We investigated the antibiotic susceptibility of glycopeptide-resistant enterococci (GRE). Seventy consecutive GRE were tested. Sixty-two isolates were identified as Enterococcus faecium (88.6%), and 8 (11.4%) as Enterococcus faecalis. All strains were susceptible to linezolid and daptomycin, while 17.1% (12/70) and 11.4% (8/70) were resistant to quinupristin/dalfopristin (QD) and tigecycline, respectively. All E. faecalis isolates were resistant to QD, while 4 of 62 (6.5%) E. faecium isolates were resistant to QD. All E. faecalis isolates were susceptible to tigecycline, while 14.5% (9/62) E. faecium isolates were resistant. Continued surveillance of GRE antibiotic susceptibilities is important for combating these multi-resistant nosocomial pathogens.
Daptomycin* ; Enterococcus faecalis ; Enterococcus faecium ; Linezolid ; Teicoplanin

BACKGROUND: Three chromogenic media using direct inoculation were compared with enriched enterococcosel broth for vancomycin-resistant Enterococcus faecium and/or Enterococcus faecalis (VRE) surveillance. METHODS: A total of 174 rectal swabs were included for VRE surveillance. The specimens were transferred in enterococcosel broth (EB). An aliquot of the broth was inoculated onto Brilliance VRE, chromID VRE, and VRESelect media and incubated for up to 48 h. We examined each media and EB after 24 h and 48 h of incubation. When appropriately colored colonies were observed, identification was confirmed using the VITEK-2 system and/or VITEK MS. Vancomycin susceptibility was confirmed by disk diffusion test. The presence of resistance genes was confirmed using Anyplex VanR Real-time Detection (Seegene, Korea). RESULTS: Of the 174 rectal swab specimens, 73 VRE were isolated. For enterococcosel broth, Brilliance VRE, chromID VRE, and VRESelect, the sensitivity at 24 h was 79.2%, 83.3%, 79.2%, and 79.2%, respectively. The sensitivity at 48 h was 91.7%, 93.1%, 91.4%, and 90.3%, respectively. The specificity at 24 h was 85.3%, 97.1%, 98.0%, and 98.0%, while that at 48 h was 79.4%, 85.3%, 95.2%, and 95.1%, respectively. The specificity of chromogenic media at 24 h and 48 h was significantly higher than that of EB. Furthermore, the specificity at 48 h was significantly higher for chromID VRE and VRESelect than Brilliance VRE, although color distinction was easier with VRESelect. CONCLUSION: Based on our results, use of chromID VRE or VRESelect is more reliable and convenient for screening of VRE. In addition, five vanA-positive Enterococcus gallinarum, Enterococcus avium and Enterococcus durans were isolated, and two of them (one E. avium and one E. durans) were detected only on VRESelect.
Diffusion ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Mass Screening ; Sensitivity and Specificity ; Vancomycin

BACKGROUND: Vancomycin-resistant Enterococci (VRE) infections are caused by Enterococcus faecium in about 90% of the cases but can also be caused by Enterococcus faecalis. Thus, this study investigates factors that cause a low isolation rate of vancomycin-resistant E. faecalis (VREfs). To this end, the authors study the clinical traits, resistant gene structure, genomic classification, and molecular characteristics of the virulent factor. METHODS: From January 2001 through September 2011, 17 vanA-containing E. faecalis isolates were collected from hospitalized patients at Ajou University Hospital in Korea. Identification, antimicrobial susceptibility testing, and PCR of van and esp genes were performed. Pulsed-field gel electrophoresis (PFGE) was used for strain typing. PCR and sequencing of the internal regions of Tn1546 were performed for structural analysis of the van gene. RESULTS: Of 4,235 VRE infections, 3,918 (92.5%) were caused by E. faecium, and 95 (2.2%) were caused by E. faecalis. In 67% of VREfs infections, there was a preceding occurrence of E. faecium infection. All isolates were of genotype vanA. Our isolates were divided into three types according to the distribution of IS elements integrated into Tn1546 (types I to IIb). The PFGE results showed no clonal relatedness among isolates. CONCLUSION: Our study found that VREfs infections affect patients who have experienced vancomycin-resistant E. faecium. (VREfm) infection or undergo invasive procedures. The VREfs seems to involve the horizontal transfer of Tn1546 transposon from VREfm.
Classification ; DNA Transposable Elements ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecalis* ; Enterococcus faecium ; Enterococcus* ; Epidemiology* ; Genotype ; Humans ; Korea ; Polymerase Chain Reaction

