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Biehl LM, Higgins PG, Stemler J, Gilles M, Peter S, Dörfel D, Vogel W, Kern WV, Gölz H, Bertz H, Rohde H, Klupp EM, Schafhausen P, Salmanton-García J, Stecher M, Wille J, Liss B, Xanthopoulou K, Zweigner J, Seifert H, Vehreschild MJGT. Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016. Euro Surveill 2022; 27:2001876. [PMID: 35027104 PMCID: PMC8759111 DOI: 10.2807/1560-7917.es.2022.27.2.2001876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/18/2021] [Indexed: 06/14/2023] Open
Abstract
BackgroundEvidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.AimWe assessed the impact of SCP on haVRE and their transmission.MethodsWe conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis.ResultsWe included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35-2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59-12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46-3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14-2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33-2.34).ConclusionsWe show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.
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Affiliation(s)
- Lena M Biehl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Paul G Higgins
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jannik Stemler
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Meyke Gilles
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Silke Peter
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
- German Centre for Infection Research, partner site Tübingen, Germany
| | - Daniela Dörfel
- Department of Haematology, Oncology and Immunology, Siloah hospital, Hannover, Germany
| | - Wichard Vogel
- Department of Oncology, Haematology, Immunology and Rheumatology, Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hanna Gölz
- Institute for Medical Microbiology and Hygiene, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany
- German Centre for Infection Research, partner site Hamburg-Lübeck-Borstel, Germany
| | - Eva-Maria Klupp
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany
| | - Philippe Schafhausen
- Department of Oncology and Haematology, Hubertus Wald Tumorzentrum/University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Blasius Liss
- Department I of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany
- Department of Internal medicine I, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Kyriaki Xanthopoulou
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital of Cologne, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Harald Seifert
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
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Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1310-1361. [DOI: 10.1007/s00103-018-2811-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Sutcu M, Akturk H, Acar M, Salman N, Aydın D, Akgun Karapınar B, Ozdemir A, Cihan R, Citak A, Somer A. Impact of vancomycin-resistant enterococci colonization in critically ill pediatric patients. Am J Infect Control 2016; 44:515-9. [PMID: 26781220 DOI: 10.1016/j.ajic.2015.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We aimed to determine the frequency of vancomycin-resistant enterococci (VRE) infection occurrence in previously VRE-colonized children in a pediatric intensive care unit (PICU) and to identify associated risk factors. METHODS Infection control nurses have performed prospective surveillance of health care-associated infections and rectal VRE carriage in PICUs from January 2010-December 2014. This database was reviewed to obtain information about VRE-colonized and subsequently infected patients. A case-control study was performed to identify risk factors associated with VRE infection development in previously VRE-colonized patients. RESULTS Out of 1,134 patients admitted to the PICU, 108 (9.5%) were found to be colonized with VRE throughout the study period. Systemic VRE infections developed in 11 VRE-colonized patients (10.2%), and these included primary bloodstream infection (n = 6), urinary tract infection (n = 3), meningitis and bloodstream infection (n = 1), and meningitis (n = 1). Logistic regression analysis indicated long hospital stay (≥30 days) and glycopeptide use after detection of VRE colonization as risk factors for developing VRE infection in VRE-colonized patients (odds ratio [OR], 5.76; 95% confidence interval [CI], 1.6-15.8; P = .017 and OR, 12.8; 95% CI, 1.9-26.6; P = .012, respectively). CONCLUSIONS VRE colonization has important consequences in pediatric critically ill patients. Strict infection control measures should be implemented to prevent VRE colonization and thereby VRE infections. Furthermore, irrational antibiotic use and particularly glycopeptide use in VRE-colonized patients should be restricted.
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Crouzet L, Rigottier-Gois L, Serror P. Potential use of probiotic and commensal bacteria as non-antibiotic strategies against vancomycin-resistant enterococci. FEMS Microbiol Lett 2015; 362:fnv012. [DOI: 10.1093/femsle/fnv012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 12/17/2022] Open
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van der Heijden KM, van der Heijden IM, Galvao FH, Lopes CG, Costa SF, Abdala E, D’Albuquerque LA, Levin AS. Intestinal translocation of clinical isolates of vancomycin-resistant Enterococcus faecalis and ESBL-producing Escherichia coli in a rat model of bacterial colonization and liver ischemia/reperfusion injury. PLoS One 2014; 9:e108453. [PMID: 25255079 PMCID: PMC4177999 DOI: 10.1371/journal.pone.0108453] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 08/29/2014] [Indexed: 12/13/2022] Open
Abstract
The objectives of this study were to develop a rat model of gastrointestinal colonization with vancomycin-resistant Enterococcus faecalis (VRE) and extended-spectrum beta-lactamase (ESBL)-producing E. coli and to evaluate intestinal translocation to blood and tissues after total and partial hepatic ischemia. Methods - We developed a model of rat colonization with VRE and ESBL-E coli. Then we studied four groups of colonized rats: Group I (with hepatic pedicle occlusion causing complete liver ischemia and intestinal stasis); Group II (with partial liver ischemia without intestinal stasis); Group III (surgical manipulation without hepatic ischemia or intestinal stasis); Group IV (anesthetized without surgical manipulation). After sacrifice, portal and systemic blood, large intestine, small intestine, spleen, liver, lungs, and cervical and mesenteric lymph nodes were cultured. Endotoxin concentrations in portal and systemic blood were determined. Results - The best inocula were: VRE: 2.4×10(10) cfu and ESBL-E. coli: 1.12×10(10) cfu. The best results occurred 24 hours after inoculation and antibiotic doses of 750 µg/mL of water for vancomycin and 2.1 mg/mL for ceftriaxone. There was a significantly higher proportion of positive cultures for ESBL-E. coli in the lungs in Groups I, II and III when compared with Group IV (67%; 60%; 75% and 13%, respectively; p:0.04). VRE growth was more frequent in mesenteric lymph nodes for Groups I (67%) and III (38%) than for Groups II (13%) and IV (none) (p:0.002). LPS was significantly higher in systemic blood of Group I (9.761 ± 13.804 EU/mL-p:0.01). No differences for endotoxin occurred in portal blood. Conclusion -We developed a model of rats colonized with resistant bacteria useful to study intestinal translocation. Translocation occurred in surgical procedures with and without hepatic ischemia-reperfusion and probably occurred via the bloodstream. Translocation was probably lymphatic in the ischemia-reperfusion groups. Systemic blood endotoxin levels were higher in the group with complete hepatic ischemia.
