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Changes in vancomycin-resistant Enterococcus faecium causing outbreaks in Brazil

I C V Palazzo1, A Pitondo-Silva, C E Levy

  • 1Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Brazil.

The Journal of Hospital Infection
|July 12, 2011
PubMed

Insights

Vancomycin-resistant Enterococcus faecium (VREfm) strains in Brazil, though not primarily CC17, show clonal relationships and carry virulence factors. This suggests VREfm CC17 may become predominant in Brazil, similar to global trends.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Genetics

Background:

  • Enterococci cause severe human infections due to virulence and antimicrobial resistance.
  • Vancomycin-resistant Enterococcus faecium (VREfm) outbreaks globally are often linked to clonal complex 17 (CC17).
  • Brazilian VREfm outbreaks have historically not been associated with CC17.

Purpose of the Study:

  • To compare VREfm strains from outbreaks and sporadic cases in Campinas, Brazil, with other national VREfm strains.
  • To investigate the genetic characteristics and evolutionary history of Brazilian VREfm strains.
  • To determine if CC17 strains are emerging in Brazil.

Main Methods:

  • Analysis of 23 Enterococcus faecium isolates (22 VREfm, 1 VSEfm).
  • Detection of vanA gene and virulence factors (collagen-adhesin, enterococcal surface protein, hyaluronidase).
  • Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) for clonal relationship and sequence type (ST) identification.

Main Results:

  • 22 of 23 E. faecium isolates were vancomycin-resistant (VREfm) and harbored the vanA gene.
  • All VREfm strains exhibited a specific alteration in the VanA element.
  • PFGE and MLST revealed clonal relationships among VREfm and VSEfm strains, with new STs (ST447, ST448, ST478, ST412) identified, all belonging to CC17.

Conclusions:

  • Brazilian VREfm outbreaks are caused by strains with diverse evolutionary histories.
  • Despite previous trends, VREfm strains belonging to CC17 are present and may become predominant in Brazil.
  • The identified virulence factors and clonal relationships highlight the potential for VREfm to cause significant infections.

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