Vancomycin-resistant enterococcus
An emergent problem in Uruguay
Keywords:
ENTEROCOCCUS, VANCOMYCIN RESISTANCE
Abstract
Enterococcus were normally considered bacterium of low pathogenicity; in the last two decades they have been increasingly determined as an important cause of hospital-acquired infection.
In the past they were categorized as Streptococcus because they are Gram-positive cocci, facultative anaerobes and catalase-negative; however, genetic studies indicated that they belonged to a new gender, Enterococcus. They show intrinsic low antibiotic resistance to beta-lactams and aminoglucosides. They could become resistant to the same groups of antibiotics and have become resistant to glycopeptides (vancomycin and teicoplanine) which is the main problem of this gender, especially for Enterococcus faecium.
Seven resistant-glycopeptide genotypes named vanA to vanG were reported, so far only vanA y vanB have clinical impact because of their capacity of transfer among different species and gender. Vancomycin-resistant Enterococcus infection (ERV) are produced almost exclusively in hospitals. The first three cases detected in Uruguay were isolated from an urinary colony, a multibacterial intraabdominal infection and an infective endocarditis. The circulation of VRE strains in a health center demands the implementation of vigilance policies in order to identify the reservoir and set control measures against cross-transmission.
The objective of the paper is to notify Vancomycin-resistant Enterococcus faecium isolates, and a review of the issue in order to understand its significance and trascendance as well as the eventual control measures to be implemented.
References
1) Moellering RC. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis 1992; 14(6): 1173-6
2) Murray BE. The life and times of the Enterococcus. Clin Microbiol Rev 1990; 3(1): 46-65.
3) Sader HS. Resistencia antimicrobiana en Latinoamerica: ¿cómo estamos? Rev Chilena Infectol 2002; 19(suppl 1): S5-S13.
4) Sievert DM, Boulton ML, Stoltman G, Johnson D, Stobierski MG, Downes FP, et al. Staphylococccus aureus resistant to vancomycin-United States, 2002. MMWR Morb Mortal Wkly Rep 2002; 51(26): 565-7.
5) Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995; 16(2): 105-13.
6) Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmision of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003; 24(5): 362-86.
7) Zervos MJ, Dembiski S, Mikesell T, Schaberg DR. High level resistance in Streptococcus faecalis: risk factors and evidence of exogenous acquisition of infection. J Infect Dis 1986; 153(6): 1075-83.
8) Murray BE, Singh KV, Markowitz SM, Lopardo HA, Patterson JE, Zervos MJ, et al. Evidence of clonal spread of a single strain of beta-lactamase producing Enterococcus (Streptococcus) feacalis to six hospitals in five states. J Infect Dis 1991; 163(4): 780-5.
9) Maki DG, Agger WA. Enterococcal bacteremia: clinical features, the risk of endocarditis and management. Medicine (Baltimore) 1988, 67(4): 248-69.
10) Graninger W, Ragette R. Nosocomial bacteremia due to Enterococcus faecalis without endocarditis. Clin Infect Dis 1992; 15(1): 49-57.
11) Rybkine T, Mainardi Jl, Sougakoff W, Collatz E, Gutmann L. Penicillin-binding protein 5 sequence alterations in clinical isolates of Enterococcus faecium with different levels of beta-lactam resistance. J Infect Dis 1998; 178(1): 159-63.
12) Bryan LE, Van-den-Elzen HM. Effects of membrane-energy mutations and cations on streptomycin and gentamicin accumulation by bacteria: a model for entry of streptomycin and gentamicin in susceptible and resistant bacteria. Antimicrob Agents Chemother 1977; 12(2): 163-77.
13) Patterson JE, Zervos MJ. High level gentamicin resistance in Enterococcus: microbiology, genetic basis and epidemiology. Rev Infect Dis 1990; 12(4): 644-52.
14) Murray BE. Beta-lactamase producing enterococci. Antimicrob Agents Chemother 1992; 36(11): 2355-9.
15) Fontana R, Aldegheri M, Ligozzi M, López H, Sucari A, Satta G. Overproduction of a low-affinitity penicillin-binding protein and high level ampicillin resistance in Enterococcus faecium. Antimicrob Agents Chemother 1994; 38(9): 1980-3.
16) Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin resistant enterococci. Lancet 1988; 1(8575-6): 57-8.
17) Sahm DF, Kissinger J, Gilmore MS, Murray PR, Mulder R, Solliday J, et al. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother. 1989; 33(9): 1588-91.
18) Boyce JM. Vancomycin-resistant enterococcus. Infect Dis Clin North Am 1997; 11(2): 367-84.
19) Dalla-Costa LM, Souza DC, Martins LT, Zanella RC, Brandilone MC, Bokerman S, et al. Vancomycin resistant Enterococcus faecium: first case in Brazil. Braz J Infect Dis 1998; 2(3): 160-3.
20) Marin ME, Mera JR, Arduino RC, Correa AP, Coque TM, Stamboulian D, et al. First report of vancomycin-resistant Enterococcus faecium isolated in Argentina. Clin Infect Dis. 1998; 26(1): 235-6.
21) Panesso D, Ospina S, Robledo J, Vela MC, Pena J, Hernández O, et al. First characterization of a cluster of VanA-type glycopeptide resistant Enterococcus faecium, Colombia. Emerg Infect Dis 2002; 8(9): 961-5.
22) Zanella RC, Brandileone MC, Bokermann S, Almeida SC, Valdelaro F, Vitorio F, et al. Phenotype and genotype characterization of VanA Enterococcus isolated during the first nosocomial outbreak in Brazil. Microb Drug Resist 2003; 9(3): 283-91.
23) Woodford N, Johnson A, Morrison D, Speller DC. Current perspectives on glycopeptide resistance. Clin Microbiol Rev 1995; 8(4): 585-615.
24) Perichon B, Reynolds P, Courvalin P. VanD-type glycopeptide-resistant Enterococcus faecium BM4339. Antimicrob Agents Chemother 1997; 41(9): 2016-8.
25) Fines M, Perichon B, Reynolds P, Sahm D, Courvalin P. VanE, a new type of adquired glycopeptide resistance in Enterococcus faecalis BM4405. Antimicrob Agents Chemother 1999; 43(9): 2161-4
26) McKessar SJ, Berry AM, Bell JM, Turnidge JD, Paton JC. Genetic characterization of vanG, a novel vancomycin resistance locus of Enterococcus faecalis. Antimicrob Agents Chemother 2000; 44(11): 3224-8.
27) Arthur M, Molinas C, Depardieu F, Courvalin P. Characterization of Tn1546 a Tn3-related transposon conferring glycopeptide resistance by synthesis of depsipeptide peptidoglycan precursors in Enterococcus faecium. BM4147. J Bacteriol 1993; 175(1): 117-27.
28) Quintiliani R, Evers S, Courvalin P. The vanB gene confers various levels of self-transferable resistance to vancomycin in enterococci. J Infect Dis 1993; 167(5): 1220-3.
29) Miranda G, Corso A, Melano R, Arismendi P, Rodríguez M, Garbervetsky L. First isolation of vancomycin-resistant Enterococcus faecium with vanB genotype in Argentina: presentation of two cases. Rev Argent Microbiol 2003; 35(1): 41-4.
30) Coque TM, Tomayko JF, Ricke SC, Okhyusen PC, Murray BE. Vancomycin-resistant enterococci from nosocomial, community, and animal sources in the Unites States. Antimicrob Agents Chemother 1996; 40(11): 2605-9.
31) Kirst HA, Thompson DG, Nicas TI. Historical yearly usage of vancomycin (letter to editor). Antimicrob Agents Chemother 1998; 42(5): 1303-4.
32) Rice LB. Emergence of vancomycin-resistant enterococci. Emerg Infect Dis 2001; 7(2): 183-7.
33) Wegener HC, Aarestrup FM, Jensen LB, Hammerum AM, Bager F. Use of antimicrobial growth promoters in food animals and Enterococcus faecium resistance to therapeutic antimicrobial drugs in Europe. Emerg Infect Dis 1999; 5(3): 329-35.