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Affiliation(s)
- Karin M. van der Heijden
- Department of Infectious Diseases, LIM 54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Inneke M. van der Heijden
- Department of Infectious Diseases, LIM 54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Flavio H. Galvao
- Transplantation Division, Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Camila G. Lopes
- Transplantation Division, Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Silvia F. Costa
- Department of Infectious Diseases, LIM 54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Edson Abdala
- Department of Infectious Diseases, LIM 54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
- Transplantation Division, Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Luiz A. D’Albuquerque
- Transplantation Division, Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Anna S. Levin
- Department of Infectious Diseases, LIM 54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
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Staley C, Dunny GM, Sadowsky MJ. Environmental and animal-associated enterococci. ADVANCES IN APPLIED MICROBIOLOGY 2014; 87:147-86. [PMID: 24581391 DOI: 10.1016/b978-0-12-800261-2.00004-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Enterococci are generally commensal bacteria inhabiting the gastrointestinal tract of humans and animals. They have, however, been implicated as the etiological agent of a variety of illnesses and nosocomial infections. In addition to pathogenic potential, there is growing concern regarding the incidence of antibiotic resistance and genetic exchange among Enterococcus spp. within and among a variety of animal hosts. While primarily considered an enteric group, extra-enteric habitats in which enterococci persist and potentially grow have been studied for decades. Although many biotic (e.g., predation) and abiotic (e.g., sunlight, nutrients, and salinity) stressors have been thought to limit the success of enterococci in these secondary habitats, a growing body of evidence suggests that certain strains may become naturalized to environmental habitats. Enterococci have also been used for decades as indicators of fecal contamination in recreational waters where increased concentrations of this group have been linked to the incidence of illness in humans following recreational use of these waters. Persistence of enterococci in secondary habitats, however, suggests that their presence in ambient waters may prove to be a poor indicator of actual risks to public health. In this chapter, we provide a review of the existing body of literature concerning animal host associations, genetic exchange is reviewed, and emphasis is placed on the growing body of evidence for the persistence and growth of enterococci in secondary habitats.
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Affiliation(s)
- Christopher Staley
- BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA
| | - Gary M Dunny
- Department of Microbiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael J Sadowsky
- BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA; Department of Soil, Water and Climate, University of Minnesota, St. Paul, Minnesota, USA.
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Gendrin V, Hénard S, Petitfrère M, May T, Rabaud C. [Effectiveness and risks related to enteric decolonization with oral streptomycin for glycopeptide-resistant enterocci carriers]. Med Mal Infect 2011; 41:563-4. [PMID: 21703786 DOI: 10.1016/j.medmal.2011.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/10/2011] [Accepted: 05/17/2011] [Indexed: 11/25/2022]
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Hammerum AM, Lester CH, Heuer OE. Antimicrobial-resistant enterococci in animals and meat: a human health hazard? Foodborne Pathog Dis 2010; 7:1137-46. [PMID: 20578915 DOI: 10.1089/fpd.2010.0552] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Enterococcus faecium and Enterococcus faecalis belong to the gastrointestinal flora of humans and animals. Although normally regarded harmless commensals, enterococci may cause a range of different infections in humans, including urinary tract infections, sepsis, and endocarditis. The use of avoparcin, gentamicin, and virginiamycin for growth promotion and therapy in food animals has lead to the emergence of vancomycin- and gentamicin-resistant enterococci and quinupristin/dalfopristin-resistant E. faecium in animals and meat. This implies a potential risk for transfer of resistance genes or resistant bacteria from food animals to humans. The genes encoding resistance to vancomycin, gentamicin, and quinupristin/dalfopristin have been found in E. faecium of human and animal origin; meanwhile, certain clones of E. faecium are found more frequently in samples from human patients, while other clones predominate in certain animal species. This may suggest that antimicrobial-resistant E. faecium from animals could be regarded less hazardous to humans; however, due to their excellent ability to acquire and transfer resistance genes, E. faecium of animal origin may act as donors of antimicrobial resistance genes for other more virulent enterococci. For E. faecalis, the situation appears different, as similar clones of, for example, vancomycin- and gentamicin-resistant E. faecalis have been obtained from animals and from human patients. Continuous surveillance of antimicrobial resistance in enterococci from humans and animals is essential to follow trends and detect emerging resistance.
