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Journal of Clinical Microbiology, December 1999, p. 3934-3939, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

vanA and vanB Incorporate into an Endemic Ampicillin-Resistant Vancomycin-Sensitive Enterococcus faecium Strain: Effect on Interpretation of Clonality

Juhana P. Suppola,1,* Elina Kolho,2 Saara Salmenlinna,3 Eveliina Tarkka,4 Jaana Vuopio-Varkila,3 and Martti Vaara1,3,4

Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, 00014 Helsinki,1 Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, 00290 Helsinki,2 Department of Bacteriology, National Public Health Institute, 00300 Helsinki,3 and Helsinki University Central Hospital Diagnostics, Division of Bacteriology and Immunology, Laboratory of Bacteriology, 00014 Helsinki,4 Finland

Received 27 April 1999/Returned for modification 3 July 1999/Accepted 9 September 1999

Clonal spread and horizontal transfer in the spread of vancomycin resistance genes were investigated. Multiplex PCR, pulsed-field gel electrophoresis (PFGE), hybridization of enterococcal plasmids with the vanA and vanB probes, and sequencing of a fragment of vanB were used in the analysis. Before May 1996, 12 vancomycin-resistant Enterococcus faecium (VRE) isolates were found in Finland. Between May 1996 and October 1997, 156 VRE isolates were found in the Helsinki area. Between December 1997 and April 1998, fecal samples from 359 patients were cultured for VRE. One new case of colonization with VRE was found. During the outbreak period, 88% (137 of 155) of the VRE isolates belonged to two strains (VRE types I and II), as determined by PFGE. Each VRE type I isolate possessed vanB, and five isolates also had vanA. Of the 34 VRE type II isolates, 27 possessed vanA and 7 possessed vanB. Fifteen of 21 (71%) ampicillin-resistant, vancomycin-sensitive E. faecium (VSE) isolates found during and after the outbreak period in one ward were also of type II. Two VSE type II isolates were found in the hospital before the outbreak in 1995. By PFGE, the three groups (vanA, vanB, or no van gene) of type II shared the same band differences with the main type of VRE type II with vanA. None of the differences was specific to or determinative for any of the groups. Our material suggests that vanA and vanB incorporate into an endemic ampicillin-resistant VSE strain.

* Corresponding author. Mailing address: Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland. Phone: 358-0-43461. Fax: 358-0-4346382. E-mail: JUHANA.SUPPOLA{at}HELSINKI.FI.

Journal of Clinical Microbiology, December 1999, p. 3934-3939, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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