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Heteroresistance to vancomycin in Enterococcus faecium.

M R Alam1, S Donabedian, W Brown

  • 1Division of Infectious Disease, Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.

Journal of Clinical Microbiology
|August 30, 2001
PubMed
Summary
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This study reports the first case of vancomycin heteroresistance in Enterococcus faecium. A patient

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Clinical Science

Background:

  • Enterococcus faecium is a common cause of hospital-acquired infections.
  • Vancomycin is a critical antibiotic for treating serious enterococcal infections.
  • Emergence of vancomycin resistance in enterococci poses a significant public health threat.

Purpose of the Study:

  • To report the first instance of vancomycin heteroresistance in an Enterococcus faecium isolate from a clinical setting.
  • To characterize the genetic basis of vancomycin heteroresistance in this isolate.

Main Methods:

  • Phenotypic detection of vancomycin heteroresistance using E-tests.
  • Molecular confirmation of vancomycin resistance genes via Polymerase Chain Reaction (PCR).
  • Strain typing using Pulse Field Gel Electrophoresis (PFGE) to confirm clonal origin.

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Main Results:

  • An Enterococcus faecium isolate initially appeared susceptible to vancomycin.
  • Subcolonies exhibiting high-level vancomycin resistance (MIC >256 microg/ml) were observed on E-tests.
  • Both susceptible and resistant subpopulations were confirmed to be the same strain and harbored the vanA gene.

Conclusions:

  • This finding highlights the potential for vancomycin heteroresistance to emerge in clinical Enterococcus faecium isolates.
  • The presence of the vanA gene in both susceptible and resistant populations explains the observed heteroresistance.
  • Clinical laboratories should be vigilant for vancomycin heteroresistance in Enterococcus faecium to ensure appropriate treatment.