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PubMed1991

Chromosomally mediated beta-lactamase production and gentamicin resistance in Enterococcus faecalis.

We have analyzed four distinct strains of multiply resistant, beta-lactamase-producing enterococci isolated during an outbreak of colonization with these strains on an infant-toddler surgical ward at The Children's Hospital in Boston, Mass. All four strains were resistant to erythromycin, penicillin, and tetracycline and to high levels of gentamicin and streptomycin. One strain was also resistant to chloramphenicol. Plasmid profiles revealed four different plasmid patterns, with the number of identified plasmids ranging from zero to three. The gene coding for beta-lactamase production could be transferred at low frequency (less than 10(-8)) to an enterococcal recipient from one strain in conjunction with all of the other resistance determinants. Probes derived from the staphylococcal beta-lactamase gene and gentamicin resistance gene failed to hybridize with any of the detectable plasmids, but both genes were present on restriction fragments of genomic DNA in all strains. Our results indicate that the beta-lactamase genes and gentamicin resistance genes in these strains are integrated into the bacterial chromosome. The cotransmissibility of the resistance determinants raises the possibility of their incorporation into a multiresistance transposable genetic element.

Conjugation, Genetic↗
PubMed1995

Enterococcus faecalis plasmid pAD1 replication and maintenance.

A determinant has been identified which is required for the stable inheritance of a replicon isolated from the pheromone-responsive E. faecalis plasmid pAD1. This determinant, called par, is encoded on a DNA fragment no larger than 457 bp and directs the production of two small RNAs of approximately 250 (RNAI) and 145 (RNAII) nucleotides. Mutations affecting par RNA production also affected plasmid stability, indicating that these RNAs play a central role in par function. Putative transcription start sites were identified within par by DNA sequence analysis, but the sizes of the observed RNAs and the effects of transposon inserts on RNA production are not entirely consistent with predictions based on the hypothetical RNAs produced from these start sites. The absence of clearly functional open reading frames and the presence of various sequence repeat elements within par suggest that these RNAs may not be translated but may perform some structural role in the partition apparatus. The isolated par determinant was capable of producing both RNAs and stabilizing a heterologous vector, indicating that no other pAD1-encoded determinants are required for par function.

Base Sequence↗
PubMed1999

Single-cell analysis of glycopeptide resistance gene expression in teicoplanin-resistant mutants of a VanB-type Enterococcus faecalis.

The vanB gene cluster confers resistance to vancomycin but not to the related antibiotic teicoplanin, as the VanRB SB two-component regulatory system triggers expression of the glycopeptide resistance genes only in response to vancomycin. The VanRB regulator activates promoters PRB and PYB for transcription of the regulatory (vanRB SB) and resistance (vanYB WHB BXB) genes respectively. The gfpmut1 gene encoding a green fluorescent protein was fused to PYB to analyse promoter activation in single cells by fluorescence microscopy and flow cytometry. Characterization of 17 teicoplanin-resistant mutants indicated that amino acid substitutions on either side of the VanSB autophosphorylation site led to a constitutive phenotype. Substitutions in the membrane-associated domain resulted in a gain of function, as they allowed induction by teicoplanin. A vanSB null mutant expressed gfpmut1 at various levels under non-inducing conditions, and the majority of the bacteria were not fluorescent. Bacteria grown in the presence of vancomycin or teicoplanin were homogeneously fluorescent. The increase in the number of fluorescent bacteria resulted from induction in negative cells rather than from selection of a resistant subpopulation, indicating that VanRB was activated by cross-talk. Transglycosylase inhibition was probably the stimulus for the heterologous kinase, as moenomycin was also an inducer.

Anti-Bacterial Agents↗
PubMed2006

Risk factors for vancomycin-resistant Enterococcus faecalis bacteremia in hospitalized patients: an analysis of two case-control studies.