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Affiliation(s)
- Anette M Hammerum
- Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark.
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Leendertse M, Willems RJL, Giebelen IAJ, Roelofs JJTH, Top J, Bonten MJM, van der Poll T. Intestinal colonization with Enterococcus faecium does not influence pulmonary defense against Pseudomonas aeruginosa in mice. PLoS One 2009; 4:e6775. [PMID: 19710930 PMCID: PMC2729381 DOI: 10.1371/journal.pone.0006775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Accepted: 07/14/2009] [Indexed: 11/19/2022] Open
Abstract
Background Enterococci, and especially multiresistant Enterococcus faecium, are increasingly found colonizing hospitalized patients. This increased prevalence of colonization is not only associated with an increased prevalence of infections caused by enterococci, but also by infections with other nosocomial pathogens. In this study we investigated the causality of this observed relationship, by determining the influence of intestinal colonization with E. faecium on pulmonary defense against Pseudomonas aeruginosa. Methodology/Principal Findings Three groups of mice were tested; 2 groups of mice were pre-treated with vancomycin, of which one group was subsequently treated by oral gavage of vancomycin-resistant E. faecium (VRE). The third group did not receive any pre-treatment. P. aeruginosa pneumonia was induced in all mice. Vancomycin treatment resulted in intestinal gram-negative bacterial overgrowth and VRE treatment resulted in colonization throughout the intestines. All 3 groups of mice were able to clear P. aeruginosa from the lungs and circulation, with comparable lung cytokine responses and lung damage. Mice treated with vancomycin without VRE colonization displayed modestly increased plasma levels of TNF-α and IL-10. Conclusion Overgrowth of E. faecium and/or gram-negative bacteria does not impact importantly on pulmonary defense against P. aeruginosa pneumonia.
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Affiliation(s)
- Masja Leendertse
- Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
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Jacobsen BL, Skou M, Hammerum AM, Jensen LB. Horizontal Transfer of thesatAGene Encoding Streptogramin A Resistance Between IsogenicEnterococcus faeciumStrains in the Gastrointestinal Tract of Gnotobiotic Rats. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/08910609908540834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- B. L. Jacobsen
- From the Danish Veterinary and Food Administration,,Mørkhøj Bygade 19, DK-2860, Søborg, Denmark
| | - M. Skou
- From the Danish Veterinary and Food Administration,,Mørkhøj Bygade 19, DK-2860, Søborg, Denmark
| | - A. M. Hammerum
- Danish Veterinary Laboratory,Bülowsvej 27, DK-1790, Copenhagen V, Denmark
| | - L. B. Jensen
- Danish Veterinary Laboratory,Bülowsvej 27, DK-1790, Copenhagen V, Denmark
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Boureau, L. Hartmann, T. Karjalaine H. Models to Study Colonisation and Colonisation Resistance. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.1080/08910600050216246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- H. Boureau, L. Hartmann, T. Karjalaine
- Microbiologie, Faculté de Pharmacie, Université Paris-Sud, Châtenay Malabry, France
- Gastrointestinal Microbiology, German Institute of Human Nutrition, Potsdam Rehbrücke, Germany
- Northern Ireland Centre for Diet and Health, University of Ulster, Coleraine, Northern Ireland
- Instituut voor Wiskunde en Informatica, Faculteit des Wiskunde en Natuurwetenschappen, Groningen, The Netherlands
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Lye DJ. A mouse model for characterization of gastrointestinal colonization rates among environmental Aeromonas isolates. Curr Microbiol 2009; 58:454-8. [PMID: 19130126 DOI: 10.1007/s00284-008-9342-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 12/01/2022]
Abstract
The colonization rates of 10 different environmental Aeromonas isolates were determined using a novel mouse-streptomycin pretreatment method. As demonstrated, alterations to the colon flora of mice pretreated with streptomycin allowed transient colonization by bacterial species normally excluded by host competition. A novel procedure is described for determining the colonization abilities of Aeromonas isolates under these conditions. The colonization rates of A. salmonicida, A. encheleia, and A. allosaccharophila were either negative or occurred randomly at low levels with respect to concentrations of the dosage consumed by the animals. In contrast, A. hydrophila, A. veronii biovar sobria, and A. caviae exhibited relatively high rates of mouse colon tissue colonization.
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Affiliation(s)
- Dennis J Lye
- National Exposure Research Laboratory, Microbial and Chemical Exposure Assessment Research Division, USEPA, Cincinnati, OH 45268, USA.
