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Abstract
We investigated an outbreak of vancomycin-resistant Enterococcus faecium affecting
14 patients in a 20-bed intensive care unit (ICU) between September 2006 and August
2007 (incidence: 3.56 cases per 1000 ICU patient days). Eighteen isolates of vanA
type E. faecium were analysed by pulsed field gel electrophoresis, which showed 14
types overall. Multilocus sequence typing (MLST) identified eight different sequence
types (STs) (ST78, ST117, ST203, ST316, ST362, ST363, ST364 and ST365), including
four new types (ST362, ST363, ST364 and ST365) and 17 strains belonged to clonal complexes
CC17. Sixteen of these carried the esp gene. Eighteen Tn1546-like elements encoding
vanA-type VRE were classified into three types (types I to III) and all of them contained
both IS1216V and IS1542 insertions. Vancomycin resistance of 14 vanA type E. faecium
isolates was transferred at a frequency of 1.3 x 10(-6) to 6.4 x 10(-5) between E.
faecium strains during filter mating. Our findings indicate that conjugative dissemination
of Tn1546-like elements among CC17 E. faecium occurred during the outbreak in this
ICU.