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Molecular characterisation of outbreak-related strains of vancomycin-resistant Enterococcus faecium from an intensive

X Zhu1, B Zheng, S Wang

  • 1Department of Critical Care Medicine, Peking University Third Hospital, Beijing, China.

The Journal of Hospital Infection
|April 3, 2009
PubMed

Insights

An intensive care unit (ICU) outbreak involved vancomycin-resistant Enterococcus faecium (VRE). Conjugative transfer of resistance genes likely spread VRE among specific E. faecium strains during the event.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Public Health

Background:

  • An outbreak of vancomycin-resistant Enterococcus faecium (VRE) occurred in a 20-bed intensive care unit (ICU).
  • The outbreak affected 14 patients over a 12-month period, with an incidence of 3.56 cases per 1000 ICU patient days.

Purpose of the Study:

  • To investigate the genetic relatedness and transmission mechanisms of vanA-type VRE isolates during the ICU outbreak.
  • To characterize the vancomycin resistance elements and their dissemination pathways.

Main Methods:

  • Pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to analyze 18 VRE isolates.
  • Analysis included characterization of Tn1546-like elements, esp gene presence, and conjugation experiments.

Main Results:

  • PFGE revealed 14 distinct E. faecium types, while MLST identified eight sequence types (STs), including four novel ones.
  • Seventeen strains belonged to clonal complex CC17, with 16 carrying the esp gene. Three types of Tn1546-like elements were identified.
  • Vancomycin resistance was transferable between E. faecium strains, indicating a conjugative mechanism.

Conclusions:

  • Conjugative dissemination of Tn1546-like elements played a significant role in the spread of VRE within the ICU.
  • The findings highlight the importance of understanding mobile genetic element transfer in VRE outbreaks.

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