BACKGROUND: Vancomycin-resistant enterococci (VRE) is an important pathogen in the hospital environment, and a progressive increase in its incidence is a cause of nosocomial infections. Bacteremia is one of the major infections caused by this pathogen. Risk factors for VRE bacteremia were assessed at a university-affiliated hospital. METHODS: Two case-control studies with different control groups were used. In study 1, patients with VRE bacteremia were compared with control patients matched by sex, admission unit, age (+/-10 years), and time of admission (+/-1 year). In study 2, the case group (VRE patients) was compared with vancomycin-susceptible enterococci (VSE) patients. RESULTS: A total of 34 patients with VRE bacteremia and 102 control patients were included in study 1, and 34 patients with VRE bacteremia and 55 patients with VSE bacteremia were included in study 2. In study 1, vancomycin use (OR, 10.19; CI 95%, 3.63-28.57) was associated with VRE bacteremia. In study 2, vancomycin use (OR, 17.58; CI 95%, 5.24-58.96) was also associated with VRE bacteremia. CONCLUSION: Because vancomycin use was the only variable associated with VRE bacteremia in the two studies, we confirmed that vancomycin exposure is the major risk factor for VRE bacteremia.

Bacteremia↗
PubMed2002

Gene structure, organization, expression, and potential regulatory mechanisms of arginine catabolism in Enterococcus faecalis.

Although Enteroccus faecalis is the paradigm for biochemical studies on the arginine deiminase (ADI) pathway of fermentative arginine catabolism, little genetic information exists on this pathway in this organism. We fill this important gap by characterizing, in an 8,228-bp region cloned from a lambdagt11 genomic library of E. faecalis, a five-gene cluster forming a transcriptional unit (revealed by Northern blots and primer extension in E. faecalis) that corresponds to the ADI operon. Four additional genes in the opposite DNA strand and one in the same DNA strand are also identified. Studies on the protein products, including heterologous expression and/or sequence comparisons, allow us to ascertain or propose functions for all but 1 of the 10 genes. The ADI operon genes, arcABCRD, encode, respectively, ADI, ornithine transcarbamylase, carbamate kinase, a putative Crp/Fnr-type regulator (ArcR), and a putative ornithine-arginine antiporter (ArcD). Arginine induces the expression of arcABCRD, most likely by means of two homologous ArgR/AhrC-type regulators encoded by two genes, argR1 and argR2, that precede arcABCRD in each DNA strand and that are transcribed monocistronically, their transcription being influenced differentially by glucose and arginine. Potential ArgR1/ArgR2 (double and single) binding sequences are found in the promoter regions of arcA and of argR1/argR2 themselves. In addition, putative binding sequences for ArcR and for CcpA are found, respectively, in the argR1/argR2 and arcA promoter regions. Of the three other genes identified, two form a transcriptional unit and encode a putative metal-sensitive transcriptional regulator (ArsR) and a cysteine protease.

Amino Acid Sequence↗
PubMed1993

Cephalosporins as risk factor for nosocomial Enterococcus faecalis bacteremia. A matched case-control study.

BACKGROUND: Nosocomial enterococcal infections have increased in various institutions, and patients with these infections had often been treated with cephalosporins during the previous weeks. The objective of this study was to determine whether the use of second- and third-generation cephalosporins is a risk factor for nosocomial enterococcal bacteremia (NEB), by means of a matched case-control study design. METHODS: Two hundred seven cases of NEB were studied. A control was matched to each case by sex, age (+/- 10 years), date of admission (+/- 2 years), hospital service, days of hospitalization, primary diagnosis, and operative procedures. RESULTS: One hundred fifty-six cases had an appropriate matched control. The univariate analysis of unmatched variables showed that the presence of a urinary catheter (odds ratio [OR], 3.8), mechanical ventilation (OR = 2.6), and cephalosporin use (OR = 5.1) were associated with NEB. Using a conditional logistic regression model, cephalosporin use (adjusted OR = 4.8, 95% confidence interval, 2.3 to 9.8) and urinary catheter use (adjusted OR = 3.6, 95% confidence interval, 1.7 to 7.4) remained significantly associated with NEB after controlling for other unmatched variables. CONCLUSIONS: These data show that the use of second- and third-generation cephalosporins may be a major risk factor for NEB. It may explain, at least partially, the steadily increasing number of enterococcal infections observed in some hospitals.

