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Prevalence of vancomycin resistant Enterococcus species in prenatal screening cultures

Prevalence of vancomycin resistant Enterococcus species in prenatal screening cultures

Abstracts of the General Meeting of the American Society for Microbiology 103: C-413

In 2002, the CDC recommended that all pregnant women be screened for the presence of Streptococcus agalactiae (Group B). Vertical transmission of S. agalactiae from the mother to the fetus is associated with increased morbidity and mortality in neonates due to sepsis and meningitis. Penicillin is the drug of choice for the prophylactic treatment of colonized, pregnant women. For penicillin-allergic mothers that are at high risk for anaphylaxis, the alternative treatment is a macrolide such as erythromycin or clindamycin. However, macrolide resistance among S. agalactiae is increasing, and in some cases in vitro susceptibility data may not be available for the prenatal isolate. In these instances, vancomycin has been recommended for S. agalactiae prenatal prophylaxis. The new vancomycin guideline prompted us to survey the prevalence of vancomycin resistant Enterococcus species in S. agalactiae prenatal screening cultures. We surveyed prenatal screening cultures (n=299) for enterococcal species that grew on Thayer-Martin medium. Isolates were subsequently speciated and vancomycin MICs were performed. Our baseline study indicates that 74% of the prenatal screening cultures grew Enterococcus (n=221). 4.5% of the Enterococcus isolated had intermediate vancomycin MICs of 8 ug/ml (n=10), and no vancomycin resistant Enterococcus species have been recovered. The prenatal isolates included species with intrinsic vancomycin resistance (E. gallinarum, n=6) and species with acquired, transferable vancomycin determinants (E. faecium, n=2). We were unable to speciate two of the vancomycin intermediate enterococcal isolates. Continued surveillance of prenatal screening cultures for vancomycin resistance in both Enterococcus and S. agalactiae will be necessary to monitor the potential transfer of vancomycin resistance genes from Enterococcus to Streptococcus.

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