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Furtado GHC, Mendes RE, Pignatari ACC, Wey SB, Medeiros EAS. Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two case-control studies. Am J Infect Control 2006; 34:447-51. [PMID: 16945692 DOI: 10.1016/j.ajic.2005.08.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 08/16/2005] [Accepted: 08/18/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) is an important pathogen in the hospital environment, and a progressive increase in its incidence is a cause of nosocomial infections. Bacteremia is one of the major infections caused by this pathogen. Risk factors for VRE bacteremia were assessed at a university-affiliated hospital. METHODS Two case-control studies with different control groups were used. In study 1, patients with VRE bacteremia were compared with control patients matched by sex, admission unit, age (+/-10 years), and time of admission (+/-1 year). In study 2, the case group (VRE patients) was compared with vancomycin-susceptible enterococci (VSE) patients. RESULTS A total of 34 patients with VRE bacteremia and 102 control patients were included in study 1, and 34 patients with VRE bacteremia and 55 patients with VSE bacteremia were included in study 2. In study 1, vancomycin use (OR, 10.19; CI 95%, 3.63-28.57) was associated with VRE bacteremia. In study 2, vancomycin use (OR, 17.58; CI 95%, 5.24-58.96) was also associated with VRE bacteremia. CONCLUSION Because vancomycin use was the only variable associated with VRE bacteremia in the two studies, we confirmed that vancomycin exposure is the major risk factor for VRE bacteremia.
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Affiliation(s)
- Guilherme Henrique Campos Furtado
- Infection Control Committee, Division of Infectious Diseases, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
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Cookson BD, Macrae MB, Barrett SP, Brown DFJ, Chadwick C, French GL, Hateley P, Hosein IK, Wade JJ. Guidelines for the control of glycopeptide-resistant enterococci in hospitals. J Hosp Infect 2006; 62:6-21. [PMID: 16310890 DOI: 10.1016/j.jhin.2005.02.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 02/18/2005] [Indexed: 11/26/2022]
Abstract
The increase since the mid 1980s in glycopeptide resistant enterococci (GRE) raised concerns about the limited options for antimicrobial therapy, the implications for ever-increasing numbers of immunocompromised hospitalised patients, and fuelled fears, now realised, for the transfer of glycopeptide resistance to more pathogenic bacteria, such as Staphylococcus aureus. These issues underlined the need for guidelines for the emergence and control of GRE in the hospital setting. This Hospital Infection Society (HIS) and Infection Control Nurses Association (ICNA) working party report reviews the literature relating to GRE prevention and control. It provides guidance on microbiological investigation, treatment and management, including antimicrobial prescribing and infection control measures. Evidence identified to support recommendations has been categorized. A risk assessment approach is recommended and areas for research and development identified.
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Affiliation(s)
- B D Cookson
- Laboratory of Healthcare Associated Infection, Specialist and Reference Microbiology Division, Health Protection Agency, London, UK
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Rice LB. Antibiotics and gastrointestinal colonization by vancomycin-resistant enterococci. Eur J Clin Microbiol Infect Dis 2005; 24:804-14. [PMID: 16362383 DOI: 10.1007/s10096-005-0057-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although several classes of antimicrobial agents have been associated with colonization or infection with glycopeptide-resistant enterococci (GRE) in individual clinical studies, the agents most commonly implicated are extended-spectrum cephalosporins and compounds with potent activity against anaerobic bacteria, including ticarcillin-clavulanic acid. In some clinical studies, formulary alterations designed to minimize the use of extended-spectrum cephalosporins or ticarcillin-clavulanic acid have resulted in significant decreases in colonization and infection by GRE. Experimental data using a mouse model of GRE gastrointestinal colonization indicate that persistence of high-level GRE colonization of the mouse gastrointestinal tract is promoted by exposure to agents with potent activity against anaerobic bacteria, suggesting that reduction of competing flora is the major factor leading to persistence of high-level colonization. One study performed in humans is consistent with this model and suggests that high levels of colonization may promote spread of resistant organisms in the nosocomial setting. Establishing colonization with GRE in uncolonized mice correlates with exposure to agents that are (a) secreted into the bile in significant concentrations and (b) have negligible activity against the colonizing enterococcal strain. Differences between piperacillin-tazobactam and ceftriaxone in the establishment model can be attributed directly to differences in their anti-enterococcal activity. Modification of antimicrobial prescribing practices may play an important role in facilitating successful infection control efforts to limit GRE in the nosocomial setting.
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Affiliation(s)
- L B Rice
- Medical Service 111(W), Louis Stokes Cleveland VA Medical Center and Case Medical School, 10701 East Boulevard, Cleveland, OH 44106, USA.
