When was vre first discovered

Huycke M. Lindahl G. Infect Immun 67 : — Lockatell C. Drachenberg C. Johnson D. Infect Immun 69 : — Nature : — Smabrekke L. Monnet D. J Antimicrob Chemother 51 : — Aasnes B. Rosvoll T. Van Den B. Suppola J. Kolho E. Salmenlinna S. Tarkka E. Vuopio-Varkila J. Vaara M. Swaminathan B. Barrett T. Hunter S. Tauxe R. Emerg Infect Dis 7 : — Gerner-Smidt P. Lukinmaa S. Kam K. Rolando S.

Gutierrez E. Binsztein N. Foodborne Pathog Dis 3 : 36 — Tankovic J. Mahjoubi F. Leclerco R. Tendolkar P. Teng F. Kawalec M. Hryniewicz W. Infect Immun 71 : — Arbeit R. Mickelsen P. Persing D. J Clin Microbiol 33 : — Thouverez M. Talon D. Clin Microbiol Infect 10 : — Timmers G. Van Der Zwet W. Simoons-Smit I. Savelkoul P. Meester H. Vandenbroucke-Grauls C. Huijgens P. Br J Haematol : — Toledo-Arana A.

Valle J. Solano C. Arrizubieta M. Cucarella C. Lamata M. Amorena B. Leiva J. Penades J. Lasa I. Schouls L. J Clin Microbiol 42 : — Blok H. De Regt M. Jalink K. Goorhuis B.

Clin Microbiol Infect 13 : — Torell E. Cars O. Olsson-Liljequist B. Hoffman B. Lindback J. Burman L. Treitman A. Yarnold P. Warren J. Noskin G. Uttley A. Collins C. Naidoo J. George R. Lancet 1 : 57 — Van Belkum A. Thomassen R. Verbrugh H. Endtz H. Lancet : — Mertens P. J Antimicrob Chemother 40 : — J Antimicrob Chemother 46 : — J Antimicrob Chemother 49 : — Van Den Braak N. Van Keulen M. Vliegenthart J. Van der Auwera P. Pensart N. Korten V. Van Der Steen L. Van Kregten E. Harssema-Poot J.

Gaillard C. Ned Tijdschr Geneeskd : — Hendrickx A. Posthuma G. Infect Immun 75 : — Weaver K. Churchward G. Weigel L. Gill S. Clark N. McDougal L. Flannagan S. Kolonay J. Shetty J. Killgore G. Donlan R. Shin D. Antimicrob Agents Chemother 51 : — Werner G.

Spencker F. J Antimicrob Chemother 52 : — Hildebrandt B. Drug resistance in Enterococci Kobayashi N. Research Signpost , Kerala, India. Mevius D. Hendriks G. Van Santen M. Grundmann H. Emerg Infect Dis 11 : — Le Bouguenec C. Horaud T. J Gen Microbiol : — Delbos F. Acar J. Wirth R. Chemotherapy 45 : — Adebiyi A. Palepou M.

Zervos M. Kauffman C. Therasse P. Bergman A. Mikesell T. Schaberg D. An epidemiologic study. Ann Intern Med : — Zorzi W. Zhou X. Dardenne O. Lamotte J. Raze D. Pierre J. Coyette J. Oxford University Press is a department of the University of Oxford.

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Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume This article was originally published in. Article Contents Abstract. Antimicrobial resistance in enterococci. Ampicillin resistance. Glycopeptide resistance. Clinical epidemiology of ampicillin and VRE. Methods to study the genetic relatedness of E. Virulence determinants in E. Concluding remarks.

Emergence of CC17 Enterococcus faecium : from commensal to hospital-adapted pathogen. Janetta Top , Janetta Top. Oxford Academic.

Rob Willems. Marc Bonten. Editor: Willem van Leeuwen. Revision received:. Select Format Select format. Permissions Icon Permissions. Abstract For many years, Enterococcus faecium was considered to be a commensal of the digestive tract, which only sporadically caused opportunistic infections in severely ill patients.

Enterococcus faecium , ampicillin resistance , vancomycin resistance , virulence , clinical epidemiology , molecular typing methods. Table 1 Antimicrobial susceptibility of enterococci. Open in new tab. Table 2 Level and type of resistance to vancomycin in enterococci.

Effect of abolishment of the use of antimicrobial agents for growth promotion on occurrence of antimicrobial resistance in fecal enterococci from food animals in Denmark. Google Scholar Crossref. Search ADS. Al Obeid. Modification of penicillin-binding proteins of penicillin-resistant mutants of different species of enterococci.