BACKGROUND: Vancomycin-resistant enterococci (VRE) were first recovered from clinical isolates in Korea in 1992, and the incidence has been steadily increasing. Alternatives to vancomycin are few because VRE are frequently resistant to commonly used antimicrobial agents. The present study was designed to assess the in-vitro activity of fosfomycin to clinical isolates of VRE. METHODS: For 199 VRE isolates from 1995 to 2000, and 91 enterococcal isolates that were consecutively isolated during the January of 2001 at Wonju Christian Hospital, fosfomycin (200 microgram) disk diffusion test was done by NCCLS method. The number of enterococcal isolates tested for fosfomycin were as follows:58 E. faecalis (42 vancomycin susceptible isolates, 16 vancomycin resistant isolates, and 1 vancomycin intermediate resistance isolate); 210 E. faecium (185 vancomycin resistant and 25 vancomycin susceptible isolates); 15 E. gallinarum, and 6 E. casseliflavus isolates. RESULTS: Among the VRE isolates, the resistance rates of fosfomycin according to enterococcal species were 6.3% in E. faecalis, 4.9% in E. faecium, 0% in E. casseliflavus, and 16.7% in E. gallinarum. CONCLUSION: Fosfomycin could be a potentially useful drug for the treatment of infections caused by VRE.
Anti-Infective Agents ; Diffusion ; Enterococcus faecalis ; Enterococcus faecium ; Fosfomycin* ; Gangwon-do ; Incidence ; Korea ; Vancomycin*

No abstract available.
Endophthalmitis ; Enterococcus faecalis ; Enterococcus

The study was conducted to investigate the distribution of pathogenic bacteria related to agricultural herb products that are sold on the market in South Korea. A survey was conducted on the microbial contamination levels and antibiotic susceptibility of Bacillus cereus (B. cereus) among 194 agricultural herb products on sale in Seoul. Distributions of those isolates were 252 coliforms, 148 Bacillus spp., 75 Enterococcus spp., 10 Staphylococcus spp., and 6 Listeria spp., respectively. The number of B. cereus isolates was 34, Escherichia coli isolates was three, Enterococcus faecium isolate was one, and Enterococcus faecalis isolate was one. Antibiotic susceptibility of B. cereus isolates was tested against 36 kinds of antibiotic susceptibility discs by disc diffusion method. B. cereus isolates were resistant to 20 kinds of antibiotics and semi-resistant to 11 kinds of antibiotics. On the basis of these results, any agricultural herb product can be assumed to be resistant or semi-resistant to the antibiotics used in human. In conclusion, we suggest sanitary control and special management regarding B. cereus contamination in agricultural herb products.
Anti-Bacterial Agents ; Bacillus cereus ; Bacillus* ; Bacteria ; Commerce ; Diffusion ; Enterococcus faecalis ; Enterococcus faecium ; Enterococcus* ; Escherichia coli ; Humans ; Korea ; Listeria* ; Methods ; Seoul ; Staphylococcus*

BACKGROUND: Episode of Enterococcal bacteremia has increasingly been reported for the past 15 years in USA, but there have been few systematic studies on its occurrence among Korean children. This study was carried out to determine the epidemiologic, clinical and laboratory characteristics of enterococcal bacteremia in Korean children. METHODS: Fifty episodes of enterococcal bacteremia among Korean children were retrospectively analyzed. Clinical and microbiological data were collected for all episodes of enterococcal bacteremia which occurried during 9-year period between November, 1992, and August, 2001 at the Seoul National University Children's Hospital. RESULTS: Significant underlying diseases were present in 47 (94%) episodes, including cardiac or abdominal surgery (44%), cardiac disease (30%), and chronic gastrointestinal disorders (16%). Thirty- eight (76%) episodes were nosocomial in origin, and 14 (28%) episodes were polymicrobial bacteremia. The source of bacteremia was identified in 16 (32%) episodes, intravascular device being the most common identifiable source. Of the 47 isolates identified at species level, 20 strains were Enterococcus faecium, 26 Enterococcus faecalis and one Enterococcus avium. Seventy-two percent of E. faecium cases were resistant to ampicillin. 36 cases (80%) had high-level resistance to gentamicin and sixteen cases (36%) to streptomycin. There was no strain resistant to vancomycin. Three clinical patterns were identified; self-limited bacteremia, 20%; low grade sepsis with favorable outcome after specific therapy, 42%; severe and prolonged infection, 30%; and unclassified, 8%. The overall mortality rate was 10.8%. CONCLUSION: Enterococcal bacteremia in children was usually nosocomial and comprised a heterogeneous group. The majority of cases occurred in children with serious underlying diseases. The frequency of high-level resistance to gentamicin in enterococcal isolates was high.
Ampicillin ; Bacteremia* ; Child ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Gentamicins ; Heart Diseases ; Hospitals, Pediatric* ; Humans ; Mortality ; Retrospective Studies ; Seoul ; Sepsis ; Streptomycin ; Vancomycin

