Emergence of vancomycin-dependent enterococci following glycopeptide therapy: case report and review

• Published in: Pathologie biologie (Paris) 2009-02, Vol.57 (1), p.56-60
• Main Authors: Bert, F, Leflon-Guibout, V, Le Grand, J, Bourdon, N, Nicolas-Chanoine, M-H
• Format: Article
• Language: fre
• Subjects: Bacterial Proteins - genetics; Bacteriuria - drug therapy; Bacteriuria - microbiology; Carbon-Oxygen Ligases - genetics; Cecal Diseases - complications; Ceftriaxone - therapeutic use; Citrobacter freundii - drug effects; Citrobacter freundii - isolation & purification; Codon, Nonsense; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae Infections - etiology; Enterobacteriaceae Infections - microbiology; Enterococcus faecium - drug effects; Enterococcus faecium - genetics; Enterococcus faecium - growth & development; Enterococcus faecium - isolation & purification; Female; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Humans; Intestinal Perforation - complications; Liver Transplantation; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Norfloxacin - therapeutic use; Peritonitis - etiology; Peritonitis - microbiology; Postoperative Complications - drug therapy; Postoperative Complications - microbiology; Staphylococcal Infections - drug therapy; Teicoplanin - pharmacology; Vancomycin - pharmacology; Vancomycin - therapeutic use; Vancomycin Resistance
• ISSN: 0369-8114
• DOI: 10.1016/j.patbio.2008.07.017

Outbreaks of vancomycin-resistant enterococci have been increasingly reported in France over the last three years. We report here, the emergence of a vancomycin-dependent enterococci isolate following glycopeptide therapy. An Enterococcus faecium isolate that required vancomycin for growth was cultured from the stools of a liver transplant recipient who was colonised with vancomycin-resistant enterococci and who received vancomycin treatment for methicillin-resistant Staphylococcus aureus infection. The resistant isolate and the dependent isolate were typed by pulsed-field gel electrophoresis. The sequence of the ddl gene coding for the D-Ala: D-Ala ligase was analysed. The dependent isolate was primary cultured onto a vancomycin-containing screening medium and could not be subcultured in the absence of vancomycin. Both the resistant and dependent isolates harboured the vanA gene and they had the same DNA restriction pattern after pulsed-field gel electrophoresis. Dependence on vancomycin was associated with a 1-bp deletion in the D-Ala: D-Ala ligase gene leading to an early stop odon. Cultures onto vancomycin-containing media are warranted for clinical specimens from patients, who are known to carry vancomycin-resistant enterococci and receive vancomycin therapy.