Appearance of vanD-positive Enterococcus faecium in a tertiary hospital in the Netherlands: prevalence of vanC and vanD in hospitalized patients

Sci Rep. 2019 May 6;9(1):6949. doi: 10.1038/s41598-019-42824-4.

Abstract

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-negative VRE 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.

Publication types

  • Case Reports

MeSH terms

  • Bacterial Proteins / genetics*
  • Cross Infection*
  • Enterococcus faecium / classification
  • Enterococcus faecium / drug effects
  • Enterococcus faecium / genetics*
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / epidemiology*
  • Gram-Positive Bacterial Infections / microbiology*
  • Humans
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Peptide Synthases / genetics*
  • Phylogeny
  • Prevalence
  • Public Health Surveillance
  • Severity of Illness Index
  • Tertiary Care Centers*
  • Vancomycin Resistance
  • Vancomycin-Resistant Enterococci

Substances

  • Bacterial Proteins
  • Peptide Synthases
  • VanC protein, Enterococcus
  • VanD protein, Enterococcus faecium