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Molecular Characterization of Vancomycin-Resistant Enterococcus spp. from Clinical Samples and Identification of a
Raúl Alejandro Atriano Briano1, Nallely S Badillo-Larios2, Perla Niño-Moreno2,3
1Laboratory of Hematology, Faculty of Chemical Sciences, Autonomous University of San Luis Potosi, San Luis Potosi 78240, Mexico.
Abstract:
Background:Enterococcus spp. is the third leading cause of healthcare-associated infections in the American continent, often because of the virulence factors that protect the bacterium against host defenses and facilitate tissue attachment and genetic material exchange. In addition, vancomycin, considered a last-resort treatment, has shown reduced efficacy in Enterococcus spp. strains. However, the relationship between bacterial resistance and virulence factors remains unclear. This study intends to evaluate the prevalence of glycopeptide-resistant genotypes and virulence factors in Enterococcus spp. strains. Methods: Over six months, 159 Enterococcus spp. strains causing nosocomial infections were analyzed. Multiplex PCR was performed to identify species, glycopeptide-resistant genotypes, and 12 virulence factors. Results: The most abundant species identified were Enterococcus faecalis and E. faecium. Vancomycin resistance was observed in 10.7% of the isolates, and the vanA genotype was present in 47% of resistant samples. The main virulence factors detected were acm (54%), which is related to cell adhesion; gel E (66%), a metalloproteinase linked to tissue damage; and the sex pheromones cpd (64%) and ccf (84%), which are involved in horizontal gene transfer. A significant association was found between the prevalence of acm, ccf, and cpd in VRE isolates, indicating the potential dissemination of genes to emerging strains via horizontal gene transfer. In addition, a new E. faecium, which displayed five virulence factors and harbored the vanA sequence type, was identified and registered as ST2700. Conclusions:Enterococcus faecalis and E. faecium are clinically critical due to multidrug resistance and virulence factors like acm, which aids host colonization. Genes ccf and cpd promote resistance spread via horizontal transfer, while the emerging ST2700 strain requires urgent monitoring to curb its virulent, drug-resistant spread.
Insights
This study reveals that common hospital-acquired infection bacteria, Enterococcus, possess virulence factors and resistance genes. The emerging ST2700 strain shows high virulence and drug resistance, requiring urgent monitoring.
Area of Science:
- Microbiology and Infectious Diseases
- Molecular Biology and Genetics
- Antimicrobial Resistance Research
Background:
- Enterococcus species are a leading cause of healthcare-associated infections, driven by virulence factors and increasing vancomycin resistance.
- The interplay between antimicrobial resistance and virulence in Enterococcus remains incompletely understood.
- Vancomycin, a critical last-resort antibiotic, exhibits diminished effectiveness against certain Enterococcus strains.
Purpose of the Study:
- To investigate the prevalence of glycopeptide-resistant genotypes within Enterococcus species.
- To identify and quantify key virulence factors in clinical Enterococcus isolates.
- To explore the association between vancomycin resistance and specific virulence factor genes.
Main Methods:
- Analysis of 159 Enterococcus strains isolated from nosocomial infections over six months.
- Utilized multiplex PCR for species identification, detection of glycopeptide resistance genes (e.g., vanA), and 12 distinct virulence factors.
- Statistical analysis to determine associations between resistance and virulence markers.
Main Results:
- Enterococcus faecalis and Enterococcus faecium were the predominant species identified.
- Vancomycin resistance was detected in 10.7% of isolates, with the vanA genotype found in 47% of these resistant strains.
- Key virulence factors included acm (cell adhesion, 54%), gelE (tissue damage, 66%), cpd (sex pheromone, 64%), and ccf (horizontal gene transfer, 84%). A significant association was observed between acm, ccf, and cpd prevalence in vancomycin-resistant Enterococcus (VRE) isolates.
- A novel Enterococcus faecium strain (ST2700) exhibiting five virulence factors and the vanA genotype was identified.
Conclusions:
- Enterococcus faecalis and Enterococcus faecium pose significant clinical challenges due to multidrug resistance and virulence factors like acm, which promotes host colonization.
- Genes ccf and cpd facilitate the spread of antimicrobial resistance through horizontal gene transfer.
- The emergence of the virulent, drug-resistant ST2700 strain necessitates immediate surveillance and control strategies.
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