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Multi-institutional study of in vitro antimicrobial resistance and molecular epidemiology of vancomycin resistant Enterococcus faecium



Multi-institutional study of in vitro antimicrobial resistance and molecular epidemiology of vancomycin resistant Enterococcus faecium



Abstracts of the General Meeting of the American Society for Microbiology 101: 167



Enterococci have emerged as important pathogens and are now the second most common cause of nosocomial infections. Patients with vancomycin-resistant enterococci (VRE) have longer hospital stays, greater overall cost, and higher mortality than those with vancomycin-susceptible enterococcal infections. E. faecium resistance to vancomycin has been steadily increasing at UAB Hospital (UABH) and the Birmingham Veteran Affairs Medical Center (BVAMC) to 73% and 94% respectively. Thus further study of factors that contribute to the development, transmission, and acquisition of VRE is needed. We identified 185 patients with VRE isolated between 1997-2000, performed in vitro evaluation of 17 antimicrobial agents, including two new agents, linezolid and quinupristin/dalfopristin, and have begun typing them using pulsed field gel electrophoresis (PFGE). Susceptibility testing indicated that linezolid and quinupristin/dalfopristin were the most active drugs with 100% of isolates susceptible. The next most active drugs were chloramphenicol (74.6%; S) and rifampin (66.5%; S). No other agents showed susceptibilities exceeding 18%. PFGE performed on 65 isolates to date revealed 38 distinct strains. Twenty-seven PFGE patterns were unique, each representing a single strain. The remaining 38 isolates were identified as clones of 2, 3, 4, or 14 isolates each, indicating the apparent spread of individual VRE strains within the institutions. Newer drugs such as linezolid and quinupristin/dalfopristin have great potential for use against vancomycin-resistant enterococcal infections. However, they should be used judiciously in view of their considerable expense and the potential for development of resistance. It is unlikely that reduction of antimicrobial agent use alone will completely prevent spread of VRE in view of its potential for clonal spread within hospitals. Active infection control surveillance coupled with epidemiologic tools such as strain typing is necessary in the containment of the current epidemic of VRE.

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Accession: 035349256

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