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Decelis S, Borg MA, Cuschieri P. Absence of carriage of glycopeptide-resistant enterococci by at-risk hospitalised patients in Malta. Clin Microbiol Infect 2004; 10:861-2. [PMID: 15355423 DOI: 10.1111/j.1198-743x.2004.00971.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Stiefel U, Pultz NJ, Helfand MS, Donskey CJ. Efficacy of oral ramoplanin for inhibition of intestinal colonization by vancomycin-resistant enterococci in mice. Antimicrob Agents Chemother 2004; 48:2144-8. [PMID: 15155213 PMCID: PMC415563 DOI: 10.1128/aac.48.6.2144-2148.2004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ramoplanin is a glycolipodepsipeptide antibiotic with activity against gram-positive bacteria that is in clinical trials for prevention of vancomycin-resistant Enterococcus (VRE) bloodstream infections and treatment of Clostridium difficile diarrhea. Orally administered ramoplanin suppresses VRE intestinal colonization, but recurrences after discontinuation of treatment have frequently been observed. We used a mouse model to examine the efficacy of ramoplanin for inhibition of VRE colonization and evaluated the etiology of recurrences of colonization. Eight days of treatment with ramoplanin (100 microg/ml) in drinking water suppressed VRE to undetectable levels, but 100% of mice developed recurrent colonization; a higher dose of 500 microg/ml in water was associated with recurrent colonization in 50% of mice. Two of eight (25%) mice treated with the 100-microg/ml dose of ramoplanin had low levels of VRE in their cecal tissues on day 8 despite undetectable levels in stool and cecal contents. Mice that received prior ramoplanin treatment did not develop VRE overgrowth when challenged with 10(7) CFU of oral VRE 1, 2, or 4 days later. In communal cages, rapid cross-transmission and overgrowth of VRE was observed among clindamycin-treated mice; ramoplanin treatment effectively suppressed VRE overgrowth in such communal cages. Ramoplanin treatment promoted increased density of indigenous Enterobacteriaceae and overgrowth of an exogenously administered Klebsiella pneumoniae isolate. These results demonstrate the efficacy of ramoplanin for inhibition of VRE colonization and suggest that some recurrences occur due to reexpansion of organisms that persist within the lining of the colon. Ramoplanin treatment may be associated with overgrowth of gram-negative bacilli.
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Affiliation(s)
- Usha Stiefel
- Division of Infectious Diseases, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106, USA
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18
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McCafferty DG, Cudic P, Frankel BA, Barkallah S, Kruger RG, Li W. Chemistry and biology of the ramoplanin family of peptide antibiotics. Biopolymers 2003; 66:261-84. [PMID: 12491539 DOI: 10.1002/bip.10296] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The peptide antibiotic ramoplanin factor A2 is a promising clinical candidate for treatment of Gram-positive bacterial infections that are resistant to antibiotics such as glycopeptides, macrolides, and penicillins. Since its discovery in 1984, no clinical or laboratory-generated resistance to this antibiotic has been reported. The mechanism of action of ramoplanin involves sequestration of peptidoglycan biosynthesis Lipid intermediates, thus physically occluding these substrates from proper utilization by the late-stage peptidoglycan biosynthesis enzymes MurG and the transglycosylases (TGases). Ramoplanin is structurally related to two cell wall active lipodepsipeptide antibiotics, janiemycin, and enduracidin, and is functionally related to members of the lantibiotic class of antimicrobial peptides (mersacidin, actagardine, nisin, and epidermin) and glycopeptide antibiotics (vancomycin and teicoplanin). Peptidomimetic chemotherapeutics derived from the ramoplanin sequence may find future use as antibiotics against vancomycin-resistant Enterococcus faecium (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and related pathogens. Here we review the chemistry and biology of the ramoplanins including its discovery, structure elucidation, biosynthesis, antimicrobial activity, mechanism of action, and total synthesis.
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Affiliation(s)
- Dewey G McCafferty
- Department of Biochemistry and Biophysics and the Johnson Research Foundation, The University of Pennsylvania School of Medicine, Philadelphia 19104-6059, USA.
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Harbarth S, Cosgrove S, Carmeli Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci. Antimicrob Agents Chemother 2002; 46:1619-28. [PMID: 12019066 PMCID: PMC127216 DOI: 10.1128/aac.46.6.1619-1628.2002] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Stephan Harbarth
- Division of Infectious Diseases, Children's Hospital, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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20
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Sundsfjord A, Simonsen GS, Courvalin P. Human infections caused by glycopeptide-resistant Enterococcus spp: are they a zoonosis? Clin Microbiol Infect 2002; 7 Suppl 4:16-33. [PMID: 11688531 DOI: 10.1046/j.1469-0691.2001.00055.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following the detection of glycopeptide-resistant enterococci (GRE) in 1986 and their subsequent global dissemination during the 1990s, many studies have attempted to identify the reservoirs and lines of resistance transmission as a basis for intervention. The eradication of reservoirs and the prevention of GRE spread is of major importance for two reasons: (i) the emergence of high-level glycopeptide resistance in invasive enterococcal clinical isolates that are already multiresistant, has left clinicians with therapeutic options that are only at the experimental stage; and (ii) the resistance genes may spread to more virulent bacterial species such as Staphylococcus aureus, Streptococcus pneumoniae and Clostridium difficile. VanA-type strains, resistant to high levels of both vancomycin and teicoplanin, are the most commonly encountered enterococci with acquired glycopeptide resistance in humans. A widespread VanA-type GRE reservoir was detected early in farm animals that were exposed to the glycopeptide growth-promoter avoparcin. Numerous studies have provided indirect evidence for the transfer of VanA-type GRE and their resistance determinants from animal reservoirs to humans. The data collected have expanded our understanding of the promiscuous nature of antibiotic resistance, and have provided the groundwork for logical decision-making with the objective of deterring the dissemination of resistant bacteria and of their resistance genes.
