PMID- 16081891 OWN - NLM STAT- MEDLINE DCOM- 20050915 LR - 20181113 IS - 0095-1137 (Print) IS - 1098-660X (Electronic) IS - 0095-1137 (Linking) VI - 43 IP - 8 DP - 2005 Aug TI - First nosocomial outbreak of vancomycin-resistant Enterococcus faecium expressing a VanD-like phenotype associated with a vanA genotype. PG - 3642-9 AB - Although enterococci expressing acquired vancomycin resistance phenotype have been reported increasingly worldwide, they have been rarely reported in France. From August to December 2004 we faced an outbreak of vancomycin-resistant Enterococcus faecium (VRE) isolates in the nephrology department at Bicetre Hospital (K.-Bicetre, France). The expression of the glycopeptide resistance varied among the 26 VRE isolates, with vancomycin MICs ranging from 12 to >256 microg/ml, whereas teicoplanin MICs ranged from 4 to 48 microg/ml. However, several strains appeared to be susceptible to glycopeptides according to disk diffusion testing and expressed resistance only after subculture with glycopeptides. In addition, a heterogeneous expression of glycopeptide resistance was also observed. This so-called VanD-like phenotype of resistance (low-level resistance to vancomycin and mostly susceptibility to teicoplanin) was surprisingly associated with a vanA gene. Plasmid extraction and mating-out experiments indicated that the vanA gene was located on a 200-kb self-transferable plasmid. Pulsed-field gel electrophoresis identified mostly dissemination of a single clone, whereas diffusion of the VanA-positive plasmid in different genomic backgrounds had also occurred. The vanA gene was part of a vanA-type operon for expression of resistance located on a Tn1546-like transposon. Sequencing of this transposon identified insertion of insertion sequence IS16 in the vanY gene that encodes a d,d-carboxypeptidase that might explain in part the peculiar VanD-type phenotype of resistance. This report is the first description of a VRE outbreak in France and underlines the difficulty in detecting this organism due to variability on the expression of the glycopeptide resistance trait, if any. FAU - Naas, Thierry AU - Naas T AD - Service de Bacteriologie-Virologie, Hopital de Bicetre, Assistance Publique-Hopitaux de Paris, Faculte de Medecine Paris-Sud, Universite Paris IX, 78 rue du General Leclerc 94275 Le Kremlin-Bicetre Cedex, France. thierry.naas@bct.ap-hop-paris.fr FAU - Fortineau, Nicolas AU - Fortineau N FAU - Snanoudj, Renaud AU - Snanoudj R FAU - Spicq, Colette AU - Spicq C FAU - Durrbach, Antoine AU - Durrbach A FAU - Nordmann, Patrice AU - Nordmann P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Microbiol JT - Journal of clinical microbiology JID - 7505564 RN - 0 (Bacterial Proteins) RN - 0 (DNA Transposable Elements) RN - 0 (VanA ligase, Bacteria) RN - EC 6.1.- (Carbon-Oxygen Ligases) RN - EC 6.3.2.- (Peptide Synthases) RN - EC 6.3.2.4 (VanD protein, Enterococcus faecium) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Bacterial Proteins/*analysis/*genetics MH - Bacterial Typing Techniques MH - Carbon-Oxygen Ligases/*genetics MH - Cross Infection/epidemiology/*microbiology MH - DNA Transposable Elements MH - *Disease Outbreaks MH - Enterococcus faecium/classification/*drug effects/genetics MH - Female MH - Genotype MH - Humans MH - Male MH - Microbial Sensitivity Tests MH - Middle Aged MH - Peptide Synthases/*analysis MH - Phenotype MH - *Vancomycin Resistance PMC - PMC1233916 EDAT- 2005/08/06 09:00 MHDA- 2005/09/16 09:00 PMCR- 2006/02/01 CRDT- 2005/08/06 09:00 PHST- 2005/08/06 09:00 [pubmed] PHST- 2005/09/16 09:00 [medline] PHST- 2005/08/06 09:00 [entrez] PHST- 2006/02/01 00:00 [pmc-release] AID - 43/8/3642 [pii] AID - 0297-05 [pii] AID - 10.1128/JCM.43.8.3642-3649.2005 [doi] PST - ppublish SO - J Clin Microbiol. 2005 Aug;43(8):3642-9. doi: 10.1128/JCM.43.8.3642-3649.2005.