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Antimicrobial Agents and Chemotherapy, March 2001, p. 992-993, Vol. 45, No. 3
0066-4804/01/$04.00+0 DOI: 10.1128/AAC.45.3.992-993.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
LETTERS TO THE EDITOR
Identification of a Tn1546-Like (Type 2) Element in
Vancomycin-Resistant Enterococcus faecium Isolated from
Hospitalized Patients in Japan
 |
LETTER |
Vancomycin-resistant enterococci (VRE) have been isolated from
about 50 Japanese patients since the first incidence in 1996 (1,
6; N. Fujita, M. Yoshimura, T. Komori, K. Tanimoto, and Y. Ike, Letter,
Antimicrob. Agents Chemother. 42:2150, 1998). A
connection between Japanese outbreaks and imported chickens has been
suggested (5; Y. Ozawa, T. Nomura, T. Murata, K. Tanimoto, S. Fujimoto, and Y. Ike, Abstr. 1st Intl. Am. Soc. Microbiol. Conf.
Enterococci, abstr. 103, p. 62, 2000). The link between animal
colonization with VRE and human infection has been established in
Europe, where the glycopeptide avoparcin previously was used as a feed
additive (13). Clones of VRE identical to VRE of animal origin have been found not only in hospitalized patients but also in
nonhospitalized humans, indicating the dynamic transfer of vancomycin
resistance affecting public health (8, 12). Vancomycin resistance disseminates not only clonally but also by transfer of
resistant elements horizontally to different clones of enterococci in
animals and humans (4). Therefore, molecular
epidemiological studies of these resistant elements are very important
for the understanding of possible dissemination and elucidation of the spread of VRE.
In May 1998, a patient colonized with VanA-type Enterococcus
faecium (VREF) was hospitalized at the Okayama University Hospital (Okayama, Japan). Fourteen isolates with indistinguishable
pulsed-field gel electrophoresis (PFGE) patterns were collected from
this patient, who was undergoing a bone marrow transplantation. The
genetic background for vancomycin resistance was confirmed to be
vanA (Tn1546) by using PCR methods (3,
9). A more thorough investigation of the Tn1546-like
elements in these isolates was performed by using a combination of PCR,
nucleotide sequencing, and hybridization (7). The results
were compared to previously published variations in Tn1546
and indicated that all isolates possessed the unique molecular
variations characteristic of a Tn1546-like (type 2) element,
as defined by Jensen et al. (7; L. B. Jensen, Letter, Antimicrob. Agents Chemother. 42:2463-2464, 1998).
The variations included the presence of an
IS1216V-IS3-like element in the left end of
Tn1546 and a point mutation (G to T) at position 8234 in the
essential vanX gene of Tn1546. We have further
characterized Tn1546-like elements from selected VanA-type
VRE of human and poultry origin from Japan. VRE have not been isolated
from domestic porcine origin and imported pork samples tested in Japan
(Y. Ike [Gunma University School of Medicine, Japan], personal
communication). No Tn1546-like (type 2) elements were
detected in vanA-containing VRE (7 E. faecalis
and 1 E. faecium isolates) isolated from chicken fecal
samples from three poultry farms (H. Yoshimura, M. Ishimaru, Y. S. Endoh, M. Suginaka, and S. Yamatani, Letter, Antimicrob. Agents
Chemother. 42:3333, 1998). The Tn1546-like
(type 2) element was detected in only 3 isolates (all from one
hospital) out of 17 vanA-containing VRE (16 E. faecium and 1 E. faecalis isolates) isolated from 17 patients in six hospitals. The Tn1546-like (type 1) element
was detected in 12 isolates from human and poultry origin, and 10 isolates indicating new variations in the Tn1546-like elements were untypeable according to the typing method of Jensen et
al. (Table 1). Four human isolates possessing
Tn1546-like (type 2) elements had closely related PFGE
patterns, indicating clonal relationship according to the criteria of
Tenover et al. (11), but were unrelated to other VRE
isolates of human and poultry origin from Japan.
The Tn1546-like (type 2) element has previously been
associated with VREF isolated from pig feces in Europe (2, 10,
14, 15) and has thus far been found in some hospitalized
patients but not in feces from other food animals (Table 1). Genetic
characterization of VRE isolates from patients in Japan revealed that
Tn1546-like (type 2) elements were present in independent
isolates from a small geographical area in Japan. Since
Tn1546-like (type 2) elements have not been found in VRE of
poultry origin either from Europe or from Japan, it is unlikely that
the VRE containing Tn1546-like (type 2) elements originated
from poultry. In Japan, no glycopeptides have been used as growth
promoters for domestic pigs. Therefore, the Japanese VREF isolates
containing Tn1546-like (type 2) elements could have come
from porcine origin outside Japan.
(This work was presented in part at the 1st International American
Society for Microbiology Conference on Enterococci-Banff, Alberta,
Canada, 27 February to 2 March 2000.)
We thank H. Yoshimura, National Veterinary Assay
Laboratory, Ministry of Agriculture, Forestry and Fisheries, Japan, for
providing VRE isolated from chickens. We also thank many colleagues in
Japan for providing clinical isolates for this study. We acknowledge J. W. Chow for reviewing the manuscript.
| |
FOOTNOTES |
*
Phone: 81-86-235-7287
Fax: 81-86-231-3986
E-mail: kariyama{at}med.okayama-u.ac.jp
| |
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| | | | |
Reiko Kariyama*
Hiromi Kumon
Section of Infection Control
Okayama University Hospital and Department of Urology
Okayama University Medical School
2-5-1 Shikata
Okayama 700-8558
Japan
|
| | | | |
Anette M. Hammerum
Frank M. Aarestrup
Lars Bogø Jensen
Danish Veterinary Laboratory
Bülowsvej 27
DK-1790 Copenhagen V
Denmark
|
Antimicrobial Agents and Chemotherapy, March 2001, p. 992-993, Vol. 45, No. 3
0066-4804/01/$04.00+0 DOI: 10.1128/AAC.45.3.992-993.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
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