The emergence of vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus. Resistance of Enterococcus faecium to neutrophil-mediated phagocytosis. Google Scholar PubMed.

Characterization of Tn , a Tn 3 -related transposon conferring glycopeptide resistance by synthesis of depsipeptide peptidoglycan precursors in Enterococcus faecium BM Variant esp gene in vancomycin-sensitive Enterococcus faecium. The structure and mode of action of glycopeptide antibiotics of the vancomycin group. Vancomycin-resistant Enterococcus faecium isolates causing hospital outbreaks in northern Italy belong to the multilocus sequence typing C1 lineage.

Stability of vancomycin-resistant enterococcal genotypes isolated from long-term-colonized patients. Vancomycin-resistant enterococci: why are they here, and where do they come from? Continuing high prevalence of VanA-type vancomycin-resistant enterococci on Norwegian poultry farms three years after avoparcin was banned. Persistence of vancomycin-resistant enterococci VRE on Norwegian broiler farms.

VanA-type vancomycin-resistant enterococci VRE remain prevalent in poultry carcasses 3 years after avoparcin was banned. Cloning and heterospecific expression of the resistance determinant v anA encoding high-level resistance to glycopeptides in Enterococcus faecium BM Different levels of genetic homogeneity in vancomycin-resistant and -susceptible Enterococcus faecium isolates from different human and animal sources analyzed by amplified-fragment length polymorphism.

Genetic linkage and cotransfer of a novel, vanB -containing transposon Tn and a low-affinity penicillin-binding protein 5 gene in a clinical vancomycin-resistant Enterococcus faecium isolate. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene.

Separation of large DNA molecules by contour-clamped homogeneous electric fields. Vancomycin-resistant enterococci from nosocomial, community, and animal sources in the United States. High occurrence of esp among ampicillin-resistant and vancomycin-susceptible Enterococcus faecium clones from hospitalized patients.

Population structure of Enterococcus faecium causing bacteremia in a Spanish university hospital: setting the scene for a future increase in vancomycin resistance? Streptococcus faecium outbreak in a neonatal intensive care unit. Novel mechanism of resistance to glycopeptide antibiotics in Enterococcus faecium. Survey for virulence determinants among Enterococcus faecalis isolated from different sources. In the outbreak wards, cleaning in general, and point disinfection in particular, were reinforced, and hospitalization of patients in the ward corridor was no longer accepted.

Patients who had been admitted to the hospital while the spread of VRE was assumed to be at the highest July—September were screened if rehospitalized. Each new VRE case led to further screening of all patients on the ward in which the patient was hospitalized. Prior to the outbreak, the hospital already cooperated well with the municipal health services and this was very useful in the outbreak setting. Patients were screened before transfer between the hospital and primary health care institutions.

To discover satellite outbreaks, thorough screenings were also conducted in nursing homes where residents were VRE-positive. VRE-sampling was also performed ahead of transfer to other hospitals, and with readmission of patients who had previously stayed at the hospital during the outbreak period.

In accordance with recommendations from the Norwegian Institute of Public Health, hospital staff was not tested From October, the number of new cases was declining steadily, from eight cases in November to one case per month in May and June In July and August all patients on the major wards were screened, and no more cases were detected.

The outbreak was considered over after the last screening in August. Resistance was confirmed by detection of the vanA resistance gene by PCR analysis In most cases this PCR test was used before transfer of patients to other health care institutions, but to confirm VRE carriage a positive result from culture was also required. PFGE was performed based on the procedure of Murray et al. Some modifications were made to achieve optimal results.

Cultures identified as vancomycin resistant E. An aliquot of the mixture was transferred to a plug-mold and left to set. The band pattern was interpreted by visual inspection using established criteria from Tenover et al. For quality control and standardization between experiments the vanB positive E. VRE isolates were cultivated on blood agar Oxoid Ltd. The previously developed highly-discriminatory SNP genotyping method was performed for profiling the isolates using eight allele-specific real-time PCRs Primers are listed in Supplementary Information Table 1.

All strains were spotted in duplicates or triplicates, and each replicate was measured three times. The resulting spectra were assembled in order to generate a mean spectrum profile MSP for each analyzed strain, and downloaded into the BioNumerics software version 7. An UPGMA dendrogram unweighted pair group method with algorithmic mean was created using Pearson correlation as similarity coefficient. As part of the measures taken during and after the outbreak, medical records of all patients with a positive finding for VRE were included in an outbreak database used to guide epidemiological investigations, including risk factors and outcomes.

