Longer intestinal persistence of Enterococcus faecalis compared to Enterococcus faecium clones in intensive-care-unit patients

J Clin Microbiol. 2009 Feb;47(2):345-51. doi: 10.1128/JCM.01597-08. Epub 2008 Dec 3.

Abstract

The dynamics of intestinal colonization with enterococcal clones in intensive-care-unit (ICU) patients was evaluated. Eight patients admitted directly to the neurosurgical ICU at the Ramón y Cajal University Hospital (Madrid, Spain) from the community and with no overlapping stay during a 10-month period in 2006 were studied. Rectal swab specimens were collected on admission and daily until the patients were discharged. Clonality was determined by pulsed-field gel electrophoresis and multilocus sequence typing. Clonal colonization dynamics were estimated by using two new parameters: the clonal diversity per patient per day (CDPD) and the clonal persistence ratio (CPR). Enterococcus faecalis isolates (n = 123) and Enterococcus faecium isolates (n = 66) were resolved into 13 and 15 clones, respectively. The CDPD of E. faecalis steadily increased during admission, and E. faecalis showed a higher (P = 0.001) CPR value than E. faecium (0.86 and 0.42, respectively). E. faecium, with the exception of an ampicillin-resistant clone belonging to clonal complex 17, frequently appeared as a short-term colonizer, even though the E. faecalis clones had significantly (P = 0.03) more days under antibiotic exposure than E. faecium (77.5 and 65 days/100 colonization days, respectively). E. faecalis had a longer persistence than E. faecium, except for the CC17 ampicillin-resistant clone, and E. faecalis showed a cumulative increase in CDPD, whereas E. faecium did not. CDPD and CPR were useful for measuring the dynamics of intestinal colonization with enterococcal clones.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ampicillin Resistance
  • Bacterial Typing Techniques
  • Carrier State / microbiology*
  • Cluster Analysis
  • DNA Fingerprinting
  • DNA, Bacterial / genetics
  • Electrophoresis, Gel, Pulsed-Field
  • Enterococcus faecalis / isolation & purification*
  • Enterococcus faecium / isolation & purification*
  • Female
  • Gastrointestinal Tract / microbiology*
  • Genotype
  • Gram-Positive Bacterial Infections / microbiology*
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Rectum / microbiology
  • Sequence Analysis, DNA
  • Spain

Substances

  • DNA, Bacterial