Adult↗
PubMed1991

Characterization of a region of the Enterococcus faecalis plasmid pAM beta 1 which enhances the segregational stability of pAM beta 1-derived cloning vectors in Bacillus subtilis.

The nucleotide sequence of a 2.13-kb EcoRI-HindIII, pAM beta 1-derived fragment, isolated from the gram-positive cloning vector pHV1431, has been determined and shown to encode two ORFs. ORF H encodes for a protein of 23,930 Da which exhibits substantial homology to bacterial site-specific recombinases, particularly the resolvases of the gram-positive transposons Tn917 (30.3% identity) and Tn552 (31.6% identity) and the clostridial plasmid pIP404 (27.1% identity). The second ORF (I) is incomplete and encodes a polypeptide which has significant homology with Escherichia coli topoisomerase I (26.0% identity). Insertion of either the entire 2.13-kb EcoRI-HindIII fragment or a 0.73-kb EcoRI-DraI subfragment encoding only the resolvase into the pAM beta 1-based cloning vector pMTL500E causes a significant enhancement of segregational stability (from 6.5 X 10(-2) to 3.0-4.0 X 10(-3) plasmid loss per cell per generation). Improved segregational stability is mirrored by a reduction in plasmid polymerization. The introduction of a stop codon into the resolvase coding region negates its ability to promote segregational stability. It is proposed that the identified determinant stabilizes pAM beta 1-based vectors in Bacillus subtilis by maintaining the plasmid population in the monomeric state, thereby reducing the chances of producing plasmid-free segregants.

Amino Acid Sequence↗
PubMed2005

Naturally acquired antibodies against four Enterococcus faecalis capsular polysaccharides in healthy human sera.

Healthy human sera (HHS) contain naturally acquired enterococcal antibodies which promote neutrophil-mediated killing. The target antigens remain unknown. The present study used a capsular polysaccharide (CPS)-enzyme-linked immunosorbent assay (ELISA) to investigate whether the HHS antibodies of 12 healthy donors bound to the CPS of four E. faecalis serotypes (CPS-A to CPS-D) and then employed an opsonic-killing assay to determine if these antibodies mediated phagocyte-dependent killing. All HHS contained immunoglobulin G (IgG) and IgM antibodies directed against capsular polysaccharides of the four serotypes. Absorption of the sera with homologous and heterologous strains showed a majority of antibodies to be cross-reactive among the prototype strains. The susceptibility of the four prototype strains to opsonic killing varied. Opsonic killing of CPS-A and CPS-B strains was significantly higher than killing of CPS-C and CPS-D strains. Absorption studies revealed that the opsonic killing of HHS was only partially type specific, with cross-reactivity between CPS-A and CPS-B strains and between CPS-C and CPS-D strains. These data indicate that healthy individuals possess opsonic antibodies specific for CPS-A and CPS-B but only low titers of opsonic antibodies against CPS-C and CPS-D. Titers of opsonic antibodies did not correlate with antibody titers measured by ELISA. Whether this lack of correlation is due to the low frequency of opsonic antibodies or to increased resistance to the opsonophagocytic killing of some serotypes remains to be determined.

Adult↗
PubMed2005

[Flow cytometric analysis of Enterococcus faecalis aph2"(+) response to aph2" (-) strains with high and low gene transfer rate].

Resistance genes, as aph2" are usually encoded on conjugate plasmids and spread with high rate 2 among Gram-positive cocci. The conjugation is inducted by recipient strains by secreting specific pheromone involved in formation of mating aggregates with donor cells. The project aimed to check if strain with lower rate of gene transfer differ also from strains with high gene transfer in ability to aggregate to donor strains. In our study we used two aph2"(+), three aph2"(-) with low transfer e and three aph2"(-) with high transfer strains. Each time one aph2"(+) and one aph2" strains were cultivated for 18h in BHI. The bacteria was washed, stained with carboksyfluorescein, and analyzed by flow cytometry in FACS BD cytometr. Relative fluorescence and size of aggregation was used to compare influence on particular stains. In result of induction of aph2"(+) strains with aph2" recipients with high transfer rate we observed increase of size and number aggregates. Surprisingly, induction with aph2" recipients with low transfer rate result in two different reaction of aph2"(+) donors. In case of one of the , according to expectation we do not observe increase of aggregation. Second of the donors aggregate with induction with aph2" recipients with low transfer rate, but in contrast to reaction to presence of other recipients, fluorescence of such aggregates increased. The results show that strain with lower rate of gene transfer in fact differ from strains with high gene transfer in ability to aggregate to donor strains ant that analysis of aggregation alone is insufficient to distinguish between recipients of high and low transfer rate.