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Affiliation(s)
- A Sundsfjord
- Unité des Agents Antibactériens, Institut Pasteur, Paris, France.
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21
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Baran J, Ramanathan J, Riederer KM, Khatib R. Stool colonization with vancomycin-resistant enterococci in healthcare workers and their households. Infect Control Hosp Epidemiol 2002; 23:23-6. [PMID: 11868888 DOI: 10.1086/501963] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the prevalence of stool colonization with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) and their families. DESIGN Prospective assessment of fecal colonization with VRE. SETTING A 603-bed, tertiary-care teaching hospital. PARTICIPANTS Healthy volunteers recruited from hospital employees and their households were screened to exclude pregnancy, diabetes mellitus, immunosuppressive disorders, and recent use of antimicrobials. INTERVENTION Self-obtained stool swabs were used to obtain cultures. Isolated enterococci were screened for vancomycin resistance and species were identified. Intra-household isolates were genotyped using pulsed-field gel electrophoresis (PFGE). RESULTS The participants (n = 228; age range, 28 days to 80 years) were from 137 households with and 91 without employees who had contact with patients. Enterococcus species were isolated from 127 stool specimens (55.7%). VRE were detected in 12 individuals, representing 6 E. casseliflavus, 5 E. faecium, and 1 E. gallinarum. VRE were more commonly isolated in employees who had contact with patients (5 of 52 vs 0 of 40; relative risk [RR], 1.9; 95% confidence interval [CI95], 1.5 to 2.2; P = .07) and their household members (10 of 137 vs 2 of 91; RR, 3.3; CI95, 0.7 to 14.8; P = .13). In 2 households (2 adults in a physician's household and an adult plus a child in a nurse's household) PFGE analysis demonstrated identical intra-household strains of vancomycin-resistant E. faecium. CONCLUSIONS VRE colonization was found in 5.3% of screened stools and was more prevalent in HCWs who had contact with patients and their households. Identical PFGE patterns between 2 employees who had contact with patients and their household members demonstrated probable intra-household spread. Although the mode of acquisition was uncertain, the association with employees who had contact with patients suggests possible occupational sources. These findings demonstrate the spread of VRE within the household and implicate occupational risk for its acquisition.
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Affiliation(s)
- Joseph Baran
- Medical Education Department, St John Hospital & Medical Center, Detroit, MI 48236, USA
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22
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McDonald LC, Rossiter S, Mackinson C, Wang YY, Johnson S, Sullivan M, Sokolow R, DeBess E, Gilbert L, Benson JA, Hill B, Angulo FJ. Quinupristin-dalfopristin-resistant Enterococcus faecium on chicken and in human stool specimens. N Engl J Med 2001; 345:1155-60. [PMID: 11642231 DOI: 10.1056/nejmoa010805] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The combination of the streptogramins quinupristin and dalfopristin was approved in the United States in late 1999 for the treatment of vancomycin-resistant Enterococcus faecium infections. Since 1974, another streptogramin, virginiamycin, has been used at subtherapeutic concentrations to promote the growth of farm animals, including chickens. METHODS To determine the frequency of quinupristin-dalfopristin-resistant E. faecium, we used selective medium to culture samples from chickens purchased in supermarkets in Georgia, Maryland, Minnesota, and Oregon and stool samples from outpatients. RESULTS Between July 1998 and June 1999, samples from 407 chickens from 26 stores in four states were cultured, as were 334 stool samples from outpatients. Quinupristin-dalfopristin-resistant E. faecium was isolated from 237 chicken carcasses and 3 stool specimens. The resistant isolates from stool had low-level resistance (minimal inhibitory concentration [MIC], 4 microg per milliliter; resistance was defined as a MIC of at least 4 microg per milliliter). The resistant isolates from chickens in general had higher levels of resistance (MICs ranging from 4 to 32 microg per milliliter; MIC required to inhibit 50 percent of isolates, 8 microg per milliliter). CONCLUSIONS Quinupristin-dalfopristin-resistant E. faecium contaminates a large proportion of chickens sold in U.S. supermarkets. However, the low prevalence and low level of resistance of these strains in human stool specimens suggest that the use of virginiamycin in animals has not yet had a substantial influence. Foodborne dissemination of resistance may increase, however, as the clinical use of quinupristin-dalfopristin increases.
