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Abstract

Purpose. Enterococcus faecalis is commonly found as a commensal gut bacteria, but some linages have caused increasing extra-gastrointestinal infections. In particular, strains with high-level virulence or antimicrobial resistance are prevalent in healthcare settings as nosocomial pathogens. This study was performed to elucidate the epidemiological characteristics and antimicrobial susceptibility profiles of E. faecalis causing nosocomial infections in a Chinese general hospital over a 4-year period.

Methodology. We collected 77 isolates causing extra-gastrointestinal infections from patients at 14 different wards in a tertiary hospital from 2011 to 2014. The population relationship was assessed by multilocus sequence typing and multilocus variable-number tandem repeat analysis. The Kirby–Bauer disk diffusion method was used to evaluate susceptibility against 11 antimicrobial agents.

Results. The isolates showed high-level resistance to tetracycline (86.5 %), erythromycin (78.4 %), rifampin (62.2 %), etc. The major clonal complexes (CCs) included CC4, CC16 and CC21. As the most dominant subtype, CC16 was identified in almost all of the wards and all types of samples, but the isolation rate decreased continually. In contrast, the isolation rates of CC4 and CC21 increased and the proportion of these two CCs in 2014 was more than three times that in 2011. In addition, CC4 showed higher resistance than CC16.

Conclusions. This study demonstrated the prevalent subtypes and resistance profiles of E. faecalis causing nosocomial infection, and indicated that CC4 may be a newly emerging high-risk, multi-resistant cluster. More surveillance is urgently needed, which will increase our understanding of the prevention and treatment of such infections.

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2018-06-20
2024-04-19
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References

