J Korean Med Sci.  2005 Apr;20(2):169-176. 10.3346/jkms.2005.20.2.169.

Vancomycin-resistant Enterococcal Bacteremia in a Hematology Unit: Molecular Epidemiology and Analysis of Clinical Course

• Yoo JH
• Lee DG
• Choi SM
• Choi JH
• Shin WS
• Kim M
• Yong D
• Lee K
• Min WS
• Kim CC

• KMID: 1095185
• DOI: http://doi.org/10.3346/jkms.2005.20.2.169

Abstract

An increase in vancomycin-resistant enterococcal (VRE) bacteremia in hemato-oncological patients (n=19) in our institution from 2000 through 2001 led us to analyze the molecular epidemiologic patterns and clinical features unique to our cases. The pulsed field gel electrophoresis of the isolates revealed that the bacteremia was not originated from a single clone but rather showed endemic pattern of diverse clones with small clusters. A different DNA pattern of blood and stool isolates from one patient suggested exogenous rather than endogenous route of infection. Enterococcus faecium carrying vanA gene was the causative pathogen in all cases. Patients with VRE bacteremia showed similar clinical courses compared with those with vancomycin-susceptible enterococcal (VSE) bacteremia. Vancomycin resistance did not seem to be a poor prognostic factor because of similar mortality (5/8, 62.5%) noted in VSE bacteremia. Initial disease severity and neutropenic status may be major determinants of prognosis in patients with VRE bacteraemia.

Keyword

Vancomycin Resistance; Enterococcus faecium; Enterococcus faecalis; Neutropenia; Bacteremia; Korea; Epidemiology, Molecular; VanB Protein, Enterococcus

MeSH Terms

Adolescent
Adult
Bacteremia/*drug therapy/microbiology
Bacterial Proteins/genetics
Carbon-Oxygen Ligases/genetics
Electrophoresis, Gel, Pulsed-Field
Enterococcus/*drug effects/genetics
Female
Humans
Male
Middle Aged
*Vancomycin Resistance

Figure

• 

  Fig. 1 Summary of monthly occurrence of vancomycin-resistant Enterococcus (VRE) bacteremia from January 2000 to December 2001.

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  Fig. 2 Pulsed field gel electrophoresis (PFGE) of isolates from patients with VRE. 1-14, case numbers; A-J, PFGE genotypes (See Table I).

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  Fig. 3 PFGE analysis of VRE isolates from bacteremic patients and from non-bacteremic (NB) patients. M, molecular weight markers; lane 1-14: blood isolates from bacteremic patients (see Table I and Fig. 2); lane 15: blood isolate identical with that of lane 13; lane 16: stool isolates from the same person as lane 13; lanes 17-31: isolates from NB patients; lanes 17 & 18: urine and stool isolates from patient NB1, respectively; lanes 19 & 20: patient NB2; lanes 21 & 22: patient NB3; lanes 23 & 24: patient NB4; lanes 25 & 26: patient NB5; lanes 27 & 28: patient NB6; lanes 29 & 30: patient NB7; lane 31: urine isolate from patient NB8. Lines connecting lanes 7 and 31, lanes 9 and 30, lanes 12 and 21-22 indicate clonally related pairs and groups.

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  Fig. 4 Summary of epidemiological patterns of four main clones (B, C, E, F) circulating in our institution during 2 yr (2000-2001).

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