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High abundance and diversity of antimicrobial resistance determinants among early vancomycin-resistant Enterococcus faecium in Poland

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Abstract

The purpose of this study was to investigate the clonal structure, antimicrobial resistance phenotypes and their determinants among early vancomycin-resistant Enterococcus faecium (VREm) isolates in Poland. Two hundred and eighty-one VREm isolates collected between 1997 and 2005 were studied. VREm isolates were characterised by multilocus sequence typing (MLST). The presence of antimicrobial resistance determinants, transposon-specific genes, IS16 and esp Efm was checked by polymerase chain reaction (PCR). Ciprofloxacin and ampicillin resistance determinants were investigated by sequencing. Two hundred and twenty-two (79 %) and 59 (21 %) VREm isolates were vanA- and vanB-positive, respectively. Among 135 representative isolates, MLST yielded 33 different sequence types (STs), of which 29 were characteristic of hospital-associated E. faecium; 128 (94.8 %) and 123 (91.1 %) isolates harboured the IS16 and esp Efm genes, and all 135 isolates were resistant to ciprofloxacin and ampicillin. Resistance to tetracycline (71.1 % isolates) was mostly associated with tetM (75.0 %) and the concomitant presence of the Tn916 integrase gene. High-level resistance to streptomycin (93.3 % of isolates) and high-level resistance to gentamicin (94.1 % of isolates) were due to ant(6′)-Ia and aac(6′)-Ie-aph(2″) genes, respectively, the latter of which is known to be located on various Tn4001-type transposons. Fifteen combinations of mutations in the quinolone-determining regions of GyrA and ParC were identified, including changes not previously reported, such as S83F and A84P in GyrA. Twenty-three variants of the penicillin-binding protein PBP5 occurred in the studied group, and novel insertions at amino acid positions 433 and 568 were identified. This analysis revealed the predominance of hospital-associated strains of E. faecium, carrying an abundant and divergent range of resistance determinants among early VREm isolates in Poland.

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Acknowledgements

We thank all the Polish microbiologists who sent VREm isolates to our laboratory, Magdalena Kawalec for the helpful advice, Rob Willems for sharing the BAPS results and assigning new alleles and STs, and Stephen Murchan for the critical reading of the manuscript. This publication made use of the Enterococcus faecium MLST website (http://efaecium.mlst.net/) hosted at Imperial College of the University of Oxford and funded by the Wellcome Trust. This work was supported by grant ACE from the European Union 6th Framework Programme under contract LSHE-CT-2007-037410, a complementary funding from the Ministry of Science and Higher Education, Poland (decision 937/6. PR UE/2009/7), by MIKROBANK funding from the Ministry of Science and Higher Education, Poland, and by grant NN401588540 from the Ministry of Science and Higher Education, Poland.

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Authors and Affiliations

  1. Department of Molecular Microbiology, National Medicines Institute, ul. Chełmska 30/34, 00-725, Warsaw, Poland

    E. Sadowy, I. Gawryszewska & A. Bojarska

  2. Epidemiological Response Centre of the Polish Armed Forces, ul. Radiowa 49, 00-908, Warsaw, Poland

    A. Sieńko

  3. Department of Epidemiology and Clinical Microbiology, National Medicines Institute, ul. Chełmska 30/34, 00-725, Warsaw, Poland

    K. Malinowska & W. Hryniewicz

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  1. E. Sadowy
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Sadowy, E., Sieńko, A., Gawryszewska, I. et al. High abundance and diversity of antimicrobial resistance determinants among early vancomycin-resistant Enterococcus faecium in Poland. Eur J Clin Microbiol Infect Dis 32, 1193–1203 (2013). https://doi.org/10.1007/s10096-013-1868-y

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  • DOI: https://doi.org/10.1007/s10096-013-1868-y

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