Appearance of vanD-positive Enterococcus faecium in a tertiary hospital in the Netherlands: prevalence of vanC and vanD in hospitalized patients
Appearance of vanD-positive Enterococcus faecium in a tertiary hospital in the Netherlands: prevalence of vanC and vanD in hospitalized patients
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DOI：
10.1038/s41598-019-42824-4
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发表时间：
2019-05-06
影响因子：
4.6
通讯作者：
van Alphen, Lieke B.
中科院分区：
文献类型：
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作者：
Flipse, Jacky;von Wintersdorf, Christian J. H.;van Alphen, Lieke B.
耐万古霉素肠球菌（VRE）可以在医院迅速传播。因此，我们医院采用了一项筛查计划，即对直肠拭子进行vanA和vanB的筛查，仅在VRE选择琼脂上培养PCR阳性肉汤。2016年11月初，在vanA/vanB筛查阴性患者中检测到临床vanA/vanB阴性VRE分离株，这表明未检测到的VRE可能在我院传播。全基因组测序结果表明，该菌株的耐药性是由vanD介导的，核心基因组多位点序列分型结果表明，该菌株为一种罕见类型：ST 17/CT 154。为了确定携带vanA/B/C/D的肠球菌的患病率，我们设计了vanC 1/2/3和vanD的实时PCR，并筛选了360例患者的直肠拭子。vanD阳性率为27.8%，而培养仅检出E. vanA阳性培养液中的屎肠球菌和E. vanC 1阳性肉汤中的鸡胚。未发现vanD阳性VRE，限制了该VRE医院传播的可能性。此外，直肠拭子中非VRE vanD的高患病率使得在我们的VRE筛查中包括vanD PCR不可行。然而，验证vanC 1/2/3和vanD PCR使我们能够快速检查未来vanA/B阴性VRE是否存在vanC和vanD基因。
Vancomycin-resistant enterococci (VRE) can rapidly spread through hospitals. Therefore, our hospital employs a screening program whereby rectal swabs are screened for the presence of vanA and vanB, and only PCR-positive broths are cultured on VRE selection agar. Early November 2016, a clinical vanA-/vanB-negativeVRE isolate was detected in a vanA/vanB-screening-negative patient, giving the possibility that an undetected VRE might be spreading within our hospital. Whole-genome-sequencing of the isolate showed that resistance was vanD-mediated and core genome multilocus sequence typing showed it was a rare type: ST17/CT154. To determine the prevalence of vanA/B/C/D-carrying enterococci, we designed a real-time PCR for vanC1/2/3 and vanD and screened rectal swabs from 360 patients. vanD was found in 27.8% of the patients, yet culture demonstrated only E. faecium from vanA-positive broths and E. gallinarum from vanC1-positive broths. No vanD-positive VRE were found, limiting the possibility of nosocomial spread of this VRE. Moreover, the high prevalence of non-VRE vanD in rectal swabs makes it unfeasible to include the vanD PCR in our VRE screening. However, having validated the vanC1/2/3 and vanD PCRs allows us to rapidly check future vanA/B-negative VRE for the presence of vanC and vanD genes.