These data contributed to this study in terms of mapping the development of the outbreak i. Genetic characterization of the isolates by the PFGE was used for epidemiological characterization of the outbreak. Contact tracing and screening revealed a total of 89 cases before the outbreak came to an end. All isolates were E. The negative predictive value of the vanA part of the PCR test was Distribution of patients positive for VRE was highest in September with 33 positive isolates.

By July , no more positive samples were found among the screened samples. All 86 outbreak isolates were phenotypically and genotypically resistant to glycopeptide antibiotics. All isolates were also resistant to ampicillin. Pulsotype 1. The index case strain ID 1 is highlighted with a yellow box. The pulsotypes are assigned by PFGE in a. The largest cluster cluster 1 consisted of 56 isolates The predominant pulsotype 1.

The second most dominant pulsotype 1. Several isolates were indistinguishable from each other and hence clonally identical. The second cluster cluster 2 showed a distinct pattern, compared to cluster 1, and consisted of 21 isolates The predominant pulsotype in the second group 2. Monthly distribution of cluster 1 and cluster 2 related strains.

Strains unrelated to the two main clusters are not included in the chart. Most of the isolates in cluster 1 were found during screening September and October , concurrent with the decline of positive isolates related to strains in cluster 1, cluster 2 related strains were introduced in November All isolates were identified as E.

Pulsotypes are indicated with colors; green and blue correspond to isolates in cluster 1, while red and pink correspond to isolates in cluster 2. Unrelated strains are illustrated colorless, except for the index case strain in yellow color. Three isolates 3. Cases were reported from more than ten different wards out of a total of 23, including both medical and surgical specialties.

Retrospective review of hospital admissions showed that many patients were admitted to multiple wards during their hospital stays. A total of 40 VRE-carrying patients were identified in the first two months of the outbreak August and September Seven of the remaining 12 patients were indirectly associated with one of these three hospital wards.

They had been hospitalized together with a VRE-positive patient with previous stay at one of these wards during July-October, however at the time the VRE-positive diagnosis was not yet stated.

In particular, in March , four isolates with pulsotype 1. Review of their medical records showed that patients numbered 78—80 were hospitalized simultaneously in March at the same ward, and that patient number 78 had previously been hospitalized at one of the three index wards on two occasions in July , before the primary outbreak was discovered.

None of the 21 isolates belonging to cluster 2 were isolated from patients that had been admitted to any of the index outbreak wards in the three first months of the outbreak. Before proven positive, 15 of these patients had tested negative in earlier screening tests conducted after the peak of the outbreak. Spread of VRE is a serious issue in many hospitals. Rapid and sensitive microbial detection is important to limit the spread of infection, and determination of epidemiological relatedness is necessary for investigation of contamination patterns of resistant bacteria, and for outbreak management.

Genotyping results are, however, often available only far into the outbreak, or even after the situation has ended. In this study, we describe epidemiological relatedness of Vancomycin-resistant E. From screening conducted throughout all hospital wards, the majority of patients with VRE strains in PFGE cluster 1 were hospitalized within the three consecutive months July, August and September , in only three of the 23 hospital wards the three index wards.

In addition, a few isolates belonging to cluster 1 were detected in patients hospitalized together in March , of which one had previously been hospitalized in one of the index wards July Likely, this patient carried the infection at that time, and initiated the small outbreak when rehospitalized March In conclusion, spread of isolates belonging to cluster 1 seems to mainly have taken place in three hospital wards Gastric surgery, Infectious diseases, and Pulmonary diseases during a three-month period starting from July , before the outbreak was recognized.

After the discovery of the first VRE isolate mid-August , 49 isolates were identified by the end of October, 42 belonging to cluster 1 and seven sporadic cases. Following initiation of infection control measures throughout September, a continuous and rapid decreasing incidence could be seen, proving that the increased focus on infection control and the measures taken were highly effective in limiting the outbreak. The importance of hand hygiene and other infection control issues in limiting the spread of hospital bacteria is also well documented in previous studies 27 , 28 , 29 , The majority of isolates belonging to cluster 2 were from patients who had not been hospitalized in any of the three index outbreak wards in the three summer months of , and most of these patients had screened negative in the early phase of the outbreak.

