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Journal of Clinical Microbiology, November 1998, p. 3303-3308, Vol. 36, No. 11
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Molecular Analysis of Glycopeptide-Resistant Enterococcus faecium Isolates Collected from Michigan Hospitals over a 6-Year Period

LeeAnn Thal,1,2,3,4 Susan Donabedian,1,2,3,4 Barbara Robinson-Dunn,5,6 Joseph W. Chow,1,3 Louise Dembry,1,3,8,9 Don B. Clewell,10,11 Drew Alshab,5,6 and Marcus J. Zervos1,2,3,4,8,12,13,*

Departments of Medicine,1 Epidemiology,8 Clinical Pathology,2 Biologic and Materials Sciences,10 Microbiology,12 and Immunology13 and Sections of Infectious Disease3 and Microbiology and Disease Surveillance,5 Wayne State University, Detroit,7 William Beaumont Hospital, Royal Oak,4 Michigan Department of Community Health, Lansing,6 and The University of Michigan, Ann Arbor,11 Michigan, and Yale University School of Medicine, New Haven, Connecticut9

Received 9 February 1998/Returned for modification 2 June 1998/Accepted 18 August 1998

The purpose of this study was to evaluate the molecular relatedness of clinical isolates of glycopeptide-resistant Enterococcus faecium isolates collected from hospitals in Michigan. A total of 379 isolates used in this study were all vancomycin-resistant E. faecium isolates collected from 28 hospitals and three extended-care facilities over a 6-year period from 1991 to 1996. For the 379 isolates, there were 73 pulsed-field gel electrophoresis (PFGE) strain types. Within strain types, there were as many as six restriction fragment differences. Most isolates (70%) belonged to six strain types, which were designated M1 (36%), M2 (3%), M3 (18%), M4 (6%), M10 (4%), and M11 (3%). PFGE strain M1 was cultured from 135 patients in 13 hospitals during the period 1993 to 1996. Strain type M2 was cultured from 11 patients in two hospitals during the period 1991 to 1992 and was not observed after 1992. Strain type M3 was cultured from 70 patients in 10 hospitals during the period of 1994 to 1996. Both M4 and M10 were cultured from 23 patients in three hospitals and from 15 patients in two hospitals, respectively, during 1995 to 1996. M11 was cultured from 13 patients in four hospitals during 1996. A total of 23 of 28 hospitals had evidence of clonal dissemination of some isolates. Plasmid content and hybridization analysis done on 103 isolates from one hospital and two affiliated extended-care facilities indicated that the strains contained from one to eight plasmids. Mating experiments indicated transfer of vancomycin resistance from 94 of these isolates into plasmid-free E. faecium GE-1 at transfer frequencies of <10-9 to 10-4. Gentamicin resistance and erythromycin resistance were cotransferred at various frequencies. A probe for the vanA gene hybridized to the plasmids of 23 isolates and to the chromosomes of 72 isolates. A probe for the vanB gene hybridized to the chromosomes of 8 isolates. The results of this study suggest inter- and intrahospital dissemination of vancomycin-resistant E. faecium strains over a 6-year period in southeastern Michigan. The majority of isolates studied belonged to the same few PFGE strains, indicating that clonal dissemination was responsible for most of the spread of resistance that occurred.

* Corresponding author. Mailing address: William Beaumont Hospital, 3601 West 13 Mile Rd., Royal Oak, MI 48073. Phone: (248) 551-0419. Fax: (248) 551-8880. E-mail: MZervos{at}Beaumont.edu.

Journal of Clinical Microbiology, November 1998, p. 3303-3308, Vol. 36, No. 11
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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