34) Devriese L, Ieven M, Goossens H, Vandamme P, Pot B, Hommez J, et al. Presence of vancomycin-resistant enterococci in farm and pet animals. Antimicrob Agents Chemother 1996; 40(10): 2285-7.
35) Lai KK, Fontecchio SA, Kelley AL, Melvin ZS, Baker S. The epidemiology of fecal carriage of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997; 18(11): 762-5.
36) Bonten MJ, Hayden MK, Nathan C, van Voorhis J, Matushek M, Slaughter S, et al. Epidemiology of colonization of patients and environment with vancomycin-resistant enterococci. Lancet 1996; 348(9042): 1615-9.
37) DeLisle S, Perl TM. Vancomycin-resistant enterococci. Chest 2003; 123(5 Suppl): 504S-18S.
38) Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant enterococci. Clin Microbiol Rev 2000; 13(4): 686-707.
39) Mensa J, García-Vázquez E, Vila J. Macrólidos, estólidos y estreptograminas. Enf Infecc Microbiol Clin 2003; 21: 200-8.
40) Pigrau C. Oxazolidonas y glicopéptidos. Enf Infecc Microbiol Clin 2003; 21: 157-65.
41) Potoski B, Mangino JE, Goff DA. Clinical failures of linezolid and implications for the clinical microbiology laboratories. Emerg Infect Dis 2002; 8(12): 1519-20.
42) Pedreira W, Sáenz C, Varela A. Resistencia bacteriana en Enterococcus. Resultados preliminares. Encuentro Nacional de Microbiólogos, 1. Montevideo, Noviembre 1989.
43) Quintana A, Rodríguez G, Jorge L, Seija V. Nuevos mecanismos de resistencia antibiótica en Enterococcus spp: situación epidemiológica en el Uruguay. Arch Med Interna 1994; 3: 113-6.
44) Bazet C, Elicabe M, Velázquez JL, Viña L Silveira P. Resistencia del género Enterococcus, vigilancia epidemológica. Rev Urug Patol Clin 2000; 33: 83-4.
45) Wong AH, Wenzel R, Edmond MB. Epidemiology of bacteriuria caused by vancomycin resistant enterococci, a retrospective study. Am J Infect Control 2000; 28(4): 277-81.
46) Bazet C, Soca A, Bono C, Velázquez JL, Bentancourt S. Bacteriuria por Enterococcus faecium resistente a vancomicina. Rev Urug Patol Clin 2001; 34: 23-34.
47) Harbarth S, Uckay I. Are there patients with peritonitis who require empiric therapy for enterococcus? Eur J Clin Microbiol Infect Dis 2004; 23(2): 73-7.
2) Murray BE. The life and times of the Enterococcus. Clin Microbiol Rev 1990; 3(1): 46-65.
3) Sader HS. Resistencia antimicrobiana en Latinoamerica: ¿cómo estamos? Rev Chilena Infectol 2002; 19(suppl 1): S5-S13.
4) Sievert DM, Boulton ML, Stoltman G, Johnson D, Stobierski MG, Downes FP, et al. Staphylococccus aureus resistant to vancomycin-United States, 2002. MMWR Morb Mortal Wkly Rep 2002; 51(26): 565-7.
5) Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995; 16(2): 105-13.
6) Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmision of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003; 24(5): 362-86.
7) Zervos MJ, Dembiski S, Mikesell T, Schaberg DR. High level resistance in Streptococcus faecalis: risk factors and evidence of exogenous acquisition of infection. J Infect Dis 1986; 153(6): 1075-83.
8) Murray BE, Singh KV, Markowitz SM, Lopardo HA, Patterson JE, Zervos MJ, et al. Evidence of clonal spread of a single strain of beta-lactamase producing Enterococcus (Streptococcus) feacalis to six hospitals in five states. J Infect Dis 1991; 163(4): 780-5.
9) Maki DG, Agger WA. Enterococcal bacteremia: clinical features, the risk of endocarditis and management. Medicine (Baltimore) 1988, 67(4): 248-69.
