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dc.contributor.authorJohnson, Paul D R-
dc.contributor.authorBallard, Susan A-
dc.contributor.authorGrabsch, Elizabeth A-
dc.contributor.authorStinear, Timothy P-
dc.contributor.authorSeemann, Torsten-
dc.contributor.authorYoung, Heather L-
dc.contributor.authorGrayson, M Lindsay-
dc.contributor.authorHowden, Benjamin P-
dc.identifier.citationThe Journal of Infectious Diseases; 202(8): 1278-86en_US
dc.description.abstractA 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.en_US
dc.subject.otherAnti-Bacterial Agents.pharmacologyen
dc.subject.otherBacteremia.drug therapy.epidemiology.microbiologyen
dc.subject.otherBacterial Proteins.geneticsen
dc.subject.otherBacterial Typing Techniquesen
dc.subject.otherCommunicable Diseases, Emerging.microbiologyen
dc.subject.otherCross Infection.drug therapy.epidemiology.microbiologyen
dc.subject.otherDisease Outbreaksen
dc.subject.otherElectrophoresis, Gel, Pulsed-Fielden
dc.subject.otherEnterococcus faecium.classification.drug effects.geneticsen
dc.subject.otherGram-Positive Bacterial Infections.drug therapy.epidemiology.microbiologyen
dc.subject.otherMicrobial Sensitivity Testsen
dc.subject.otherThienamycins.therapeutic useen
dc.subject.otherVancomycin.therapeutic useen
dc.subject.otherVancomycin Resistance.geneticsen
dc.titleA sustained hospital outbreak of vancomycin-resistant Enterococcus faecium bacteremia due to emergence of vanB E. faecium sequence type 203.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleThe Journal of Infectious Diseasesen_US
dc.identifier.affiliationMonash University, Melbourne, Victoria, Australiaen_US
dc.identifier.affiliationInfectious Diseasesen_US
dc.type.austinJournal Articleen, Elizabeth A
item.openairetypeJournal Article-
item.fulltextNo Fulltext-
item.grantfulltextnone- Diseases- Diseases- Diseases- Diseases-
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