Enterococcus (VRE) : 45  [in Japanese] Epidemiological Study on Vancomycin-Resistant Enterococci from Fecal Samples in the East Area of Japan  [in Japanese]

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Abstract

東日本の45病院の協力を得て, 患者糞便中のVRE保菌状況を調査した. 6914例の患者糞便から1, 583株の<I>Enteroccu</I>属菌が分離された. 最も多かったのは<I>E. gallinarum</I> 1, 040株 (65.7%), 次いで<I>E. casseliflavus</I> 386株 (244%), <I>E. faecalis</I> 72株 (2.1%), <I>E. flavescens</I> 35株 (2.2%), <I>E. faecium</I> 33株 (21%), <I>E. avium</I> 17株 (11%) であった.<BR><I>vanA</I>および<I>vanB</I>遺伝子保有株は4株検出された. <I>vanA</I>保有<I>E. faecalis</I>の2株は1株が関東地区 (東京以外) 病院の入院患者から, もう1株は都内の病院の外来患者から検出された. VCMのMICは>128μg/mlであったが, TEICのMICは4μg/mlと低い値であった. また, MINO, OFLXのMIC値が大きく異なっていたが, その他の薬剤では同等であった. <I>vanB</I>保有株は<I>E. faecalis</I>, <I>E. gallinarum</I>のそれぞれ1株が検出され, いずれも都内の入院患者から検出された. <I>vanB</I>保有の<I>E. facalis</I>ではVCMのMICは64μg/mlで耐性, TEICは0.25μg/mlで感性と判定された. <I>E. gallinarum</I>は<I>vanB</I>のほか<I>vanC</I><SUB>1</SUB>遺伝子も保有しており, VCMおよびTEICのMIC値は他の<I>vanC</I><SUB>1</SUB>保有株と同等であった (VCM: 8μg/ml, TEIC: 0.25μg/ml). <I>vanC</I><SUB>2/3</SUB>遺伝子保有株で色素非産生株が5株認められ, これらは<I>E. casseliflavus</I>と考えられた. <I>vanA</I>または<I>vanB</I>保有<I>E. faecalis</I>は<I>Sma</I>IによるPFGEのバンドパターンが異なっており, それぞれ由来を異にすることが示唆された. 以上より院内感染の原因菌として重要な<I>vanA</I>または<I>vanB</I>保有株は, 現在のところ非常にまれであると考えられる.

Recently, Vancomycin-resistant enterococci (VRE) have become important nosocomial pathogens in the world. In Japan, the VRE-infection was first reported in 1996. However, an epidemiological study on VRE has not been aggressively done in Japan. We conducted a survey study to explore the incidence and antimicrobial susceptibility of vancomycin-resistant enterococci isolated from fecal samples at 45 hospitals in the east area of Japan (Kanto, Koshinetsu, Tohoku, and Hokkaido) during June 1998 to March 1999.<BR>The Enterococcosel agar containing vanocomycin (BBL) was used for screening VRE from fecal samples in each hospital. The suscceptibilities of the isolates to 8 antimicrobials were determined by the broth microdilution method and the definitions of resistance were based on current standards of the NCCLS standards. The VRE genotypes (<I>vanA</I>, <I>vanB</I>, <I>vanC</I>, and <I>vanC</I><SUB>2/3</SUB>) were confirmed by amplifying the respective genes by PCR. Eight hundred and ninety four strains of enterococci were tested by the microtiter plates hybridization method (WAKUNAGA SEIYAKU, Japan).<BR>One thousand five hundred eighty three strains of enterococci were collected from 6, 914 patients in 45 hospitals. These strains included 72 (4.5%) strains <I>Enterococcus faecalis</I>, 33 (2.1%) strains <I>Enterococcus faecium</I>, 17 (1.1%) strains Enterococcus avium, 1, 040 (65.7%) strains <I>Enterococcus gallinarum</I>, 386 (24.4%) strains <I>Enterococcus cassliflavus</I>, and 35 (2.2%) strains <I>Enterococcus flavescens</I>.<BR>These strains of vancomycin-resistant <I>E. faecalis</I> were isolated from 3 patients, two of these 3 strains had <I>van A</I> gene and other one had <I>van B</I> gene. Those 3 strains were in the Kanto area, and 2 of 3 strains were in Tokyo, Generally, though <I>van A</I> type VRE was highly resistaant to both vancomycin and teicoplanin. In our study, two strains of <I>van A</I> type <I>E. faecalis</I> were highly resistant to vancomycin (MICs>128μg/ml) and susceptible to teicoplanin with MICs 4μg/ml. Those two strains were different in susceptibilities of minocycline and ofloxacin, The result of the analysis of PFGE had also different patterns. <I>VanB</I> type <I>E. fecalis</I> was highly resistant to vancomycin and susceptible to teicoplanin (MICs 0.251μg/ml). For ampicillin and imipenem, 3 strains of <I>E. faecalis</I> were susceptible (MIC≤1μg/ml). One of 562 strains of <I>E. gallinarum</I> had <I>vanB</I> and <I>vanC</I>1 genes and was moderately resistant to vancomycin and susceptible to teicoplanin. All strains of <I>E. casseliflavus</I> and <I>E. flavescens</I> had <I>vanC</I>2/C3 gene only. All strains of <I>E. faecium</I> and <I>E. avium</I> did not detect van genes.<BR>From this result, it was supposed that VRE were very rare in the east of Japan.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 75(7), 541-550, 2001-07-20

    The Japanese Association for Infectious Diseases

References:  19

Cited by:  6

Codes

  • NII Article ID (NAID)
    10008703483
  • NII NACSIS-CAT ID (NCID)
    AN00047715
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03875911
  • NDL Article ID
    5850667
  • NDL Source Classification
    ZS9(科学技術--医学--病理学・微生物学・寄生虫学・感染・免疫学・血清学・アレルギー)
  • NDL Call No.
    Z19-193
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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