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Navarra A, Cicalini S, D’Arezzo S, Pica F, Selleri M, Nisii C, Venditti C, Cannas A, Mazzarelli A, Vulcano A, Carrara S, Vincenti D, Bartolini B, Giacomini P, Bocci MG, Fontana C. Vancomycin-Resistant Enterococci: Screening Efficacy and the Risk of Bloodstream Infections in a Specialized Healthcare Setting. Antibiotics (Basel) 2025; 14:304. [PMID: 40149114 PMCID: PMC11939376 DOI: 10.3390/antibiotics14030304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 03/08/2025] [Accepted: 03/11/2025] [Indexed: 03/29/2025] Open
Abstract
Background: Vancomycin-resistant enterococci (VRE) rectal colonization represents a critical risk factor for subsequent bloodstream infections (BSIs), posing a serious concern in healthcare settings. This study aims to investigate the association between the presence of VRE in rectal swabs and the occurrence of BSIs, highlighting the challenges of rapid detection and patient care implications in an infectious disease hospital setting. Methods: We performed a retrospective analysis of cultural rectal swab screening and molecular assays (MAs) for VRE detection between January 2020 and December 2023. All adult patients admitted with at least one rectal swab screening performed during hospitalization were included. All blood cultures that yielded VRE were identified, and the first Enterococcus-positive blood sample for each patient with at least one prior rectal swab per year was analyzed. Results: The results showed a 15.4% positivity rate for VRE in cultural screening, predominantly Enterococcus faecium. MA showed a higher prevalence of 49.4%, with a significant discordance between MA rectal swab screening and cultural testing. Patients with VRE intestinal colonization by E. faecium were significantly more likely to develop E. faecium BSI, with a risk ratio of 9.78 (p < 0.001). Conclusions: The study identified a strong correlation between VRE rectal colonization and the risk of developing BSI, emphasizing the need for effective screening and infection control measures. The results support the inclusion of molecular testing in VRE detection protocols and highlight the importance of ongoing surveillance for antimicrobial resistance.
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Affiliation(s)
- Assunta Navarra
- Clinical Epidemiology Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy;
| | - Stefania Cicalini
- Systemic and Immune Depression-Associated Infections Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy
| | - Silvia D’Arezzo
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Francesca Pica
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Marina Selleri
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Carla Nisii
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Carolina Venditti
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Angela Cannas
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Antonio Mazzarelli
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Antonella Vulcano
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Stefania Carrara
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Donatella Vincenti
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Barbara Bartolini
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
| | - Paolo Giacomini
- Health Direction, Hospital Information Service, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy;
| | - Maria Grazia Bocci
- Intensive Care Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy;
| | - Carla Fontana
- Microbiology and Biobank Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, 00149 Rome, Italy; (S.D.); (M.S.); (C.N.); (C.V.); (A.C.); (A.M.); (A.V.); (S.C.); (D.V.); (B.B.); (C.F.)
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Giersch K, Tanida K, Both A, Nörz D, Heim D, Rohde H, Aepfelbacher M, Lütgehetmann M. Adaptation and validation of a quantitative vanA/vanB DNA screening assay on a high-throughput PCR system. Sci Rep 2024; 14:3523. [PMID: 38347048 PMCID: PMC10861526 DOI: 10.1038/s41598-024-54037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
Vancomycin resistant enterococci (VRE) are a leading cause of ICU-acquired bloodstream infections in Europe. The bacterial load in enteral colonization may be associated with a higher probability of transmission. Here, we aimed to establish a quantitative vanA/vanB DNA real-time PCR assay on a high-throughput system. Limits of detection (LOD), linear range and precision were determined using serial bacterial dilutions. LOD was 46.9 digital copies (dcp)/ml for vanA and 60.8 dcp/ml for vanB. The assay showed excellent linearity between 4.7 × 101 and 3.5 × 105 dcp/ml (vanA) and 6.7 × 102 and 6.7 × 105 dcp/ml (vanB). Sensitivity was 100% for vanA and vanB, with high positive predictive value (PPV) for vanA (100%), but lower PPV for vanB (34.6%) likely due to the presence of vanB DNA positive anerobic bacteria in rectal swabs. Using the assay on enriched VRE broth vanB PPV increased to 87.2%. Quantification revealed median 2.0 × 104 dcp/ml in PCR positive but VRE culture negative samples and median 9.1 × 104 dcp/ml in VRE culture positive patients (maximum: 107 dcp/ml). The automated vanA/B_UTC assay can be used for vanA/vanB detection and quantification in different diagnostic settings and may support future clinical studies assessing the impact of bacterial load on risk of infection and transmission.