10) Graninger W, Ragette R. Nosocomial bacteremia due to Enterococcus faecalis without endocarditis. Clin Infect Dis 1992; 15(1): 49-57.
11) Rybkine T, Mainardi Jl, Sougakoff W, Collatz E, Gutmann L. Penicillin-binding protein 5 sequence alterations in clinical isolates of Enterococcus faecium with different levels of beta-lactam resistance. J Infect Dis 1998; 178(1): 159-63.
12) Bryan LE, Van-den-Elzen HM. Effects of membrane-energy mutations and cations on streptomycin and gentamicin accumulation by bacteria: a model for entry of streptomycin and gentamicin in susceptible and resistant bacteria. Antimicrob Agents Chemother 1977; 12(2): 163-77.
13) Patterson JE, Zervos MJ. High level gentamicin resistance in Enterococcus: microbiology, genetic basis and epidemiology. Rev Infect Dis 1990; 12(4): 644-52.
14) Murray BE. Beta-lactamase producing enterococci. Antimicrob Agents Chemother 1992; 36(11): 2355-9.
15) Fontana R, Aldegheri M, Ligozzi M, López H, Sucari A, Satta G. Overproduction of a low-affinitity penicillin-binding protein and high level ampicillin resistance in Enterococcus faecium. Antimicrob Agents Chemother 1994; 38(9): 1980-3.
16) Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin resistant enterococci. Lancet 1988; 1(8575-6): 57-8.
17) Sahm DF, Kissinger J, Gilmore MS, Murray PR, Mulder R, Solliday J, et al. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother. 1989; 33(9): 1588-91.
18) Boyce JM. Vancomycin-resistant enterococcus. Infect Dis Clin North Am 1997; 11(2): 367-84.
19) Dalla-Costa LM, Souza DC, Martins LT, Zanella RC, Brandilone MC, Bokerman S, et al. Vancomycin resistant Enterococcus faecium: first case in Brazil. Braz J Infect Dis 1998; 2(3): 160-3.
20) Marin ME, Mera JR, Arduino RC, Correa AP, Coque TM, Stamboulian D, et al. First report of vancomycin-resistant Enterococcus faecium isolated in Argentina. Clin Infect Dis. 1998; 26(1): 235-6.
21) Panesso D, Ospina S, Robledo J, Vela MC, Pena J, Hernández O, et al. First characterization of a cluster of VanA-type glycopeptide resistant Enterococcus faecium, Colombia. Emerg Infect Dis 2002; 8(9): 961-5.
22) Zanella RC, Brandileone MC, Bokermann S, Almeida SC, Valdelaro F, Vitorio F, et al. Phenotype and genotype characterization of VanA Enterococcus isolated during the first nosocomial outbreak in Brazil. Microb Drug Resist 2003; 9(3): 283-91.
23) Woodford N, Johnson A, Morrison D, Speller DC. Current perspectives on glycopeptide resistance. Clin Microbiol Rev 1995; 8(4): 585-615.
24) Perichon B, Reynolds P, Courvalin P. VanD-type glycopeptide-resistant Enterococcus faecium BM4339. Antimicrob Agents Chemother 1997; 41(9): 2016-8.
25) Fines M, Perichon B, Reynolds P, Sahm D, Courvalin P. VanE, a new type of adquired glycopeptide resistance in Enterococcus faecalis BM4405. Antimicrob Agents Chemother 1999; 43(9): 2161-4
26) McKessar SJ, Berry AM, Bell JM, Turnidge JD, Paton JC. Genetic characterization of vanG, a novel vancomycin resistance locus of Enterococcus faecalis. Antimicrob Agents Chemother 2000; 44(11): 3224-8.
27) Arthur M, Molinas C, Depardieu F, Courvalin P. Characterization of Tn1546 a Tn3-related transposon conferring glycopeptide resistance by synthesis of depsipeptide peptidoglycan precursors in Enterococcus faecium. BM4147. J Bacteriol 1993; 175(1): 117-27.
28) Quintiliani R, Evers S, Courvalin P. The vanB gene confers various levels of self-transferable resistance to vancomycin in enterococci. J Infect Dis 1993; 167(5): 1220-3.
