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A number of Enterococcus strains with high-level inducible resistance to vancomycin have been identified, and the relative incidence of these strains has increased significantly in the last years. The first outbreak caused by vancomycin-resistant enterococci in Poland was reported in 1999. Vancomycin-resistant Enterococcus faecium is known for its propensity to cause infections which are difficult to eradicate. In this study, we determined the genetic similarities between vancomycin-resistant E. faecium isolates consecutively recovered from single patients to assess the duration of infection or colonization. The isolates taken in the study were identified by the conventional methods as E. faecium. PCRmelting profile (PCR-MP) and pulsed-field gel electrophoresis (PFGE) typing revealed that the isolates belonged to six distinct genotypes and that two of them were predominant. Consecutive E. faecium isolates with identical genotypes were found in 7 of 12 (58.0%) patients. The delay between the times of recovery of the first and last isolates of identical genotypes from each patient was from 9 days to about 1 year. In six patients, paired blood and non-blood isolates showed identical genotypes. Data presented here demonstrate the complexity of the epidemiological situation concerning vancomycin-resistant enterococci that may occur in a single medical ward. We also show for the first time the evaluation of PCR-MP technique in enterococci strains differentiation and we revealed that there is at least a similar power of discrimination between the presentjjold-standard REA-PFGE and a PCR-MP method.
Enterococcus faecalis and Enterococcus faecium are among the main agents associated with nosocomial infections with high mortality in immunocompromised patients. Antibiotic resistance, especially against gentamicin and vancomycin among Enterococci, is a risk factor that could increase the morbidity and mortality rate. 179 Enterococci isolates from burn patients were included in this study. Antibiotic susceptibility testing was done using the disk diffusion test and minimum inhibitory concentration (MIC) was evaluated by agar microdilution. Vancomycin and gentamicin resistance associated genes including vanA, vanB, vanC, aac (6’)-Ie aph(2’’), aph(3’)-IIIa and ant(4’)-Ia were detected by PCR and their statistical relation with antibiotic resistance was evaluated. E. faecalis was the more prevalent strain among our local isolates and showed a higher antibiotic resistance in comparison to E. faecium. Vancomycin had a good antibacterial effect on the Enterococcus spp. isolates; however, resistance to this antibiotic and a high-level gentamicin resistance (HLGR) phenotype were observed. Among van operon genes, vanA was the most prevalent gene and among the gentamicin resistance genes, aph (3’)-IIIa was more frequent. The HLGR Enterococci are a real challenge in nosocomial infections. Vancomycin is a key antibiotic to treat such infections but emergence of VRE in our region could be a real concern and, therefore, phenotypic and molecular surveillance must be considered.
Oliveria decumbens Vent (Umbelliferae) is a shrub commonly found in the South-East of Iran. Its aerial section is extensively used in herbal medicine. The Disk Diffusion Test and Microbroth Dilution Assay were used to determine the antimicrobial activity of the essential oil from Oliveria decumbens Vent against Staphylococcus aureus. To detect synergy, vancomycin was added to Mueller-Hinton agar at sub-inhibitory concentrations and the inhibitory zones were recorded in millimeters. The main components of oil were thymol (22%), carvacrol (22%) and p-cymene (19%). The O. decumbens oil exhibited strong antistaphylococcal activity (18.0±0.86). Carvacrol was considerably more effective (29.8±1.5) than thymol (17.2±1.13) and p-cymene (0.0±0.0) against Staphylococcus aureus. The oil presented strong synergism with vancomycin (24.9±0.75 vs. 19.3±0.54, p<0.001). However, further studies are required to evaluate its in vivo efficacy.
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