Abstract

High-level resistance to glycopeptides in Enterococcus faecium is associated with an inducible 39-kDa cytoplasmic membrane protein. The present paper shows that such glycopeptide-resistant E. faecium strains can not only be isolated in a definite clinical setting but also from waste water of sewage treatment plants. Nearer characterization of these and of clinical isolates by resistance pattern, biotyping, and genotyping (DNA-fingerprinting with pulsed-field get electrophoresis) has shown that different glycopeptide-resistant E. faecium strains have been isolated from clinical sources and from waste water.

References

1
Lütticken
R.
Kunstmann
G.
(
1988
)
Vancomycin-resistant Streptococcaceae from clinical material
Zbl. Bakteriol. Hyg. A
 ,
267
,
379
382
.
2
Johnson
A.P.
Uttley
A.H.D.
Woodford
N.
George
R.C.
(
1990
)
Resistance to vancomycin and teicoplanin: an emerging clinical problem
Clin. Microbiol. Rev.
 ,
3
,
280
291
.
3
Uttley
A.H.C.
George
R.C.
Naidoo
J.
Woodford
N.
Johnson
A.P.
Collins
C.H.
Morrison
D.
Gilfillan
A.J.
Fitch
L.E.
Heptonstall
J.
(
1989
)
High-level vancomycin-resistant enterococci causing hospital infections
Epidemiol. Infect.
 ,
103
,
173
181
.
4
Courvalin
P.
(
1990
)
Resistance of enterococci to glycopeptides
Antimicrob. Agents. Chemother.
 ,
34
,
2291
2296
.
5
Reynolds
P.E.
(
1989
)
Structure, biochemistry, and mechanism of action of glycopeptide antibiotics
Eur. J. Clin. Microbiol. Infect. Dis.
 ,
8
,
943
950
.
6
Nicas
T.I.
Wu
C.Y.E.
Hobbs
J.N.
Preston
P.A.
Allen
N.E.
(
1989
)
Characterization of vancomycin resistance in Enterococcus faecium and Enterococcins faecalis
Antimicrob. Agents Chemother.
 ,
33
,
1121
1124
.
7
Shlaes
D.M.
Al-Obeid
S.
Shlaes
J.H.
Boisivon
A.
Williamson
R.
(
1989
)
Inducible, transferrable resistance to vancomycin in Enterococcus faecium D 399
J. Antimicrob. Chemother.
 ,
23
,
503
508
.
8
Williamson
R.
Al-Obeid
S.
Shlaes
J.H.
Goldstein
F.W.
Shlaes
D.M.
(
1989
)
Inducible resistance to vancomycin in Enterococcus faecium D 366
J. Infect. Dis.
 ,
159
,
1095
1104
.
9
Al-Obeid
S.
Collatz
E.
Gutmann
L.
(
1990
)
Mechanism of resistance to vancomycin in Enterococcus faecium D 366 and Enterococcus faecalis A 256
Antimicrob. Agents Chemother.
 ,
34
,
252
256
.
10
Dutka-Malen
S.
Molinas
C.
Arthur
M.
Courvalin
P.
(
1990
)
The VanA glycopeptide resistance protein is related to d-alanyl-d-alanine ligase cell wall bioxynthesis enzymes
Mol. Gen. Genet.
 ,
224
,
364
372
.
11
Bugg
T.D.H.
Dutka-Malen
S.
Arthur
M.
Courvalin
P.
(
1991
)
Identification of vancomycin resistance protein VanA as a d-alanine: d-alanine ligase of altered substrate specifity
Biochemistry (USA)
 ,
30
,
2017
2021
.
12
Gutmann
L.
Billot-Klein
D.
Al-Obeid
S.
Klare
I.
Francoual
S.
Collatz
E.
Van Heijenoort
J.
(
1992
)
Inducible carboxypeptidase activity in glycopeptide-resistant enterococci
Antimicrob. Agents Chemother.
 ,
36
,
77
80
.
13
Arthur
M.
Molinas
C.
Courvalin
P.
(
1992
)
The VansS-VanR two-component regulatory system controls synthesis of depsipeptide peptidoglycan precursors in Enterococcus faecium BM 4147
J. Bacteriol.
 ,
174
,
2582
2591
.
14
Klare
I.
Collatz
E.
Al-Obeid
S.
Wagner
J.
Rodloff
A.C.
Witte
W.
(
1992
)
Glycopeptidresistenz bei Enterococcus faecium aus Besiedlungen und Infektionen von Patienten aus Intensivstationen Berliner Kliniken und einem Transplantationszentrum
ZAC Zschr. antimikrob. antineoplast. Chemother.
 ,
10
,
45
53
.
15
Ziesché
K.
Reissbrodt
R.
Rische
H.
(
1985
)
Der Galle-Chrysoidin-Glycerol-(GCG)-Nährboden in seiner Anwendung zur Diagnostik gramnegativer aerober Bakterien, besonders der Enterobacteriaceae
Zschr. gesamte Hyg.
 ,
31
,
516
518
.
16
Lautrop
H.
(
1974
)
Acinetobacter
8th edn.
In
Bergey's Manual of Determinative Bacteriology
 