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Affiliation(s)
- L C McDonald
- Hospital Infections Program, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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23
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Berends BR, van den Bogaard AE, Van Knapen F, Snijders JM. Human health hazards associated with the administration of antimicrobials to slaughter animals. Part II. An assessment of the risks of resistant bacteria in pigs and pork. Vet Q 2001; 23:10-21. [PMID: 11205995 DOI: 10.1080/01652176.2001.9695069] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Risks for the consumer regarding the acquisition of resistant bacteria and/or resistance genes via the consumption of pork are discussed. In general, Salmonella spp. and Escherichia coli that originate from animals do not easily transfer their resistance genes to the resident intestinal flora of humans. The prevalence of resistant E. coli in humans seems more associated with being a vegetarian (odds ratio (OR) 1.89) than with the consumption of meat and meat products. Other risk factors are treatment with antimicrobials (OR 2-5), becoming hospitalized (OR 5.93), or working in a health setting (OR 4.38). In the Netherlands, annually an estimated 45,000 people (0-150,000) become a carrier of resistant E. coli and/or resistance genes that ori ginate from pigs, while an estimated 345,000 persons (175,000-600,000) become a carrier of resistant E. coli and/or resistance genes that originate from hospitals, e.g. other patients. Any problems with resistant Salmonella spp. that stem from pigs are, in fact, an integral part of the total problem of food-borne salmonellosis. Sometimes there are outbreaks of a specific multi-resistant clone of S. typhimurium that causes problems in both farm animals and humans. The probability that in the next 30 years there is no or maximally one outbreak of a specific clone that originates from pig herds is estimated at about 75%. Antimicrobials used as a growth promoter can have a measurable influence on the prevalence of resistant bacteria. The likely chain of events regarding avoparcin and the selection and dissemination of resistance against vancomycin in the enterococci gives the impression that the impact of the use of antimicrobials in animals on the prevalence of resistance in humans is largely determined by whether resistance genes are, or become, located on a self-transferable transposon. Furthermore, consumer health risks of antimicrobials used in slaughter pigs are mainly determined by the selection and dissemination of bacterial resistance and much less by the toxicological properties of any residues in pork. It is also concluded that most of the problems with resistant bacteria in humans are associated with the medical use of antimicrobials, and that the impact of particularly the veterinary use of antimicrobials is limited. However, the impact of antimicrobials used as a feed additive appears to be much greater than that of antimicrobials used for strictly veterinary purposes. The use of antimicrobials as a feed additive should therefore be seriously reconsidered.
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Affiliation(s)
- B R Berends
- Department of the Science of Food of Animal Origin, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
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24
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Levison ME, Mallela S. Increasing Antimicrobial Resistance: Therapeutic Implications for Enterococcal Infections. Curr Infect Dis Rep 2000; 2:417-423. [PMID: 11095886 DOI: 10.1007/s11908-000-0068-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Enterococcus was designated a genus distinct from the streptococci in 1984. Enterococci cause a variety of monomicrobial and polymicrobial infections, mainly in compromised patients. These infections include bacteremia, urinary and biliary tract infections, intra-abdominal sepsis, and decubitus and diabetic foot ulcers. Enterococcal infections may be acquired from the patient's endogenous intestinal flora or exogenously from a fecally contaminated environment. Enterococci are inherently resistant to many antimicrobial agents and readily acquire additional resistances, which is likely the reason that enterococci have become prominent nosocomial pathogens. Only the combination of a cell wall-active antibiotic to which the Enterococcus is susceptible (ie, certain beta-lactams or vancomycin) plus an aminoglycoside (ie, gentamicin or streptomycin) is bactericidal, and is required for cure of endocarditis, meningitis and probably infection in neutropenic patients; bacteriostatic activity is sufficient to treat most other infections. Treatment of infections caused by strains resistant to beta-lactams, glycopeptides and aminoglycosides has become problematic due the limited number of therapeutic options. No medical therapy is reliably effective for endocarditis caused by strains resistant to all cell wall-active antibiotics and all aminoglycosides. New antimicrobial agents, such as linezolid and quinupristin/dalfopristin, have recently become available, but their activity against enterococci is mainly bacterostatic.
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Affiliation(s)
- ME Levison
- Division of Infectious Diseases, MCP Hahnemann University, 3300 Henry Avenue, Philadelphia, PA 19129, USA.
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25
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Antibiotic-resistant genes in gram-positive bacterial pathogens. Curr Opin Crit Care 2000. [DOI: 10.1097/00075198-200010000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Dever LL, Handwerger S. Persistence of vancomycin-resistant Enterococcus faecium gastrointestinal tract colonization in antibiotic-treated mice. Microb Drug Resist 2000; 2:415-21. [PMID: 9158812 DOI: 10.1089/mdr.1996.2.415] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Colonization with vancomycin-resistant Enterococcus faecium (VREF) is strongly associated with previous antimicrobial therapy. The gastrointestinal (GI) tract appears to be the major reservoir for this organism. We used antibiotic-treated Swiss Webster mice to study GI tract colonization with a characterized strain of VREF (E. faecium 228). Mice were pretreated with antibiotics in their daily drinking water and inoculated with 10(9) colony-forming units (CFU) of E. faecium 228 by oral gavage. We were able to establish persistent colonization with high concentrations of E. faecium 228 (> 8.0 log10 CFU/g of feces) in animals treated with 5 mg/ml of streptomycin plus 1 mg/ml of cefotetan. RP 59500, a streptogramin antibiotic with good in vitro activity against VREF, was administered orally in mice (n = 8) colonized with E. faecium 228. After 14 days of treatment VREF was undetectable in feces of all treated mice (< 3.0 CFU/g). Seven days after discontinuation of RP 59500, VREF was present in the feces of all animals. VREF isolates recovered after treatment remained susceptible to RP 59500. Attempts to eradicate E. faecium 228 colonization by oral administration of a vancomycin-sensitive E. faecium strain (SF68) or Lactobacillus spp. were unsuccessful as long as animals continued to receive streptomycin and cefotetan. Recovery of E. faecium 228 from cultures of livers and gallbladders in some animals with persistent GI tract colonization suggests that the organisms may also colonize the hepatobiliary system.
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Affiliation(s)
- L L Dever
- Infectious Disease Section, Department of Veterans Affairs Medical Center, East Orange, New Jersey 07018, USA
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27
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Affiliation(s)
- B E Murray
- Department of Medicine, and Center for the Study of Emerging and Re-Emerging Pathogens, University of Texas Medical School, Houston 77030, USA.
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28
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Abstract
Vancomycin-resistant enterococci have spread widely throughout the United States. Mechanisms of glycopeptide resistance are understood to a significant extent. These organisms are associated with considerable morbidity. Treatment options are limited, and control of their spread requires considerable effort and results in increased costs.
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29
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Toye B, Shymanski J, Bobrowska M, Woods W, Ramotar K. Clinical and epidemiological significance of enterococci intrinsically resistant to vancomycin (possessing the vanC genotype). J Clin Microbiol 1997; 35:3166-70. [PMID: 9399514 PMCID: PMC230142 DOI: 10.1128/jcm.35.12.3166-3170.1997] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Constitutive low-level vancomycin resistance is found intrinsically in certain enterococcal species and is encoded by vanC ligase genes. These intrinsically vancomycin-resistant enterococci (VRE) will be referred to as VANC VRE. A prospective study to determine the clinical and epidemiologic significance of VANC VRE was conducted. VANC VRE were recovered from the stools of 34 of 601 (5.7%) patients, a rate similar to that obtained for the stools of 100 outpatients in the community (5%). VANC VRE were also isolated from the nonstool specimens of 9 of 538 patients (1.7%), including two patients with bacteremia. No VRE of the vanA or vanB genotypes were detected in nonstool specimens. Eighty-two hospital contacts of the first 23 patients found to be colonized or infected with VANC VRE were screened, and 6 contacts were found to be gastrointestinal carriers of VANC VRE. However, typing of isolates from these 6 contacts by pulsed-field gel electrophoresis with SmaI showed the isolates to be unique and different from those recovered from the index patients. In fact, all VANC VRE isolates from different patients in this study were unique. A case-control study with patients who were negative when screened for VANC VRE as controls failed to identify any risk factor associated with colonization or infection with this organism. VANC VRE were infrequently recovered from clinical specimens but were occasionally found as part of the normal stool flora. Since no transmission between patients was documented, additional isolation procedures may not be necessary for patients colonized or infected with VANC VRE.
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Affiliation(s)
- B Toye
- Department of Pathology and Laboratory Medicine, Ottawa General Hospital, University of Ottawa, Ontario, Canada.
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Bager F, Madsen M, Christensen J, Aarestrup FM. Avoparcin used as a growth promoter is associated with the occurrence of vancomycin-resistant Enterococcus faecium on Danish poultry and pig farms. Prev Vet Med 1997; 31:95-112. [PMID: 9234429 DOI: 10.1016/s0167-5877(96)01119-1] [Citation(s) in RCA: 293] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We determined the association between the use of the glycopeptide antibiotic avoparcin as a growth promoter and the occurrence of Enterococcus faecium (VREF) with high-level resistance to vancomycin (MIC > or = 64 micrograms ml-1) on poultry and pig farms. The investigations were conducted as retrospective cohort studies, where groups of farms exposed or not exposed to avoparcin between September 1994 and April 1995 were compared. In poultry, the association between the use of avoparcin and the occurrence of VREF was confounded by the use of broad-spectrum antibiotics, and the adjusted relative risk was 2.9 (1.4-5.9). In pigs, the association had a similar magnitude with a non-adjusted relative risk of 3.3 (0.9-12.3). The similar findings in the two studies provide evidence in favour of a causal association between the use of avoparcin and the occurrence of VREF on farms, and suggest that food animals constitute a potential reservoir of infection for VREF in humans.
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Affiliation(s)
- F Bager
- Danish Veterinary Laboratory, Copenhagen, Denmark.
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31
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McDonald LC, Kuehnert MJ, Tenover FC, Jarvis WR. Vancomycin-resistant enterococci outside the health-care setting: prevalence, sources, and public health implications. Emerg Infect Dis 1997; 3:311-7. [PMID: 9284375 PMCID: PMC2627647 DOI: 10.3201/eid0303.970307] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although nosocomial acquisition and subsequent colonization of vancomycin-resistant enterococci (VRE), an emerging international threat to public health, has been emphasized in the United States, colonization among nonhospitalized persons has been infrequently documented. In contrast, in Europe, colonization appears to occur frequently in persons outside the health-care setting. An important factor associated with VRE in the community in Europe has been avoparcin, a glycopeptide antimicrobial drug used for years in many European nations at subtherapeutic doses as a growth promoter in food-producing animals. In Europe, evidence suggests that foodborne VRE may cause human colonization. Although avoparcin has never been approved for use in the United States, undetected community VRE transmission may be occurring at low levels. Further studies of community transmission of VRE in the United States are urgently needed. If transmission with VRE from unrecognized community sources can be identified and controlled, increased incidence of colonization and infection among hospitalized patients may be prevented.
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Affiliation(s)
- L C McDonald
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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