29) Miranda G, Corso A, Melano R, Arismendi P, Rodríguez M, Garbervetsky L. First isolation of vancomycin-resistant Enterococcus faecium with vanB genotype in Argentina: presentation of two cases. Rev Argent Microbiol 2003; 35(1): 41-4.
30) Coque TM, Tomayko JF, Ricke SC, Okhyusen PC, Murray BE. Vancomycin-resistant enterococci from nosocomial, community, and animal sources in the Unites States. Antimicrob Agents Chemother 1996; 40(11): 2605-9.
31) Kirst HA, Thompson DG, Nicas TI. Historical yearly usage of vancomycin (letter to editor). Antimicrob Agents Chemother 1998; 42(5): 1303-4.
32) Rice LB. Emergence of vancomycin-resistant enterococci. Emerg Infect Dis 2001; 7(2): 183-7.
33) Wegener HC, Aarestrup FM, Jensen LB, Hammerum AM, Bager F. Use of antimicrobial growth promoters in food animals and Enterococcus faecium resistance to therapeutic antimicrobial drugs in Europe. Emerg Infect Dis 1999; 5(3): 329-35.
34) Devriese L, Ieven M, Goossens H, Vandamme P, Pot B, Hommez J, et al. Presence of vancomycin-resistant enterococci in farm and pet animals. Antimicrob Agents Chemother 1996; 40(10): 2285-7.
35) Lai KK, Fontecchio SA, Kelley AL, Melvin ZS, Baker S. The epidemiology of fecal carriage of vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 1997; 18(11): 762-5.
36) Bonten MJ, Hayden MK, Nathan C, van Voorhis J, Matushek M, Slaughter S, et al. Epidemiology of colonization of patients and environment with vancomycin-resistant enterococci. Lancet 1996; 348(9042): 1615-9.
37) DeLisle S, Perl TM. Vancomycin-resistant enterococci. Chest 2003; 123(5 Suppl): 504S-18S.
38) Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant enterococci. Clin Microbiol Rev 2000; 13(4): 686-707.
39) Mensa J, García-Vázquez E, Vila J. Macrólidos, estólidos y estreptograminas. Enf Infecc Microbiol Clin 2003; 21: 200-8.
40) Pigrau C. Oxazolidonas y glicopéptidos. Enf Infecc Microbiol Clin 2003; 21: 157-65.
41) Potoski B, Mangino JE, Goff DA. Clinical failures of linezolid and implications for the clinical microbiology laboratories. Emerg Infect Dis 2002; 8(12): 1519-20.
42) Pedreira W, Sáenz C, Varela A. Resistencia bacteriana en Enterococcus. Resultados preliminares. Encuentro Nacional de Microbiólogos, 1. Montevideo, Noviembre 1989.
43) Quintana A, Rodríguez G, Jorge L, Seija V. Nuevos mecanismos de resistencia antibiótica en Enterococcus spp: situación epidemiológica en el Uruguay. Arch Med Interna 1994; 3: 113-6.
44) Bazet C, Elicabe M, Velázquez JL, Viña L Silveira P. Resistencia del género Enterococcus, vigilancia epidemológica. Rev Urug Patol Clin 2000; 33: 83-4.
45) Wong AH, Wenzel R, Edmond MB. Epidemiology of bacteriuria caused by vancomycin resistant enterococci, a retrospective study. Am J Infect Control 2000; 28(4): 277-81.
46) Bazet C, Soca A, Bono C, Velázquez JL, Bentancourt S. Bacteriuria por Enterococcus faecium resistente a vancomicina. Rev Urug Patol Clin 2001; 34: 23-34.
47) Harbarth S, Uckay I. Are there patients with peritonitis who require empiric therapy for enterococcus? Eur J Clin Microbiol Infect Dis 2004; 23(2): 73-7.
Published
2005-06-30
How to Cite
1.
Bazet C, Blanco J, Seija V, Palacio R. Vancomycin-resistant enterococcus. Rev. Méd. Urug. [Internet]. 2005Jun.30 [cited 2024May17];21(2):151-8. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/818
Section
Casuistry
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