BACKGROUND: Episode of Enterococcal bacteremia has increasingly been reported for the past 15 years in USA, but there have been few systematic studies on its occurrence among Korean children. This study was carried out to determine the epidemiologic, clinical and laboratory characteristics of enterococcal bacteremia in Korean children. METHODS: Fifty episodes of enterococcal bacteremia among Korean children were retrospectively analyzed. Clinical and microbiological data were collected for all episodes of enterococcal bacteremia which occurried during 9-year period between November, 1992, and August, 2001 at the Seoul National University Children's Hospital. RESULTS: Significant underlying diseases were present in 47 (94%) episodes, including cardiac or abdominal surgery (44%), cardiac disease (30%), and chronic gastrointestinal disorders (16%). Thirty- eight (76%) episodes were nosocomial in origin, and 14 (28%) episodes were polymicrobial bacteremia. The source of bacteremia was identified in 16 (32%) episodes, intravascular device being the most common identifiable source. Of the 47 isolates identified at species level, 20 strains were Enterococcus faecium, 26 Enterococcus faecalis and one Enterococcus avium. Seventy-two percent of E. faecium cases were resistant to ampicillin. 36 cases (80%) had high-level resistance to gentamicin and sixteen cases (36%) to streptomycin. There was no strain resistant to vancomycin. Three clinical patterns were identified; self-limited bacteremia, 20%; low grade sepsis with favorable outcome after specific therapy, 42%; severe and prolonged infection, 30%; and unclassified, 8%. The overall mortality rate was 10.8%. CONCLUSION: Enterococcal bacteremia in children was usually nosocomial and comprised a heterogeneous group. The majority of cases occurred in children with serious underlying diseases. The frequency of high-level resistance to gentamicin in enterococcal isolates was high.
Ampicillin ; Bacteremia* ; Child ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Gentamicins ; Heart Diseases ; Hospitals, Pediatric* ; Humans ; Mortality ; Retrospective Studies ; Seoul ; Sepsis ; Streptomycin ; Vancomycin

The present study was done to scrutinize the possible relation between infective genes and antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium. Considering the fact that the presence of recognized infective determinants among clinical isolates may promote the emergence of infections and persistence of Enterococci in hospital settings, which can lead to an increase in antimicrobial resistance. 175 E. faecalis and 67 E. faecium isolated from clinical specimens were used. The isolates were identified, and then antibiotic susceptibility testing was performed. The MIC of vancomycin and teicoplanin were determined by broth microdilution method. The presence of infective genes esp, hyl and asa₁ was scrutinized using PCR. Of the 280 enterococcal isolates, 175 (62.5%) isolates were identified as E. faecalis, 67 (24%) as E. faecium and 38 (13.5%) as Enterococcus spp. The results of the antibiotic susceptibility testing showed resistance rates of 5% and 73% to vancomycin and teicoplanin in E. faecalis and E. faecium isolates, respectively. The statistical analysis showed that the esp infective gene has significant associations with ciprofloxacin, erythromycin and tetracycline in E. faecium and with chloramphenicol in E. faecalis strains; the hyl with teicoplanin and vancomycin in E. faecium strains; and also asa₁ with vancomycin in E. faecium and with ampicillin and chloramphenicol in E. faecalis strains. Regarding the relationships between virulence genes and antibiotic resistance in strains of E. faecalis and E. faecium, detection of infective factors associated with invasive diseases has become a major issue of concern.
Ampicillin ; Anti-Bacterial Agents ; Chloramphenicol ; Ciprofloxacin ; Drug Resistance, Microbial ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Erythromycin ; Iran ; Methods ; Polymerase Chain Reaction ; Teicoplanin ; Tetracycline ; Vancomycin ; Virulence

BACKGROUND: Vancomycin-resistant enterococci (VRE) infection is an emerging nosocomial problem. VRE usually multidrug-resistant, poses therapeutic dilemmas. The gene that encodes the resistance against vancomycin may spread the resistance to Staphylococcus aureus. However, there are no well-organized studies on the clinical manifestations and the factors that contribute to mortality in Korea. Herein, this study was focused on the clinical manifestations and mortality risks of patients with VRE infection during 8 years (1994-2001) in a university hospital. Understanding of the epidemiology and clinical manifestations of VRE would help develop control strategy of VRE outbreak in a hospital. METHOD: Sixty seven cases that had the VRE infection in Korea University Guro Hospital from January 1, 1994to December 12, 2001, were reviewed. We analyzed the risk factors of VRE infection and death by using univariable and multivariable statistic analyses. RESULTS: VRE infections have recently been increasing. Most of VRE infections were caused by Enterococcus faecium (85.1%) and Enterococcus faecalis (10.4%). Among 67 cases, 40 cases (59.7%) expressed VanA phenotype, 23 cases (34.3%) expressed VanB phenotype, and 3 cases expressed VanC phenotype (6%). The risk factors for death were renal dysfunction, central venous catheter insertion, and tracheostomy by using univariable analysis. The risk factor for death was renal dysfunction by using multivariable analysis. CONCLUSION: VRE has been increasing during the late 1990s in Korea. The VRE infection occurs especially in the patients who have renal dysfunction, long-term hospitalization, and ICU care. The implementation of careful isolation, infection control measures, prudent use of antibiotics, especially vancomycin, and periodic screening of patients populations are required to control VRE infection.
Anti-Bacterial Agents ; Central Venous Catheters ; Enterococcus faecalis ; Enterococcus faecium ; Epidemiology ; Hospitalization ; Humans ; Infection Control ; Korea ; Mass Screening ; Mortality ; Phenotype ; Risk Factors* ; Staphylococcus aureus ; Tracheostomy ; Vancomycin