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      Resistencia a Vancomicina en Cepas de Enterococcus faecium Aisladas en un Hospital Universitario Translated title: Vancomycin Resistance in Enterococcus faecium Strains Isolated at a University Hospital

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          Abstract

          Las especies que conforman el género Enterococcus, son cocos Gram positivos, que usualmente habitan el tracto intestinal de humanos y animales, pero que también pueden ser aislados de fuentes ambientales. Son capaces de sobrevivir a un amplio rango de condiciones ambientales adversas de estrés, lo que les permite colonizar un amplio rango de nichos, incluidos los ambientes hospitalarios. La patogenicidad nosocomial de los enterococos ha emergido en los últimos años, así como su incrementada resistencia a los antibióticos glicopéptidos. El presente estudio intenta determinar la resistencia a vancomicina de cepas de Enterococcus faecium aisladas en un hospital universitario en el período enero-diciembre del año 2009, así como caracterizar el determinante genético responsable de la resistencia. Para ello se utilizaron los métodos para determinar susceptibilidad a glicopéptidos descritos por el CLSI, adicionalmente se determinó el elemento genético responsable de la resistencia mediante la reacción en cadena de la polimerasa. El 48,81% de las cepas de E. faecium estudiadas fueron resistentes a vancomicina y el PCR demostró la presencia del gen vanA que confiere altos niveles de resistencia a glicopéptidos. Debido al elevado número de aislados resistentes a vancomicina dentro de la institución se sospecha de la presencia de un brote nosocomial producido por este microorganismo; esta cepa epidémica poseedora del gen vanA posiblemente está dispersa en los diferentes servicios de la institución, por lo que se sugiere realizar estudios epidemiológicos para determinar el rol que este microorganismos juega en la producción de infecciones nosocomiales en la institución estudiada.

          Translated abstract

          Genus Enterococcus species are gram positive cocci, usually inhabitants of human and animal intestinal tracts, but can also be isolated from their environmental sources. They are able to survive a wide range of adverse environmental stress conditions, allowing them to colonize a wide range of niches, including hospital environments. Nosocomial pathogenicity of enterococci has emerged in recent years, as well as their increased resistance to glycopeptide antibiotics. This study attempts to determine the resistance to vancomycin of Enterococcus faecium strains isolated in a university hospital during the January-December period of 2009, as well as to characterize the genetic determinant responsible for its resistance. Methods to determine susceptibility to glycopeptides described by CLSI were used; additionally, the genetic elements responsible for resistance were identified using the polymerase chain reaction. Of the E. faecium strains studied, 48.81% were resistant to vancomycin, and PCR showed presence of the vanA gene that confers high levels of resistance to glycopeptides. Due to the large number of isolates resistant to vancomycin, the presence of a nosocomial outbreak produced by this microorganism was suspected; this epidemic strain possessing a vanA gene is possibly scattered in different services of the institution; therefore, epidemiological studies should be performed to determine the role this microorganism plays in the production of nosocomial infections in the institution under study.

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          Most cited references59

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          The life and times of the Enterococcus.

          B E Murray (1990)
          Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.
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            National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1992-June 2001, issued August 2001.

            (2001)
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              Emergence of vancomycin-resistant enterococci in New York City.

              Enterococci, a common cause of nosocomial infection, are intrinsically resistant to most antimicrobials and readily acquire additional resistance. Vancomycin-resistant enterococci (VRE) have caused clusters of nosocomial infections since 1988. In April, 1991, the New York City Department of Health asked all city laboratories to submit suspected VRE isolates for confirmation. Clinical and epidemiological characteristics of the first 100 patients with VRE were identified, and antimicrobial susceptibility testing, restriction enzyme analysis, and DNA-DNA hybridisation with the vanA gene probe were done. From September, 1989, to October, 1991, 361 patients with VRE were identified at 38 hospitals. The number of hospitals reporting VRE increased from 1 in 1989 to 38 by October, 1991. 98% of 100 VRE infections were nosocomially acquired and 83% patients had received vancomycin and/or a cephalosporin in the 30 days before isolation of VRE. Of 23 isolates from 21 of the first 100 patients, 19 (83%) were resistant to all available antimicrobials. Four vanA probing patterns were noted, and restriction enzyme analysis of the 23 isolates revealed 14 strains. VRE have emerged rapidly in New York City. Molecular analyses suggest that a highly mobile genetic element--eg, a transposon--is responsible for the rapid spread of vancomycin resistance.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                km
                Kasmera
                Kasmera
                Universidad del Zulia (Maracaibo )
                0075-5222
                June 2011
                : 39
                : 1
                : 7-17
                Affiliations
                [1 ] Universidad del Zulia Venezuela
                [2 ] Universidad del Zulia Venezuela
                [3 ] Universidad del Zulia Venezuela
                [4 ] Universidad del Zulia Venezuela
                Article
                S0075-52222011000100002
                dc49df2d-8f2c-4c3b-b1a0-619a23da3025

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0075-5222&lng=en
                Categories
                TROPICAL MEDICINE

                Infectious disease & Microbiology
                Enterococcus faecium,vancomycin,resistance,vanA,vancomicina,resistencia

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