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Journal of Clinical Microbiology, September 2000, p. 3317-3322, Vol. 38, No. 9
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Outbreak of Vancomycin-Resistant Enterococci in a Hospital in Gdańsk, Poland, due to Horizontal Transfer of Different Tn1546-Like Transposon Variants and Clonal Spread of Several Strains

Magdalena Kawalec,1,* Marek Gniadkowski,1 and Waleria Hryniewicz1,2

Sera and Vaccines Central Research Laboratory1 and The National Reference Center for Antibiotic Resistance,2 00-725 Warsaw, Poland

Received 10 April 2000/Returned for modification 3 June 2000/Accepted 6 June 2000

Twenty-two vancomycin-resistant enterococcal (VRE) isolates of the VanA phenotype (21 Enterococcus faecium isolates and 1 E. faecalis isolate), representative of a large outbreak that occurred in a hospital in Gdansk, Poland, were studied. All of the isolates demonstrated resistance to a wide variety of other antimicrobial agents in addition to glycopeptides. Several lines of evidence suggested that the outbreak most probably consisted of two epidemics that followed the independent introduction of VanA determinants into two separate hematological wards of the hospital. This hypothesis is supported by the fact that isolates recovered in these wards possessed two different polymorphs of the highly conserved DNA region encompassing the vanRSHAX genes and two distinct polymorph types of Tn1546-like transposons, which contain these genes. According to pulsed-field gel electrophoresis data, the outbreak in the adult hematology ward (HW) was highly polyclonal, which suggested a major role for the horizontal transmission of Tn1546-like elements among nonrelated strains of E. faecium and E. faecalis in this environment. On the other hand, the outbreak in the pediatric hematology ward (PHW) was most probably due to the clonal spread of two epidemic E. faecium strains, which had exchanged a plasmid carrying the Tn1546-like transposon. Restriction fragment length polymorphism studies of transposons and their insertion loci in plasmid DNA have suggested that numerous isolates from both HW and PHW contained two or more copies of Tn1546-like elements that underwent diversification due to various genetic modifications. The reported data demonstrated a very complex epidemiology of the first, and up to now the only, VanA VRE outbreak characterized in Poland.

* Corresponding author. Mailing address: Sera and Vaccines Central Research Laboratory, ul. Chelmska 30/34, 00-725 Warsaw, Poland. Phone: (48) 22-841-33-67. Fax: (48) 22-841-29-49. E-mail: kawalec{at}urania.il.waw.pl.

Journal of Clinical Microbiology, September 2000, p. 3317-3322, Vol. 38, No. 9
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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