The better understanding of the outbreak dynamic obtained with PFGE genotyping results underscores the great importance of the implemented infection control measures. The second outbreak did not spread as much as the first, probably because effective infection control measures were already established. An interesting finding in this study is the fact that the first index case isolate, which was a clinical isolate and the reason why screening was initiated, was unrelated to any of the two outbreak clusters, and hence not actually linked to the large outbreak in the three index wards caused by cluster 1 VRE strains.

Thus the outbreak was discovered by coincidence, which underscores the need for systematic screening of potentially at-risk patients, including all patients transferred from hospitals abroad or from central large hospitals, for early detection of hospital outbreaks. As is common in outbreaks with VRE, the majority of VRE-positive patients in our study was colonized with the bacteria, but did not have an infection. The strains found unrelated to both cluster 1 and 2, including the index case isolate, may have originated from patients colonized with VRE prior to the outbreak.

It is unknown how long VRE is carried, but colonization could persist from weeks to months 31 , 32 , 33 , hence colonized patients will occasionally be admitted to hospitals and other health care institutions.

Expert review of anti-infective therapy. American journal of infection control. Cardiovascular interventions. Clinical and therapeutic considerations with report of three cases and review of the literature.

Archives of internal medicine. American journal of diseases of children The Journal of pediatrics. A review. International journal of clinical pharmacy. Diagnostic microbiology and infectious disease. The Medical journal of Australia. Revista espanola de cardiologia English ed.

Journal of infection and public health. Reviews of infectious diseases. Watanakunakorn C,Patel R, Comparison of patients with enterococcal bacteremia due to strains with and without high-level resistance to gentamicin. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

International journal of antimicrobial agents. Cole M,Ridley B, Absence of bioactive metabolites of ampicillin and amoxycillin in man. The Journal of antimicrobial chemotherapy. European heart journal. A case of subacute bacterial endocarditis treated with penicillin and neomycin. British medical journal. Annals of internal medicine. Scandinavian journal of infectious diseases. The Annals of pharmacotherapy. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

Critical care medicine. Journal of microbiology Seoul, Korea. Infection and immunity. Science New York, N. BioMed research international. Enterococcus Infections. Continuing Education Activity Enterococci are Gram-positive facultative anaerobic cocci in short and medium chains, which cause difficult to treat infections in the nosocomial setting. Introduction Enterococci are Gram-positive facultative anaerobic cocci in short and medium chains, first discovered in in the human gastrointestinal tract.

Mechanism of resistance to specific antibiotics : [1] [21] [22] [3] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] Antibiotic Strain Mechanism of antibiotic resistance Detection of antibiotic resistance Beta lactams E. Daptomycin All Genetic mutations like cls, gdpD, and liaF impact the cell membranes' repulsion charge and target its composition. Urinary tract infections UTI are the most common infections caused by enterococci, usually occurring in chronically ill patients in the nosocomial setting associated with obstruction, urinary catheterization, or instrumentation.

Bacteremia is usually secondary to IV catheters, UTIs including catheter-associated urinary tract infections CAUTI , intra-abdominal including biliary tract infections, wound infections including burns and ulcers, and bone infections. Meningitis is uncommon and is mainly associated with intraventricular shunts, neurosurgical procedures, CSF leakage, trauma, anatomical defects in CNS, and high-grade bacteremia in immunocompromised patients. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Abstract This nation-wide survey on the epidemiology of vancomycin-resistant enterococci VRE included healthcare institutions and showed an increasing number of VRE colonizations and infections in Switzerland, probably for the most part due to nosocomial dissemination.

Introduction Vancomycin-resistant enterococci VRE are multi-drug resistant organisms MDROs that can cause healthcare-associated infections and increase both length of stay and in-hospital mortality [ 1 , 2 ]. Methods This survey included public or private institutions providing inpatient care in Switzerland. Full size image.

References 1. Article Google Scholar 2. Article Google Scholar 3. Article Google Scholar 4. Google Scholar 6.

PubMed Google Scholar 8. Article Google Scholar Funding This study was founded by the federal office of public health, Switzerland. View author publications. Balmelli , M. Eisenring , S. Harbarth , S. Kuster , V. Masserey Spicher , D. Pittet , C. Ruef , H. Sax , M. Schlegel , A. Schweiger , N. Competing interests The authors declare that they have no competing interests.

Additional file. Additional file 1: English version of the questionnaire translated from German, French and Italian.

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