No Abstract available.
Vancomycin Resistance* ; Vancomycin*

No Abstract available.
Vancomycin Resistance* ; Vancomycin*

No abstract available.
Aerococcus* ; Gene Expression* ; Korea* ; Vancomycin Resistance* ; Vancomycin*

BACKGROUND: The precise identification of Enterococcus gallinarum and E. casseliflavus has assumed additional importance in clinical microbiology due to the intrinsic low-level resistance to vancomycin and the difficulty in differentiating them from E. faecium or E. faecalis, which are frequently found to be clinically significant vancomycin resistant enterococci(VRE). We evaluated the usefulness of Methyl-alpha-D-glucopyranoside(MDG) test for accurate species identification among them. METHODS: A total of 23 enterococci isolates including 18 clinical isolates of VRE from Nov 1997 to Aug 1998 and 5 VRE strains which had previously been reported as E. faecalis (2), E. faecium(2), E. avium(1) carrying vanC were tested for acidification of MDG. MDG test was done using 1% MDG in phenol red broth base and yellow coloration was interpreted as positive after 1 and 2 days of incubation at 35 degrees C. MDG results were compared with species identification by MicroScan Pos Combo type 6 (Dade, US A), motility test, pigment production, and PCR results of vanA, vanB, vanC1, vanC2/C3. RESULTS: Vancomycin resistance of 23 strains were genotyped as 7 strains of vanA, 12 strains of vanC1, 4 strains of vanC2/C3. MicroScan identified 7 vanA VRE as E. faecalis(1) and E. faecium(6), 12 VRE carrying vanC1 as E. faecalis(3), E. faecium(8) and E. avium(1), and 4 VRE carrying vanC2/C3 as E faecalis(3) and E. avium(1). Sixteen vanC VRE strains were all positive for MDG test and only 8(50%) of the 16 strains were motile. Yellow pigment were detected in all 4 vanC2/C3 VRE but only after a careful examination with a prolonged incubation. Seven vanA VRE were all negative in MDG tests, motility test and pigment production. CONCLUSIONS: MicroScan system plus motility and pigment production test was not able to differentiate reliably E. gallinarum and E. casseliflavus from E. faecalis and E. faecium. The MDG test was shown to be superior to motility test in differentiating those from E. faecalis and E. faecium. We conclude that the MDG test should be included for identifcation of VRE.
Enterococcus ; Phenolsulfonphthalein ; Polymerase Chain Reaction ; Vancomycin Resistance ; Vancomycin*

Leuconostoc species are Gram-positive coccobacilli and are used in dairy products and are intrinsically resistant to vancomycin. Leuconostoc infections are rare in humans, usually occurring in immune-compromised patients. We describe 6 patients with Leuconostoc bacteremia at Dong-A university hospital between 1990 and 2015. One isolate (L. lactis) was identified to species level using 16S rRNA gene sequencing analysis. All patients had underlying diseases and 5 patients underwent procedures that interrupted the normal integumentary defense. Four patients died within 30 days after being identified as carrying Leuconostoc species.
Bacteremia ; Dairy Products ; Genes, rRNA ; Humans ; Leuconostoc ; Vancomycin ; Vancomycin Resistance

BACKGROUNDS: The emergence of resistant strains to glycopeptide in enterococci(GRE) is increasingly serious problem in the worldwide. Automated methods and disk diffusion test have difficulties in detecting vancomycin resistance of some strains of vancomycin-resistant enterococci(VRE), especially having vanC genotypes. And a few studies have been done assessing the ability of antimicrobial susceptibility testing methods to detect teicoplanin resistance in enterococci. METHODS: We evaluated the abilities of two commercial kits including Vitek GPS-IZ(BioMerieux, Vitek, Inc., USA) and E-test(AB Biodisk, USA), and disk diffusion test to detect glycopeptide resistance using 34 strains of vanA and 15 strains of vanC1/C2 VRE. We compared the results with those of standard agar dilution test. RESULTS: In detecting vancomycin resistance, no very major or major errors were seen, and minor error rates were observed with disk diffusion(25%), Vitek GPS-IZ(20%) and E-test(8%). Overall sensitivities of all three methods in detecting vancomycin resistance of vanA VRE were 97-100%, but sensitivities in detecting vancomycin resistance of vanC VRE were 20% in disk diffusion, 87% in E-test and 87% in Vitek GPS-IZ. In detecting teicoplanin resistance, very major error rate was high in Vitek GPS-IZ(47%), but no very major or major errors were seen in disk diffusion and E-test; minor error rates of 2% and 6% were seen in Vitek GPS-IZ and E-test, respectively. CONCLUSION: All three methods detect vancomycin resistance of vanA VRE, but they continue to demonstrate problems in detecting low-level vancomycin resistance and the Vitek GPS-IZ is difficult to detect teicoplanin resistance in enterococci.
Agar* ; Diffusion* ; Genotype ; Teicoplanin ; Vancomycin Resistance

