Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium bacteremia from an Indian tertiary hosp
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ORIGINAL ARTICLE
Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium bacteremia from an Indian tertiary hospital Chandrabhan Rao 1 & Benu Dhawan 1 & Sreenivas Vishnubhatla 2 & Arti Kapil 1 & Bimal Das 1 & Seema Sood 1 Received: 13 July 2020 / Accepted: 27 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract We determined the clinical and molecular epidemiology of emerging nosocomial vancomycin-resistant Enterococcus 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 and E. faecium ddl genes) and tested for disk diffusion. PCR was used to detect aac(6′)-aph(2″), vanA and vanB resistance genes, and asa1, cylA, ace, esp, gelE and hyl 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%) were vanA-containing VREfm, aac(6′)-aph(2″)–positive HLGR, and vanB-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. The esp, hyl, ace, asa1, cylA, and gelE genes were detected at 55.9, 22.5, 2.9, 2.3, 1.7, and 1.2%, respectively. The esp gene was significantly associated with VREfm compared to VSEfm (P = 0.001). PFGE analysis revealed 23 clones, with 7 major clones. The MLST analysis revealed the following five sequence types: ST80, ST17, ST117, ST132, and ST280, all belonging to CC17. The emergence and expansion of VREfm CC17 with limited antibiotic options in our hospital present a serious public health menace and represent challenges to infection control. Keywords Vancomycin-resistant E. faecium (VREfm) . Bloodstream infections of E. faecium . Virulence determinants . Pulsed-field gel electrophoresis (PFGE) . Multi-locus sequence typing (MLST) . Molecular epidemiology
* Benu Dhawan [email protected] Chandrabhan Rao [email protected] Sreenivas Vishnubhatla [email protected] Arti Kapil [email protected] Bimal Das [email protected] Seema Sood [email protected] 1
Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
2
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
Introduction Enterococci are the second leading cause of healthcareassociated infections (HAIs) and health-associated bacteremia, approximately 10% of bacteremias. Today, between 30 and 80% of enterococcal infections are caused by Enterococcus faecium [1, 2]. Vancomycin-resi
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