  1. Palmer KL, Godfrey P, Griggs A, Kos VN, Zucker J et al. Comparative genomics of enterococci: variation in Enterococcus faecalis, clade structure in E. faecium, and defining characteristics of E. gallinarum and E. casseliflavus. MBio 2012; 3:e00318-11 [View Article][PubMed]
    [Google Scholar]
  2. Paulsen IT, Banerjei L, Myers GS, Nelson KE, Seshadri R et al. Role of mobile DNA in the evolution of vancomycin-resistant Enterococcus faecalis. Science 2003; 299:2071–2074 [View Article][PubMed]
    [Google Scholar]
  3. McBride SM, Coburn PS, Baghdayan AS, Willems RJ, Grande MJ et al. Genetic variation and evolution of the pathogenicity island of Enterococcus faecalis. J Bacteriol 2009; 191:3392–3402 [View Article][PubMed]
    [Google Scholar]
  4. Shankar N, Baghdayan AS, Gilmore MS. Modulation of virulence within a pathogenicity island in vancomycin-resistant Enterococcus faecalis. Nature 2002; 417:746–750 [View Article][PubMed]
    [Google Scholar]
  5. Kuch A, Willems RJ, Werner G, Coque TM, Hammerum AM et al. Insight into antimicrobial susceptibility and population structure of contemporary human Enterococcus faecalis isolates from Europe. J Antimicrob Chemother 2012; 67:551–558 [View Article][PubMed]
    [Google Scholar]
  6. Guzman Prieto AM, van Schaik W, Rogers MR, Coque TM, Baquero F et al. Global emergence and dissemination of Enterococci as nosocomial pathogens: attack of the clones?. Front Microbiol 2016; 7:788 [View Article][PubMed]
    [Google Scholar]
  7. Gilmore MS, Lebreton F, van Schaik W. Genomic transition of enterococci from gut commensals to leading causes of multidrug-resistant hospital infection in the antibiotic era. Curr Opin Microbiol 2013; 16:10–16 [View Article][PubMed]
    [Google Scholar]
  8. Kudo M, Nomura T, Yomoda S, Tanimoto K, Tomita H. Nosocomial infection caused by vancomycin-susceptible multidrug-resistant Enterococcus faecalis over a long period in a university hospital in Japan. Microbiol Immunol 2014; 58:607–614 [View Article][PubMed]
    [Google Scholar]
  9. Conceição N, Oliveira CC, Silva PR, Avila BG, Oliveira AG. Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study. Rev Soc Bras Med Trop 2011; 44:177–181 [View Article][PubMed]
    [Google Scholar]
  10. Mendes RE, Castanheira M, Farrell DJ, Flamm RK, Sader HS et al. Longitudinal (2001–14) analysis of enterococci and VRE causing invasive infections in European and US hospitals, including a contemporary (2010–13) analysis of oritavancin in vitro potency. J Antimicrob Chemother 2016; 71:3453–3458 [View Article][PubMed]
    [Google Scholar]
  11. Sun H, Wang H, Xu Y, Jones RN, Costello AJ et al. Molecular characterization of vancomycin-resistant Enterococcus spp. clinical isolates recovered from hospitalized patients among several medical institutions in China. Diagn Microbiol Infect Dis 2012; 74:399–403 [View Article][PubMed]
    [Google Scholar]
  12. Tripathi A, Shukla SK, Singh A, Prasad KN. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India. Indian J Med Microbi 2016; 34:38–45
    [Google Scholar]
  13. Palmer KL, Gilmore MS. Multidrug-resistant enterococci lack CRISPR-cas. MBio 2010; 1:e00227-10 [View Article][PubMed]
    [Google Scholar]
  14. Aanensen DM, Spratt BG. The multilocus sequence typing network: mlst.net. Nucleic Acids Res 2005; 33:W728–W733 [View Article][PubMed]
    [Google Scholar]
  15. Titze-de-Almeida R, Willems RJ, Top J, Rodrigues IP, Ferreira RF et al. Multilocus variable-number tandem-repeat polymorphism among Brazilian Enterococcus faecalis strains. J Clin Microbiol 2004; 42:4879–4881 [View Article][PubMed]
    [Google Scholar]
  16. Leavis HL, Bonten MJ, Willems RJ. Identification of high-risk enterococcal clonal complexes: global dispersion and antibiotic resistance. Curr Opin Microbiol 2006; 9:454–460 [View Article][PubMed]
    [Google Scholar]
  17. Ruiz-Garbajosa P, Bonten MJ, Robinson DA, Top J, Nallapareddy SR et al. Multilocus sequence typing scheme for Enterococcus faecalis reveals hospital-adapted genetic complexes in a background of high rates of recombination. J Clin Microbiol 2006; 44:2220–2228 [View Article][PubMed]
    [Google Scholar]
  18. Arias CA, Murray BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012; 10:266–278 [View Article]
    [Google Scholar]
  19. Kawalec M, Pietras Z, Daniłowicz E, Jakubczak A, Gniadkowski M et al. Clonal structure of Enterococcus faecalis isolated from Polish hospitals: characterization of epidemic clones. J Clin Microbiol 2007; 45:147–153 [View Article][PubMed]
    [Google Scholar]
  20. Ruiz-Garbajosa P, Bonten MJ, Robinson DA, Top J, Nallapareddy SR et al. Multilocus sequence typing scheme for Enterococcus faecalis reveals hospital-adapted genetic complexes in a background of high rates of recombination. J Clin Microbiol 2006; 44:2220–2228 [View Article][PubMed]
    [Google Scholar]
  21. Sun H, Wang H, Xu Y, Jones RN, Costello AJ et al. Molecular characterization of vancomycin-resistant Enterococcus spp. clinical isolates recovered from hospitalized patients among several medical institutions in China. Diagn Microbiol Infect Dis 2012; 74:399–403 [View Article][PubMed]