BACKGROUND: Vancomcyin-resistant enterococci(VRE) have become one of major nosocomial pathogens in USA and Europe since 1986. In Korea, only a few cases of VRE infection were reported until now. We investigated the rate of vancomycin resistance among clinical enterococcal isolates, characterized the genotypes of VRE isolates by using polymerase chain reaction (PCR), and analyzed the molecular relatedness of those isolates by using pulsed field gel electrophoresis(PFGE) technique. METHODS: Standard disk diffusion test, break point screening test and measurement of minimal inhibitory concentraion(MIC) were used for identification of VRE. Duplex vanA-vanB PCR for genotyping of vancomcyin resistance, and PFGE for molecular epidemiologic analysis were performed. RESULTS: Incidence of VRE among clinical enterococcal isolates during the study period(July, 1995~June,1996) was 1.0%(2/202). Two strains among 68 suspicious VRE, which were identified by disk diffusion method, were confirmed as true VRE by break point screening and MIC test. MIC of both VRE isolates were same(vancomycin : 512microgram/ml, teicoplanin 64microgram/ ml). Both VRE isolates were confirmed as vanA genotypes by duplex PCR and identical clones by PFGE and dendrogram analysis. CONCLUSION: Frequency of VRE among clinical enterococcal isolates is still very low(1%) in this hospital. We reported two VRE isolates which were confirmed by MIC determination and PCR genotyping. Judicious surveillance study of VRE and strict control of vancomycin usage are required to prevent the emergence and dissemination of VRE.
Clone Cells ; Diffusion ; Europe ; Genotype ; Incidence ; Korea ; Mass Screening ; Polymerase Chain Reaction ; Teicoplanin ; Vancomycin ; Vancomycin Resistance

BACKGROUND: Enterococci have emerged in recent years as a frequent cause of life-threatening nosocomial infections. The emergence of vancomycin-resistant enterococci(VRE) presents as an increasingly important problem particularly in the treatment and the potential dissemination of vancomycin-resistance. The purpose of this study is to determine the phenotypes and genotypes of VRE isolated from five hospitals and to study the genetic relatedness among them. METHODS: Antimicrobial susceptibility patterns and amplification of vancomycin resistance genes were used for phenotyping and genotyping of 42 VRE isolates respectively. For 21 isolates with vanA or vanB gene, plasmid profiles and pulsed field gel electrophoresis(PFGE) patterns were analyzed for molecular epidemiologic study. RESULTS: Out of 42 isolates, 21 were identified as E. faecium, 6 as E. faecalis, 2 as E. avium, and 13 as E. casseliflavus. Phenotyping showed 14 isolates as VanA(33%), 7 as VanB(17%) and 21 as VanC(50 %). Genotyping resulted in 12 isolates as vanA(5 of E. faecalis and 7 of E. faecium) and 9 as vanB(all E. faecium). Genotyping results were concordant with phenotyping results except for the two E. faecium isolates of VanA which had vanB genotype. Intrahospital spread of the same strains was proven in three hospitals by plasmid profiles and PFGE analysis. CONCLUSION: The study demonstrated a considerable number of VRE isolates in Korea and intrahospital spread proven by molecular epidemiologic methods. Although VRE infection has been considered very rare in Korea, practical guidelines including restriction of vancomycin usage and surveillance, are warranted to prevent infection and dissemination of VRE.
Cross Infection ; Epidemiologic Methods ; Epidemiologic Studies ; Genotype ; Korea* ; Molecular Epidemiology* ; Phenotype ; Plasmids ; Vancomycin ; Vancomycin Resistance

Although Enterococcus casseliflavus with intrinsic low-level vancomycin resistance has rarely been isolated from clinical specimens, this organism may cause serious invasive infections such as endocarditis and bacteremia. This low prevalence may be due, in part, to the inability of automated systems to recognize this organism. Vancomycin may not be effective against E. casseliflavus, despite in vitro results that indicate vancomycin susceptibility. It is important that all E. casseliflavus isolates obtained from clinical specimens that are related to serious infections should be identified to species level for appropriate antibiotic therapy. We report a case of bacteremia caused by E. casseliflavus in a 44-year-old female patient with liver disease.
Adult ; Bacteremia* ; Endocarditis ; Enterococcus* ; Female ; Humans ; Liver Diseases ; Prevalence ; Vancomycin ; Vancomycin Resistance

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of health care-associated infections. Vancomycin remains an acceptable treatment option. There has been a welcome increase in the number of agents available for the treatment of MRSA infection. These drugs have certain differentiating attributes and may offer some advantages over vancomycin, but they also have significant limitations. These agents provide some alternative when no other options are available.
Bacteremia* ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Vancomycin