Korean J Clin Pathol.  2001 Feb;21(1):40-44.

Molecular Epidemiology of Vancomycin-resistant Enterococci Isolated from Patients in a Neonatal Intensive Care Unit

• Kim JM
• Park KH
• Kim AS
• Jeong SH
• Hwang HY
• Baek YW

Abstract

BACKGROUND
Recently, an acquired resistance to vancomycin in enterococci has become a serious clinical problem. For the prevention of further propagation of vancomycin-resistant enterococci (VRE), epidemiological study of the infection is essential, but studies on the VRE infection are rare in Korea. We conducted an analysis of the epidemiology of a VRE outbreak in a neonatal intensive care unit (NICU) to clear up the route of propagation of the VRE.
METHODS
Vancomycin-resistant Enterococcus faecium (VREFM) strains were isolated from urine specimens of seven patients, rectal swabs from seven patients, and three skin swabs from two patients in the Kosin Medical Center neonatal intensive care unit, Pusan, Korea. Antimicrobial susceptibilities were tested by a disk diffusion method and agar dilution method. Genotypes of vancomycin-resistance were determined by PCR and SmaI-digested genomic enterococcal DNAs were analyzed by pulsed-field gel electrophoresis.
RESULTS
All of the 17 strains of VREFM were resistant to ampicillin, vancomycin, and teicoplanin and they showed the same genotype (vanA). SmaI-digested genomic DNAs of seven strains isolated from urine were typed as I (1), II (1), IIIb (4), and IV (1). Three strains from skin swabs were I (2) and II (1). Six strains from rectal swabs were I (2), II (1), and IIIa (3). Genomic DNA typing of one isolate from a rectal swab failed. Each genomic DNA type of VREFM strains isolated from skin swabs of two patients were the same with those from urine specimens as I and II, respectively.
CONCLUSIONS
This study suggests that VRE strains colonized in the intestines can cause infections after skin colonizing and can be transmitted/propagated to other people through skin contact. In conclusion, it is important for the prevention of the dissemination of VRE that controls for patients' skin hygiene, as well as hand washing by medical persons, be put in place.

Keyword

Vancomycin-resistant Enterococcus faecium; Neonatal intensive care unit; Genomic DNA typing

MeSH Terms

Agar
Ampicillin
Busan
Colon
Diffusion
DNA
DNA Fingerprinting
Electrophoresis, Gel, Pulsed-Field
Enterococcus faecium
Epidemiologic Studies
Epidemiology
Genotype
Hand Disinfection
Humans
Hygiene
Infant, Newborn
Intensive Care, Neonatal*
Intestines
Korea
Molecular Epidemiology*
Polymerase Chain Reaction
Skin
Teicoplanin
Vancomycin
Agar
Ampicillin
DNA
Teicoplanin
Vancomycin