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- Title
Long-term clonal dynamics of Enterococcus faecium strains causing bloodstream infections (1995-2015) in Spain.
- Authors
Tedim, Ana P.; Ruíz-Garbajosa, Patricia; Rodríguez, Maria Concepción; Rodríguez-Baños, Mercedes; Lanza, Val F.; Derdoy, Laura; Zurita, Gonzalo Cárdenas; Loza, Elena; Cantón, Rafael; Baquero, Fernando; Coque, Teresa M.; Cárdenas Zurita, Gonzalo
- Abstract
<bold>Objectives: </bold>To investigate the population structure of Enterococcus faecium causing bloodstream infections (BSIs) in a tertiary Spanish hospital with low glycopeptide resistance, and to enhance our knowledge of the dynamics of emergence and spread of high-risk clonal complexes.<bold>Methods: </bold>All available E. faecium causing BSIs (n = 413) in our hospital (January 1995-May 2015) were analysed for antibiotic susceptibility (CLSI), putative virulence traits (PCR, esp, hylEfm) and clonal relationship (SmaI-PFGE, MLST evaluated by goeBURST and BAPS).<bold>Results: </bold>The increased incidence of BSIs caused by enterococci [2.3‰ of attended patients (inpatients and outpatients) in 1996 to 3.0‰ in 2014] significantly correlated with the increase in BSIs caused by E. faecium (0.33‰ of attended patients in 1996 to 1.3‰ in 2014). The BSIs Enterococcus faecalis:E. faecium ratio changed from 5:1 in 1996 to 1:1 in 2014. During the last decade an increase in E. faecium BSIs episodes in cancer patients (10.9% in 1995-2005 and 37.1% in 2006-15) was detected. Ampicillin-susceptible E. faecium (ASEfm; different STs/BAPS) and ampicillin-resistant E. faecium (AREfm; ST18/ST17-BAPS 3.3a) isolates were recovered throughout the study. Successive waves of BAPS 2.1a-AREfm (ST117, ST203 and ST80) partially replaced ASEfm and ST18-AREfm since 2006.<bold>Conclusions: </bold>Different AREfm clones (belonging to BAPS 2.1a and BAPS 3.3a) consistently isolated during the last decade from BSIs might be explained by a continuous and dense colonization (favouring both invasion and cross-transmission) of hospitalized patients. High-density colonization by these clones is probably enhanced in elderly patients by heavy and prolonged antibiotic exposure, particularly in oncological patients.
- Subjects
SPAIN; DRUG resistance in bacteria; ENTEROCOCCUS faecium; GLYCOPEPTIDE antibiotics; MICROBIAL virulence; COMPETITIVE exclusion (Microbiology); TOXIN analysis; BACTEREMIA; GENETICS; GENETIC techniques; MICROBIAL sensitivity tests; MOLECULAR epidemiology; GRAM-positive bacterial infections; SPECIALTY hospitals
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2017, Vol 72, Issue 1, p48
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkw366