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Antimicrobial Agents and Chemotherapy, March 1999, p. 724-725, Vol. 43, No. 3
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
LETTERS TO THE EDITOR
Vancomycin-Resistant Enterococcus faecium Strains
with Highly Similar Pulsed-Field Gel Electrophoresis Patterns
Containing Similar Tn1546-Like Elements Isolated from a
Hospitalized Patient and Pigs in Denmark
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LETTER |
Vancomycin-resistant enterococci (VRE) have emerged as a worldwide
problem (14). The consumption of vancomycin has been steadily increasing from 2,000 kg in 1984 to 10,312 kg in 1995 in the
United States and from 200 to 1,222 kg in France (12). The
oral use of avoparcin for growth promotion in pigs increased from
13,644 kg in 1989 to 24,117 kg in 1994 in Denmark (20). The
frequency of isolation of VRE has increased (5) since
isolation of the first VRE in England in 1986 (18). The
mechanism of vancomycin resistance has been well characterized
especially for the vanA gene cluster (14). Other
resistance mechanisms named vanB, vanC, and
vanD have been defined (14). Two theories on the
selection for the presence of VRE prevail, and probably a combination
of these theories has caused the development of VRE. One theory is that
the use of the glycopeptide avoparcin as a growth promoter for animals
in Europe has selected for vanA-positive VRE in the animal
gut (1, 7, 16). Several studies have confirmed that
avoparcin selects for VRE (2, 4). VRE have also been found
in the environment (13, 17) and in nonhospitalized humans in
Europe (8). The other theory is that the use of vancomycin in hospitals has selected for VRE. Studies of nonhospitalized humans
and the environment in the United States, where avoparcin has not been
approved for use, have failed to isolate VRE (6, 16). The
genetic diversity of the vanA gene cluster encoded by
Tn1546 has been investigated, and identical
Tn1546-like elements in strains of human and animal origins
were found (9, 11, 21). This indicates that these two
reservoirs are not distinct and that exchange of Tn1546-like
elements occurs. A study on a base pair variation in the
vanX gene of Tn1546 suggests that the spread of
VRE has occurred from animals to humans. While VRE isolated from humans
contained either one or the other variant, pigs and poultry each had a
unique base pair variant (10). Indistinguishable pulsed-field gel electrophoresis (PFGE) patterns of VRE strains isolated from a Dutch farmer and one of his turkeys have been obtained,
indicating that humans and animals in close contact could harbor
identical VRE (19). In Denmark, VRE is still present at a
frequency of 20% among Enterococcus faecium isolates from pigs 3 years after the ban of use of avoparcin (3). From
humans in Denmark VRE have been isolated in only six cases. One urine and four fecal isolates have been isolated from hospitalized patients, and one fecal isolate has been isolated from a healthy human. None of
the patients had been treated with vancomycin. Among the isolates two
of fecal origin were from the same patient carrier, isolated 6 months
apart, and had identical SmaI PFGE patterns (Fig.
1). A third isolate of fecal origin from
a hospitalized patient had a SmaI PFGE pattern (Fig. 1)
highly similar to that of a VRE clone that is commonly found in Danish
pigs (unpublished data). The Tn1546-like elements of the
human and porcine isolates were identical (11). This person
was interviewed by her doctor and had no association with any farms in
Denmark and eats pork, beef, and poultry products. Since the highly
similar PFGE pattern links this human isolate to a common porcine VRE
clone, this provides further evidence for food-borne transmission of
VRE from animals to humans.
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FIG. 1.
PFGE SmaI patterns of VRE isolates of porcine
and human origins in Denmark. Lanes 1 and 9, Lambda Ladder PFG Marker
(New England Biolabs); lane 2, isolate 17243 (human); lane 3, isolate
17494 (human); lane 4, isolate 109 1A (human); lane 5, isolate 5979 (human); lane 6, isolate 86651 (human); lane 7, isolate 17575 (human);
lane 8, isolate E 8 SV 3 (porcine). Isolates 17243 and 17494 (lane 2 and 3) were obtained from the same patient 6 months apart.
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FOOTNOTES |
*
Phone: (45) 35 30 01 00
Fax: (45) 35 30 01 20
E-mail: lje{at}svs.dk
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| | | | |
Lars Bogø Jensen*
Anette M. Hammerum
Danish Veterinary Laboratory
Bülowsvej 27
DK-1790 Copenhagen V
Denmark
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| | | | |
Rikke Lykke Poulsen
Statens Serum Institut
Copenhagen, Denmark
|
| | | | |
Henrik Westh
Hvidovre Hospital, Hvidovre
and
Righospitalet, Copenhagen
Denmark
|
Antimicrobial Agents and Chemotherapy, March 1999, p. 724-725, Vol. 43, No. 3
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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