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Journal of Clinical Microbiology, February 2009, p. 345-351, Vol. 47, No. 2
0095-1137/09/$08.00+0     doi:10.1128/JCM.01597-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Longer Intestinal Persistence of Enterococcus faecalis Compared to Enterococcus faecium Clones in Intensive-Care-Unit Patients{triangledown}

Patricia Ruiz-Garbajosa,1,2 Rosa del Campo,1,2 Teresa M. Coque,1,2 Angel Asensio,3 Marc Bonten,4 Rob Willems,4 Fernando Baquero,1,2 and Rafael Cantón1,2*

Servicio de Microbiología, Hospital Universitario Ramón y Cajal, and CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid 28034, Spain,1 Unidad de Resistencia a Antibióticos y Virulencia Bacteriana, Asociada al Consejo Superior de Investigaciones Científicas (CSIC), Hospital Ramón y Cajal, Madrid 28034, Spain,2 Servicio de Medicina Preventiva, Hospital Universitario Puerta de Hierro, Madrid 28035, Spain,3 Department of Medical Microbiology, University Medical Center, Utrecht 3584 CX, The Netherlands4

Received 18 August 2008/ Returned for modification 4 November 2008/ Accepted 25 November 2008

The dynamics of intestinal colonization with enterococcal clones in intensive-care-unit (ICU) patients was evaluated. Eight patients admitted directly to the neurosurgical ICU at the Ramón y Cajal University Hospital (Madrid, Spain) from the community and with no overlapping stay during a 10-month period in 2006 were studied. Rectal swab specimens were collected on admission and daily until the patients were discharged. Clonality was determined by pulsed-field gel electrophoresis and multilocus sequence typing. Clonal colonization dynamics were estimated by using two new parameters: the clonal diversity per patient per day (CDPD) and the clonal persistence ratio (CPR). Enterococcus faecalis isolates (n = 123) and Enterococcus faecium isolates (n = 66) were resolved into 13 and 15 clones, respectively. The CDPD of E. faecalis steadily increased during admission, and E. faecalis showed a higher (P = 0.001) CPR value than E. faecium (0.86 and 0.42, respectively). E. faecium, with the exception of an ampicillin-resistant clone belonging to clonal complex 17, frequently appeared as a short-term colonizer, even though the E. faecalis clones had significantly (P = 0.03) more days under antibiotic exposure than E. faecium (77.5 and 65 days/100 colonization days, respectively). E. faecalis had a longer persistence than E. faecium, except for the CC17 ampicillin-resistant clone, and E. faecalis showed a cumulative increase in CDPD, whereas E. faecium did not. CDPD and CPR were useful for measuring the dynamics of intestinal colonization with enterococcal clones.

* Corresponding author. Mailing address: Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain. Phone: 34913368330. Fax: 34913368809. E-mail: rcanton.hrc{at}salud.madrid.org

{triangledown} Published ahead of print on 3 December 2008.

Journal of Clinical Microbiology, February 2009, p. 345-351, Vol. 47, No. 2
0095-1137/09/$08.00+0     doi:10.1128/JCM.01597-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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