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Title: A sustained hospital outbreak of vancomycin-resistant Enterococcus faecium bacteremia due to emergence of vanB E. faecium sequence type 203.
Austin Authors: Johnson, Paul D R ;Ballard, Susan A;Grabsch, Elizabeth A ;Stinear, Timothy P;Seemann, Torsten;Young, Heather L;Grayson, M Lindsay ;Howden, Benjamin P 
Affiliation: Monash University, Melbourne, Victoria, Australia
Infectious Diseases
Issue Date: 15-Oct-2010
Publication information: The Journal of Infectious Diseases; 202(8): 1278-86
Abstract: A significant increase in the rate of vancomycin-resistant Enterococcus faecium (VREfm) bacteremia at our health service, despite improved infection control, prompted us to investigate the cause.E. faecium bacteremia (including VREfm) over a 12-year period (1998-2009) was investigated using multilocus sequence typing, antibiotic and antiseptic susceptibility profiles, optical mapping, and whole genome sequencing of historical and recent isolates.For 10 years, the rate of bacteremia due to vanB VREfm remained stable and sequence type (ST) 17 was predominant. In 2005, ST203 vancomycin-susceptible E. faecium first appeared at our institution, and from March 2007, coinciding with the appearance of a vanB VREfm ST203, the rate of VRE bacteremia has increased exponentially. Although we found no difference in antiseptic susceptibility or presence of genes encoding putative virulence determinants (esp(Efm), hyl(Efm), and fms genes), comparative genomics revealed almost 500 kb of unique sequence when an ST17 and an ST203 VREfm isolate were compared, suggesting that other genomic factors are responsible for the apparent success of E. faecium.The application of multilocus sequence typing has uncovered the emergence of an epidemic clone of E. faecium ST203 that appears to have acquired the vanB locus and has caused a sustained outbreak of VRE bacteremia.
DOI: 10.1086/656319
Journal: The Journal of Infectious Diseases
Type: Journal Article
Subjects: Anti-Bacterial Agents.pharmacology
Bacteremia.drug therapy.epidemiology.microbiology
Bacterial Proteins.genetics
Bacterial Typing Techniques
Communicable Diseases, Emerging.microbiology
Cross Infection.drug therapy.epidemiology.microbiology
Disease Outbreaks
Electrophoresis, Gel, Pulsed-Field
Enterococcus faecium.classification.drug effects.genetics
Gram-Positive Bacterial Infections.drug therapy.epidemiology.microbiology
Microbial Sensitivity Tests
Thienamycins.therapeutic use
Vancomycin.therapeutic use
Vancomycin Resistance.genetics
Appears in Collections:Journal articles

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