Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium bacteremia from an Indian tertiary hospital

AbstractWe  determined the clinical and molecular epidemiology of emerging nosocomial vancomycin-resistantEnterococcus faecium (VREfm) –causing serious bloodstream infections (BSIs) and the correlations between antibiotic resistance and virulence determinants among isolates. All isolates were confirmed by molecular methods (16SrRNA andE. faecium ddl genes) and tested for disk diffusion. PCR  was used to detectaac(6 ′)-aph(2″),vanA andvanB resistance genes, andasa1,cylA,ace,esp,gelE andhyl virulence genes. VREfm and high-level gentamicin-resistant (HLGR) representative isolates were selected to characterize by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Of 173 isolates, 73  (42.2%), 146 (84.4%), and 0 (0.0%) werevanA-containing VREfm,aac(6 ′)-aph(2″)–positive HLGR, andvanB-positive. Independent predictors of VREfm infection were hematological malignancies (P = 0.001) and previous hospitalizations (P = 0.007). Observed mortality rate was 34.7%. Independent predictors of BSI-related mortality were endotracheal intubations (P< 0.001), gastrointestinal diseases (P = 0.002), and pulmonary disease (P< 0.001). All VREfm were resistant to vancomycin, teicoplanin, ciprofloxacin, and erythromycin. Theesp,hyl,ace,asa1,cylA, andgelE genes were detected at 55.9, 22.5, 2.9, 2.3, 1.7, and 1.2%, respectively. Theesp gene was significantly associated with VREfm compared to  VSEfm (P = 0.001). PFGE analysis revealed 23 clones, with 7...
Source: European Journal of Clinical Microbiology and Infectious Diseases - Category: Microbiology Source Type: research