PMID- 18844686
OWN - NLM
STAT- MEDLINE
DCOM- 20081106
LR  - 20220311
IS  - 1469-0691 (Electronic)
IS  - 1198-743X (Linking)
VI  - 14
IP  - 9
DP  - 2008 Sep
TI  - Difficulties in detection and identification of Enterococcus faecium with 
      low-level inducible resistance to vancomycin, during a hospital outbreak.
PG  - 853-7
LID - 10.1111/j.1469-0691.2008.02052.x [doi]
AB  - Between June and November 2004, a vancomycin-resistant Enterococcus faecium (VRE) 
      strain was isolated from 13 patients in the haematology/bone marrow transplant 
      unit. There were difficulties in identifying the organism, which had low-level, 
      inducible vancomycin resistance, and standard screening methods did not reveal 
      carriage in patients or their contacts. These technical failures led to spread of 
      VRE and delays in providing appropriate management, which might otherwise have 
      been avoided. Therefore, we reviewed our laboratory methods and compared three 
      identification systems to determine which would best identify this VRE strain. 
      The VITEK 2 (BioMerieux) correctly identified, as E. faecium, only two of 16 
      isolates, whereas API Rapid ID 32 Strep (BioMerieux) and Phoenix 100 (Becton 
      Dickinson and Co.) correctly identified 13 of 15 and 12 of 13 isolates tested, 
      respectively. Isolates from urine, tested by the CLSI disk diffusion method, were 
      apparently susceptible or of intermediate susceptibility to vancomycin, upon 
      primary testing. VITEK 2 and Phoenix 100 identified all isolates as 
      vancomycin-resistant, although the MICs, measured by Etest, were in the 
      susceptible range for three of 16 isolates. Reducing the vancomycin concentration 
      in screening media substantially increased the sensitivity for detection of VRE. 
      Isolates were characterized as genotype vanB2/3 by PCR and were indistinguishable 
      from each other by pulsed-field gel electrophoresis. VRE with low-level inducible 
      resistance can be missed by routine screening methods. Better identification and 
      screening methods for detection of low-level vancomycin resistance are needed to 
      improve surveillance and prevent transmission of VRE.
FAU - Pendle, S
AU  - Pendle S
AD  - Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology 
      and Medical Research, Westmead Hospital, Westmead, Westmead, New South Wales, 
      Australia. stella.pendle@symbionhealth.com
FAU - Jelfs, P
AU  - Jelfs P
FAU - Olma, T
AU  - Olma T
FAU - Su, Y
AU  - Su Y
FAU - Gilroy, N
AU  - Gilroy N
FAU - Gilbert, G L
AU  - Gilbert GL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Clin Microbiol Infect
JT  - Clinical microbiology and infection : the official publication of the European 
      Society of Clinical Microbiology and Infectious Diseases
JID - 9516420
RN  - 0 (Culture Media)
RN  - 0 (DNA, Bacterial)
SB  - IM
MH  - Bacterial Typing Techniques
MH  - Bacteriological Techniques/methods
MH  - Cross Infection/epidemiology/*microbiology
MH  - Culture Media/chemistry
MH  - DNA Fingerprinting
MH  - DNA, Bacterial/genetics
MH  - *Disease Outbreaks
MH  - Electrophoresis, Gel, Pulsed-Field
MH  - Enterococcus faecium/classification/*drug effects/genetics/*isolation & 
      purification
MH  - Genes, Bacterial
MH  - Genotype
MH  - Gram-Positive Bacterial Infections/epidemiology/*microbiology
MH  - Hospitals
MH  - Humans
MH  - Microbial Sensitivity Tests/methods
MH  - Polymerase Chain Reaction/methods
MH  - Urine/microbiology
MH  - *Vancomycin Resistance
EDAT- 2008/10/11 09:00
MHDA- 2008/11/07 09:00
CRDT- 2008/10/11 09:00
PHST- 2008/10/11 09:00 [pubmed]
PHST- 2008/11/07 09:00 [medline]
PHST- 2008/10/11 09:00 [entrez]
AID - S1198-743X(14)62110-8 [pii]
AID - 10.1111/j.1469-0691.2008.02052.x [doi]
PST - ppublish
SO  - Clin Microbiol Infect. 2008 Sep;14(9):853-7. doi: 
      10.1111/j.1469-0691.2008.02052.x.