Buchanan
R.E.
Gibbons
N.E.
, Eds), pp
436
438
Williams & Wilkins
,
Baltimore, MD
.
17
17 DIN 58940, Teil 8, Ausgabe Juni 1990: Methoden zur Empfindlichkeitspriifung von bakteriellen Krankheitser- regern (ausser Mykobakterien) gegen Chemotherapeutika: Mikrodilution
. In:
DIN-Taschenbuch 222: Medizinische Mikrobiologie und Immunologic—Normen und weitere Unterlagen (DIN Deutsches Institut fiir Normung e.V., Ed.)
 , pp.
381
384
.
Beuth
,
Berlin-Kfln
(
1992
).
18
Reissbrodt
R.
Witte
W.
Rische
H.
(
1983
)
A new semidefined nutrient medium for bacterial susceptibility testing
J. Hyg. Epidemiol. Microbiol. Immunol.
 ,
27
,
465
479
.
19
Goering
R.V.
Duensing
T.D.
(
1990
)
Rapid field inversion gel electrophoresis in combination with an rRNA gene probe in the epidemiological evaluation of staphylococci
J. Clin. Microbiol.
 ,
28
,
426
429
.
20
Miranda
A.G.
Singh
K.V.
Murray
B.E.
(
1991
)
DNA-fingerprinting of Enterococcus faecium by pulsed-field gel electrophoresis may be a useful epidemiological tool
J. Clin. Microbiol.
 ,
29
,
2752
2757
.
21
Shlaes
D.M.
Etter
L.
Gutmann
L.
(
1991
)
Synergistic killing of vancomycin-resistant enterococci of classes A, B, and C by combinations of vancomycin, penicillin, and gentamicin
Antimicrob. Agents Chemother.
 ,
35
,
776
779
.
22
Gray
J.W.
Pedler
S.J.
(
1992
)
Antibiotic resistant enterococci
J. Hosp. Infect.
 ,
21
,
1
14
.
23
Bingen
E.H.
Denamur
E.
Lambert-Zechovsky
N.Y.
Elion
J.
(
1991
)
Evidence for the genetic unrelatedness of nosocomial vancomycin-resistant Enterococcus faecium strains in a pediatric hospital
J. Clin. Microbiol.
 ,
29
,
1888
1892
.
24
Brisson-Noël
A.
Dutka-Malen
S.
Molinas
C.
Leclerq
R.
Courvalin
P.
(
1990
)
Cloning and heterospecific expression of the resistance determinant vanA encoding high-level resistance to glycopeptides in E. faecium BM 4147
Antimicrob. Agents Chemother.
 ,
34
,
924
927
.
25
Dutka-Malen
S.
Leclerq
R.
Coutant
V.
Duval
J.
Courvalin
P.
(
1990
)
Phenotyping and genotyping heterogenicity of glycopeptide resistance determinants in Grampositive bacteria
Antimicrob. Agents Chemother.
 ,
34
,
1875
1879
.
26
De Flaun
M.F.
Levy
S.B.
(
1989
) In
Gene Transfer in the Environment
 
Levy
S.B.
Miller
R.V.
, Eds) pp
1
32
McGraw-Hill Publ. Comp
,
New York, NY
.
27
Lyon
B.R.
Skurray
R.
(
1987
)
Antimicrobial resistance in Staphylococcus aureus: genetic basis
Microbiol. Rev.
 ,
51
,
88
134
.