Clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype
Clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype
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DOI：
10.1093/jac/dkn025
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发表时间：
2008-04-01
影响因子：
5.2
通讯作者：
Lee, Wee Gyo
中科院分区：
文献类型：
--
作者：
Song, Jae-Hoon;Ko, Kwan Soo;Lee, Wee Gyo
目的：探讨vancomycin耐万古霉素屎肠球菌（VRE） VanD表型和vanA基因型的临床意义。方法：对替柯planin体外和体内对VanD-vanA VRE菌株的抑制作用进行试验。在teicoplanin孵育期间监测teicoplanin mic的变化。采用小鼠腹膜炎模型进行体外、体内时间测定和生存分析。结果：VanD-vanA VRE菌株在120 mg/L Teicoplanin培养48 h内，Teicoplanin mic升高至128 mg/L。体外和体内时间测定结果表明，120 mg/L替柯planin对VanD-vanA VRE菌没有杀灭作用，而对万古霉素敏感的E. faecium和VanD-vanB菌则没有杀灭作用。替柯planin处理VanD-vanA VRE菌株感染小鼠的存活率与未处理小鼠相当。结论：临床微生物实验室无法检测到含有vanA基因的VanD型VRE感染，使用替柯planin治疗无效。
Objectives: To investigate the clinical implications of vancomycin-resistant Enterococcus faecium (VRE) with VanD phenotype and vanA genotype (VanD-vanA VRE).Methods: We tested in vitro and in vivo efficacies of teicoplanin against VanD-vanA VRE strains. Change in teicoplanin MICs was monitored during incubation with teicoplanin. In vitro and in vivo time-kill assay and survival analysis using a mouse peritonitis model were performed.Results: Teicoplanin MICs of VanD-vanA VRE strains increased to 128 mg/L within 48 h when they were cultured with 120 mg/L teicoplanin. In vitro and in vivo time-kill assay showed that VanD-vanA VRE strains were not eliminated by 120 mg/L teicoplanin in contrast to vancomycin-susceptible E. faecium and VanD-vanB strains. The survival rate of mice infected with VanD-vanA VRE strains treated with teicoplanin was comparable with that of untreated mice.Conclusion: Data suggest that teicoplanin would fail in the treatment of VanD type VRE infections if the strains contained the vanA gene, which cannot be detected in the clinical microbiology laboratory.