Emergence of vancomycin-resistant enterococci at a university hospital in Taiwan: Persistence of multiple species and multiple clones

OBJECTIVES: To describe the epidemiology of vancomycin-resistant enterococc i (VRE) in a university hospital in Taipei, Taiwan. DESIGN: Retrospective review over a 27-month period, from March 1996 to May 1998. SETTING: A tertiary-care teaching hospital in Taiwan. PARTICIPANTS: Patients with VRE isolated from any body site. METHODS: Patients were identified through hospital microbiology and infecti on control records. Patient charts were reviewed for clinical and epidemiol ogy data, including age, gender, previous hospital admissions, underlying d iseases, types of infection, and recent antibiotic use. VRE isolates were c haracterized by their typical biochemical reactions, cellular fatty acid pr ofiles, and the presence of van genes. Antibiotypes using the E-test and ra ndomly amplified polymorphic DNA (RAPD) patterns of these isolates were use d to determine the clonality. RESULTS: Twenty-five isolates of VRE recovered from 12 patients were identi fied. One patient with a perianal abscess had 12 isolates of VRE (4 Enteroc occus faecalis, 7 Enterococcus faecium, and I Enterococcus casseliflavus) r ecovered from perianal lesions. Among 3 patients who were hospitalized in t he same room, 1 had a community-acquired cellulitis over the left leg cause d by E faecalis, and the other 2 patients both had anal colonization with 2 isolates of E faecalis. The other 8 patients had 1 E faecalis isolate each from various clinical specimens. All isolates possessed vanA resistance ph enotype and vanA genes. Different antibiotypes and RAPD patterns of the iso lates from different patients excluded the possibility of nosocomial spread at the hospital. CONCLUSIONS: Multiple species of VRE (E faecalis, E faecium, and E casselif lavus) and multiple clones of E faecium could colonize or infect hospitaliz ed patients. In addition, clones of VRE can persist long-term in patients' lower gastrointestinal tracts. These results extend our knowledge of the co existence and the persistence of multiple species and multiple clones of VR E in hospitalized patients (Infect Control Hosp Epidemiol 1999;20:828-833).