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Journal of Clinical Microbiology, March 2006, p. 1059-1064, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.1059-1064.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

High-Level Ciprofloxacin Resistance from Point Mutations in gyrA and parC Confined to Global Hospital-Adapted Clonal Lineage CC17 of Enterococcus faecium

Helen L. Leavis,* Rob J. L. Willems, Janetta Top, and Marc J. M. Bonten

Department of Internal Medicine, Division of Infectious Diseases and Internal Medicine, Eijkman-Winkler Institute, University Medical Center Utrecht, Utrecht, The Netherlands

Received 17 October 2005/ Accepted 19 December 2005

To substantiate a common genetic background of ciprofloxacin-resistant Enterococcus faecium, 32 ciprofloxacin-resistant (Cipr) and 31 ciprofloxacin-susceptible (Cips) isolates from outbreaks, clinical infections, surveillances, and animals from 10 different countries were genotyped by multilocus sequence typing. Additionally, susceptibilities to ampicillin and vancomycin and the presence of esp were determined and the quinolone resistance-determining regions of parC, gyrA, parB, and gyrE were sequenced. High-level Cipr (MIC ≥ 64 µg/ml) due to point mutations in the quinolone resistance-determining region was unique to a distinct hospital-adapted genetic complex in E. faecium, previously designated CC17. Low-level Cipr (MIC = 4 µg/ml) in non-CC17 strains is not attributable to point mutations in any subunit of the topoisomerase genes, and the mechanism of resistance remains unclear. Acquisition of mutations in parC and gyrA, leading to high-level Cipr, is, in addition to ampicillin resistance and the presence of a putative pathogenicity island, another cumulative step in hospital adaptation of CC17.

* Corresponding author. Mailing address: Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, Heidelberglaan 100, Rm G04.614, 3584CX Utrecht, The Netherlands. Phone: 31 30 2507637. Fax: 31 30 2541770. E-mail: h.leavis{at}azu.nl.

Journal of Clinical Microbiology, March 2006, p. 1059-1064, Vol. 44, No. 3
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.3.1059-1064.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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