Department of Clinical Microbiology, Adana City Training and Research Hospital, Adana, Turkey.
Department of Medical Microbiology, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
J Clin Lab Anal. 2020 Dec;34(12):e23541. doi: 10.1002/jcla.23541. Epub 2020 Oct 6.
The aim of this study was to provide information about the spread and characteristics of the vancomycin-resistant Enterococcus faecium isolates (VREfm) in Turkey.
Seventy-one nonduplicate consecutive isolates of VREfm were obtained from various clinical specimens of inpatients treated at university or training hospitals in seven regions of Turkey. Further characteristics included antibiotic susceptibility testing, pulsed-field gel electrophoresis (PFGE) of SmaI-digested genomic DNA, and multilocus sequence typing (MLST) of selected isolates. The presence of vancomycin resistance and virulence genes (esp and hyl) was investigated by polymerase chain reaction (PCR).
All VREfm isolates had MICs to vancomycin of ≥32 mg/L and contained the vanA gene. The presence of esp gene was identified in 64 and hyl in eight VREfm isolates. All VREfm showed the multiresistance phenotype, including ampicillin (99%), penicillin (99%), imipenem (99%), ciprofloxacin (87%), moxifloxacin (87%), erythromycin (97%), streptomycin (86%), gentamicin (82%), tetracycline (70%), and teicoplanin (99%). All were susceptible to tigecycline while quinupristin-dalfopristin (97%) and linezolid (93%) were the most active other agents. Analysis of the PFGE profiles showed that 53 (74.6%) VREfm isolates shared a similar electrophoretic profile, designed as type 1, and were closely related (>85%). The sequence type was identified by MLST in 44 VRE isolates with unrelated or closely related PFGE patterns. MLST revealed that nosocomial spread of VREfm resulted from dissemination of lineage C1 E faecium clones. Sequence types ST78, ST203, and ST117 were the most frequently isolated. This is the first report of ST733 around the world.
Lineage C1 clones are disseminated among clinical VREfm isolates in seven different regions in Turkey. Regarding VREfm isolates, the worldwide epidemic strains are in circulation in Turkey.
本研究旨在提供土耳其万古霉素耐药粪肠球菌（VREfm）分离株的传播和特征信息。
从土耳其 7 个地区的大学或培训医院住院患者的各种临床标本中获得了 71 株非重复连续的 VREfm 分离株。进一步的特征包括抗生素敏感性测试、SmaI 消化基因组 DNA 的脉冲场凝胶电泳（PFGE）和选定分离株的多位点序列分型（MLST）。通过聚合酶链反应（PCR）检测万古霉素耐药和毒力基因（esp 和 hyl）的存在。
所有 VREfm 分离株对万古霉素的 MIC 值均≥32mg/L，且均含有 vanA 基因。64 株 VREfm 分离株中存在 esp 基因，8 株中存在 hyl 基因。所有 VREfm 均表现出多药耐药表型，包括氨苄西林（99%）、青霉素（99%）、亚胺培南（99%）、环丙沙星（87%）、莫西沙星（87%）、红霉素（97%）、链霉素（86%）、庆大霉素（82%）、四环素（70%）和替考拉宁（99%）。所有菌株均对替加环素敏感，而奎奴普丁/达福普汀（97%）和利奈唑胺（93%）是最有效的其他药物。PFGE 图谱分析显示，53 株（74.6%）VREfm 分离株具有相似的电泳图谱，设计为类型 1，且密切相关（>85%）。44 株具有不相关或密切相关 PFGE 模式的 VRE 分离株通过 MLST 确定了序列类型。MLST 显示，医院内 VREfm 的传播是由 C1 粪肠球菌克隆的传播引起的。ST78、ST203 和 ST117 是最常分离的序列类型。这是全球首次报道 ST733。
C1 谱系克隆在土耳其 7 个不同地区的临床 VREfm 分离株中传播。就 VREfm 分离株而言，全球流行株在土耳其流行。