Cell Aggregation↗
PubMed1992

Transcriptional control of sex-pheromone-inducible genes on plasmid pAD1 of Enterococcus faecalis and sequence analysis of a third structural gene for (pPD1-encoded) aggregation substance.

The expression of several neighbouring genes on plasmid pAD1 that are necessary for conjugation depend on induction with sex pheromone cAD1. Analyses of transcripts by Northern blot hybridization demonstrated that the genes sea1 (encoding surface exclusion protein) and asa1 (encoding aggregation substance) are transcribed independently. Both genes are organized in different operons together with neighbouring open reading frames of unknown function. Several transcripts could be identified for sea1 and asa1. Their transcriptional start sites were determined by primer extension experiments, confirming the results of the Northern blot experiments. We also could identify sea1- and iad- (encoding an inhibitory peptide counteracting sex pheromone cAD1) specific transcripts which are expressed constitutively, but to a lower extent relative to induced conditions. In addition, we localized the asp1 gene coding for aggregation substance of sex pheromone plasmid pPD1 and determined its DNA sequence, which was found to be highly homologous to asa1 (aggregation substance gene of pAD1) and prgB (aggregation substance gene of pCF10). The structural genes were found to be organized more or less identically on the three sex-pheromone plasmids pAD1, pCF10, and pPD1, and to be highly conserved. Regions supposed to be of crucial importance for regulatory functions, however, were found to differ. We also could identify some conserved DNA motifs which might be potential target sites for transcriptional regulators. In combination these data allowed us to formulate a model for the regulation of sex-pheromone-inducible genes of plasmid pAD1. Its main statement is that only in the presence of cAD1 can the gene traE1 be transcribed. The positive regulatory factor TraE1 then can trigger expression of the structural genes sea1 and asa1.

Amino Acid Sequence↗
PubMed2004

Clonal dissemination of VanA-type glycopeptide-resistant Enterococcus faecalis between hospitals of two cities located 100 km apart.

Nosocomial dissemination of glycopeptide-resistant enterococci represents a major problem in hospitals worldwide. In Brazil, the dissemination among hospitals in the city of São Paulo of polyclonal DNA profiles was previously described for vancomycin-resistant Enterococcus faecium. We describe here the dissemination of VanA phenotype E. faecalis between two hospitals located in different cities in the State of São Paulo. The index outbreak occurred in a tertiary care university hospital (HCUSP) in the city of São Paulo and three years later a cluster caused by the same strain was recognized in two patients hospitalized in a private tertiary care hospital (CMC) located 100 km away in the interior of the state. From May to July 1999, 10 strains of vancomycin-resistant E. faecalis were isolated from 10 patients hospitalized in the HCUSP. The DNA genotyping using pulsed-field gel electrophoresis (PFGE) showed that all isolates were originated from the same clone, suggesting nosocomial dissemination. From May to July 2002, three strains of vancomycin-resistant E. faecalis were isolated from two patients hospitalized in CMC and both patients were colonized by the vancomycin-resistant Enterococcus in skin lesions. All isolates from CMC and HCUSP were highly resistant to vancomycin and teicoplanin. The three strains from CMC had minimum inhibitory concentration >256 micro g/ml for vancomycin, and 64 (CMC 1 and CMC 2) and 96 micro g/ml (CMC 3) for teicoplanin, characterizing a profile of VanA resistance to glycopeptides. All strains had the presence of the transposon Tn1546 detected by PCR and were closely related when typed by PFGE. The dissemination of the E. faecalis VanA phenotype among hospitals located in different cities is of great concern because E. faecalis commonly colonizes the gastrointestinal tract of patients and healthy persons for periods varying from weeks to years, which, together with the persistence of vancomycin-resistant Enterococcus in hospital rooms after standard cleaning procedures, increases the risk of the dissemination and reservoir of the bacteria.