    [Google Scholar]
  22. Yang JX, Li T, Ning YZ, Shao DH, Liu J et al. Molecular characterization of resistance, virulence and clonality in vancomycin-resistant Enterococcus faecium and Enterococcus faecalis: a hospital-based study in Beijing, China. Infect Genet Evol 2015; 33:253–260 [View Article][PubMed]
    [Google Scholar]
  23. Chatzigeorgiou KS, Sergentanis TN, Tsiodras S, Hamodrakas SJ, Bagos PG. Phoenix 100 versus Vitek 2 in the identification of gram-positive and gram-negative bacteria: a comprehensive meta-analysis. J Clin Microbiol 2011; 49:3284–3291 [View Article][PubMed]
    [Google Scholar]
  24. Nascimento M, Sousa A, Ramirez M, Francisco AP, Carriço JA et al. PHYLOViZ 2.0: providing scalable data integration and visualization for multiple phylogenetic inference methods. Bioinformatics 2017; 33:128–129 [View Article][PubMed]
    [Google Scholar]
  25. Lalitha M. Manual on antimicrobial susceptibility testing. Performance standards for antimicrobial testing: Twelfth Informational Supplement; 2004; 56238454–456
  26. Gaca AO, Gilmore MS. Killing of VRE Enterococcus faecalis by commensal strains: evidence for evolution and accumulation of mobile elements in the absence of competition. Gut Microbes 2016; 7:90–96 [View Article][PubMed]
    [Google Scholar]
  27. Arias CA, Murray BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012; 10:266–278 [View Article][PubMed]
    [Google Scholar]
  28. Ruiz-Garbajosa P, Coque TM, Canton R, Willems RJ, Baquero F et al. High-risk clonal complexes CC2 and CC9 are widely distributed among Enterococcus faecalis hospital isolates recovered in Spain. Enferm Infec Micr Cl 2007; 25:513–518
    [Google Scholar]
  29. Nallapareddy SR, Wenxiang H, Weinstock GM, Murray BE. Molecular characterization of a widespread, pathogenic, and antibiotic resistance-receptive Enterococcus faecalis lineage and dissemination of its putative pathogenicity island. J Bacteriol 2005; 187:5709–5718 [View Article][PubMed]
    [Google Scholar]
  30. Olsen RH, Schønheyder HC, Christensen H, Bisgaard M. Enterococcus faecalis of human and poultry origin share virulence genes supporting the zoonotic potential of E. faecalis. Zoonoses Public Health 2012; 59:256–263 [View Article][PubMed]
    [Google Scholar]
  31. Zheng JX, Wu Y, Lin ZW, Pu ZY, Yao WM et al. Characteristics of and virulence factors associated with biofilm formation in clinical Enterococcus faecalis isolates in China. Front Microbiol 2017; 8:2338 [View Article][PubMed]
    [Google Scholar]
  32. Watanabe S, Kobayashi N, Quiñones D, Nagashima S, Uehara N et al. Genetic diversity of enterococci harboring the high-level gentamicin resistance gene aac(6')-Ie-aph(2'')-Ia or aph(2'')-Ie in a Japanese hospital. Microb Drug Resist 2009; 15:185–194 [View Article][PubMed]
    [Google Scholar]
  33. Getachew Y, Hassan L, Zakaria Z, Abdul Aziz S. Genetic variability of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis isolates from humans, chickens, and pigs in Malaysia. Appl Environ Microbiol 2013; 79:4528–4533 [View Article][PubMed]
    [Google Scholar]
  34. Sahm DF, Kissinger J, Gilmore MS, Murray PR, Mulder R et al. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 1989; 33:1588–1591 [View Article][PubMed]
    [Google Scholar]
  35. Bandyopadhyay A, O'Brien S, Frank KL, Dunny GM, Hu WS. Antagonistic donor density effect conserved in multiple enterococcal conjugative plasmids. Appl Environ Microbiol 2016; 82:4537–4545 [View Article][PubMed]
    [Google Scholar]
  36. Dunny GM, Berntsson RP. Enterococcal sex pheromones: evolutionary pathways to complex, two-signal systems. J Bacteriol 2016; 198:1556–1562 [View Article][PubMed]
    [Google Scholar]
  37. Manson JM, Hancock LE, Gilmore MS. Mechanism of chromosomal transfer of Enterococcus faecalis pathogenicity island, capsule, antimicrobial resistance, and other traits. Proc Natl Acad Sci USA 2010; 107:12269–12274 [View Article][PubMed]
    [Google Scholar]
  38. Lee SC, Wu MS, Shih HJ, Huang SH, Chiou MJ et al. Identification of vancomycin-resistant enterococci clones and inter-hospital spread during an outbreak in Taiwan. BMC Infect Dis 2013; 13:163 [View Article][PubMed]
    [Google Scholar]
  39. Matsushima A, Takakura S, Yamamoto M, Matsumura Y, Shirano M et al. Regional spread and control of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Kyoto, Japan. Eur J Clin Microbiol Infect Dis 2012; 31:1095–1100 [View Article][PubMed]
    [Google Scholar]
  40. Michael KE, No D, Roberts MC. vanA-positive multi-drug-resistant Enterococcus spp. isolated from surfaces of a US hospital laundry facility. J Hosp Infect 2017; 95:218–223 [View Article][PubMed]
    [Google Scholar]
  41. Wang L, He Y, Xia Y, Wang H, Liang S. Investigation of mechanism and molecular epidemiology of linezolid-resistant Enterococcus faecalis in China. Infect Genet Evol 2014; 26:14–19 [View Article][PubMed]
    [Google Scholar]
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