficient of the Bionumerics v. 4.6 software, with band tolerance set at 3% and threshold cut - off value set at 85%


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The prevalence of E. faecium harbouring multiple antimicrobial resistance and putative virulence genes alert us for the potential risk of infection in hospitalised patients, corroborating to the importance of the control of healthcare-associated infections.


 ~ Acknowledgements Top


This work was supported by grants from Pro-Reitoria de Pesquisa e Pσs-Graduaηγo (PROPPG) of Universidade Estadual de Londrina. This work was part of the M.Sc. dissertation of L.V.P. Gomes, which received studentship from Coordenaηγo de Aperfeiηoamento de Pessoal de Nνvel Superior-CAPES. We thank Dr. A. Leyva for English editing of the manuscript and Ediel Clementino da Costa for technical support. L.V.P.G.: Contributed in all methodological activities and, analysis and interpretation of data; A.T.M. and J.D.C: Nucleotide sequence analysis, primer design, analysis and interpretation of data; J.P.S. and C.F.O: Samples collection and isolates identification; L.M.Y. and M.R.E.P: Critical revision for important intellectual content. S.F.Y.O.: Conception, design, analysis and interpretation of data.

 
 ~ References Top

1.Ruzon FI, de Paula SB, Kanoshiki RL, Pereira-Santos J, Kerbauy G, Kobayashi RK, et al. Virulence determinants in vancomycin-resistant Enterococcus faecium vanA isolated from different sources at University Hospital of Londrina, Paraná, Brazil. J Microbiol 2010;48:814-21.  Back to cited text no. 1
    
2.Qin X, Galloway-Peña JR, Sillanpaa J, Roh JH, Nallapareddy SR, Chowdhury S, et al. Complete genome sequence of Enterococcus faecium strain T×16 and comparative genomic analysis of Enterococcus faecium genomes. BMC Microbiol 2012;12:135.  Back to cited text no. 2
    
3.Top J, Willems R, Bonten M. Emergence of CC17 Enterococcus faecium: From commensal to hospital-adapted pathogen. FEMS Immunol Med Microbiol 2008;52:297-308.  Back to cited text no. 3
    
4.Versalovic J, Koeuth T, Lupski JR. Distribution of repetitive DNA sequences in eubacteria and application to fingerprinting of bacterial genomes. Nucleic Acids Res 1991;19:6823-31.  Back to cited text no. 4
    



 
 
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