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Affiliation(s)
- Katja Giersch
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Konstantin Tanida
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Anna Both
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Denise Heim
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
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Olearo F, Both A, Belmar Campos C, Hilgarth H, Klupp EM, Hansen JL, Maurer FP, Christner M, Aepfelbacher M, Rohde H. Emergence of linezolid-resistance in vancomycin-resistant Enterococcus faecium ST117 associated with increased linezolid-consumption. Int J Med Microbiol 2021; 311:151477. [PMID: 33524636 DOI: 10.1016/j.ijmm.2021.151477] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/02/2020] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We aim to describe the epidemiological, clinical and microbiological characteristics of the linezolid- and vancomycin- resistant Enterococcus faecium (LVRE) in a tertiary care hospital in Germany. METHODS We conducted a retrospective analysis of 196 LVRE cases observed from 1st January 2012 to 31th December 2018. Patients' medical charts were reviewed and available LVRE (n = 102) were subjected to whole-genome-sequencing. Antibiotic consumption was measured in defined daily dose (DDD)/100 bed-days (BD). RESULTS The prevalence of LVRE isolates among VRE was 6.3 % in 2018. Most patients had an onco-hematological disease (134/196, 68.4 %). From 2012-2018 an increase of +356.7 % of linezolid defined daily dose/100 bed-days was observed. In 71.4 % (90/126, 70 missing values) of the patients, linezolid was prescribed in the previous 6 months. The median exposure to linezolid was 15 days (Interquartile, IQR 9-23). 42/196 (21.4 %) patients had an LVRE-related infection with an overall 30-day mortality rate of 33 %. In 121/196 (61.7 %) patients, linezolid-susceptible VREfm were isolated before LVRE, suggesting secondary acquisition of linezolid resistance. Genetic analysis revealed that most isolates belonged to ST117 (64/102 available isolates, 62.7 %). The G2576T 23S rDNA mutation was identified as the most common resistance mechanism (96/102, 94.1 %). poxtA was identified in two isolates, while cfr, and optrA were not detected. CONCLUSIONS Incidence of LVRE related to 23S rDNA mutations is rising and probably associated with antibiotic consumption. Restrictions in the use of linezolid may be needed in order to retain therapeutic options in VRE.
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Affiliation(s)
- Flaminia Olearo
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Antibiotic Stewardship Team, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Both
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Cristina Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Hilgarth
- Antibiotic Stewardship Team, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Eva-Maria Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Lennart Hansen
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Florian P Maurer
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany; Antibiotic Stewardship Team, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Christner
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Aepfelbacher
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Heuvelmans M, Sturm PDJ, Rentenaar RJ. Reduced sensitivity of vancomycin/ampicillin broth enrichment for the detection of VanB positive vancomycin-resistant Enterococcus faecium by culture. Infect Dis (Lond) 2019; 51:874-877. [PMID: 31469338 DOI: 10.1080/23744235.2019.1656817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- M Heuvelmans
- University Medical Centre Utrecht , Utrecht , The Netherlands
| | - P D J Sturm
- Laurentius Ziekenhuis Roermond , Roermond , The Netherlands
| | - R J Rentenaar
- University Medical Centre Utrecht , Utrecht , The Netherlands
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