Anti-Bacterial Agents↗
PubMed1987

Comparative survival of antibiotic-resistant and -sensitive fecal indicator bacteria in estuarine water.

The survival of antibiotic-resistant and -sensitive strains of Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Streptococcus equinus, and two environmental isolates, AP17 and AQ62, was examined in estuarine water. Each strain was rendered resistant to a combination of two antibiotics by serial passage in increasing concentrations of antibiotics. Cultures were incubated in filter-sterilized estuarine water for up to 7 days. Recovery was assessed by examining colony-forming ability on media with and without antibiotics. None of the antibiotic-resistant forms survived longer than its antibiotic-sensitive counterpart in estuarine water. Three of the resistant strains died off more rapidly than the antibiotic-sensitive wild type. Survival of the test bacteria in estuarine water was as follows: sensitive and resistant AQ62, resistant Escherichia coli less than sensitive Escherichia coli less than resistant AP17 less than resistant Enterococcus faecium less than sensitive AP17, sensitive and resistant S. equinus less than sensitive and resistant Enterococcus faecalis, sensitive Enterococcus faecium. The results supported the suggestion that fecal entercocci may serve as better indicators of fecal pollution than Escherichia coli in marine ecosystems. Moreover, the results indicated that the use of antibiotic-resistant mutants to follow the fate of bacteria in the environment is inappropriate without adequate studies to ensure that resistant and wild-type strains react similarly to environmental stressors.

Anti-Bacterial Agents↗
PubMed2004

Analysis of etiology and drug resistance of biliary infections.

The bile was collected from fro patients with biliary infections, with the bacterium isolated to study the sensitivity of each kind of the bacterium to several antibiotics in common use. Except G- bacterium, we also found some kinds of G+ bacterium in infection bile. G- bacterium were not sensitive to Clindamycin, G+ bacterium were sensitive to Ciprofloxacin. Escherichia coli, Xanthomonas maltophilia, Enterobacter cloacae, Pseudomonas aeruginosa were sensitive to Ampicillin. G+ bacterium were not sensitive to Azactam. Enterococcus faecalis, Enterococcus faecium, Enterobacter cloacae were not sensitive to Ceftazidime. Enterococcus faecalis, Staphylococcus coagulase negative, Staphylococcus epidermidis, Pseudomonas aeruginosa were not sensitive to Ceftriaxone Sodium. We didn't found any bacterium resistance Imipenem. The possibility of the existence of G+ bacterium as well as drug resistance should be considered n patients with biliary infections. The value of susceptibility test should be respected to avoid drug abuse of antibiotics.

Adult↗
PubMed2001

Transmission of opportunistic pathogens in a veterinary teaching hospital.

Acinetobacter baumannii, Enterococcus faecalis, Enterococcus faecium, and Staphylococcus intermedius isolates from infected surgical wounds and other types of infections in a veterinary teaching hospital were typed by pulsed field gel electrophoresis. A first cluster of infections with a multiresistant A. baumannii strain was observed in dogs and cats in 1998-1999. This strain disappeared after cleaning and disinfection of the companion animals intensive care unit. It was followed in 2000 by a second multiresistant strain, which caused another cluster of infections and was also transmitted to a patient in the nearby horse clinic. Transmission of a multiresistant E. faecium strain between two cats with surgical wound infections was also observed during the same period. No multiresistant S. intermedius strain was observed during this time and transmission of this organism between patients did not seem to occur. The present study demonstrates the potential for hospital nosocomial resistance problems in veterinary medicine similar to those encountered in human medicine. The results suggest that the epidemiology of nosocomial infections with A. baumannii and E. faecium may differ from that of S. intermedius infections and that preventive measures may have to be adapted to the problem organism.

Acinetobacter↗