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Infect Drug Resist. 2018 Sep 17;11:1483-1490. doi: 10.2147/IDR.S164487. eCollection 2018.

First molecular characterization of related cases of healthcare-associated infections involving multidrug-resistant Enterococcus faecium vanA in Algeria.

Author information

1
Department of Microbiology, University Hospital Center Touhami Benflis, Batna, Algeria.
2
Department of Medicine, University Batna 2, Batna, Algeria.
3
Department of Microbiology, Nîmes University Hospital, Nîmes, France, helene.marchandin@umontpellier.fr.
4
Faculty of Medicine, National Institute of Health and Medical Research, INSERM U1047, University of Montpellier, Nîmes, France.
5
HydroSciences Montpellier, CNRS, IRD, University of Montpellier, University Hospital of Montpellier-Nîmes, Montpellier, France, helene.marchandin@umontpellier.fr.
6
Faculty of Medicine, University of Lille, Lille, France.
7
Department of Bacteriology, Institute of Microbiology, Lille University Hospital, Lille, France.
8
Department of Infection Control, Montpellier University Hospital, Montpellier, France.

Abstract

Purpose:

Vancomycin-resistant Enterococcus (VRE) faecium (VREfm) are highly resistant bacteria emerging worldwide and rarely studied using molecular tools in Algeria since their first report in 2006. The aim of the study was to investigate healthcare-associated infections (HAIs) involving the first VRE in Batna University Hospital, Algeria, and characterize isolates using molecular tools.

Patients and methods:

Medical charts were reviewed for patients with VREfm. van genes were detected by multiplex polymerase chain reaction (PCR), and strains were characterized by automated repetitive sequence-based PCR (rep-PCR), multiplex rep-PCR, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST).

Results:

During a 6-month period, VREfm infections occurred in four patients hospitalized in three wards. The four isolates were E. faecium vanA belonging to the hospital-adapted clonal complex 17. PCR-based methods did not discriminate the isolates but MLST and PFGE delineated a subgroup of three VREfm of identical pulsotype and sequence type (ST) 80 (yet identified for five isolates in the international PubMLST database) while the fourth isolate was of ST789 (not previously identified for a VREfm) and displayed an unrelated pulsotype. The three genotypically related isolates were recovered in patients who underwent surgery in the same department, suggesting an outbreak for which the source and route of transmission remained unidentified.

Conclusion:

This first molecular epidemiology study of VRE in Algeria was useful in delimiting an outbreak involving three of the four HAI cases and revealed rarely encountered genotypes. Considering the threat and burden of VRE infections worldwide, particularly in the USA, and the late emergence in Algeria, our study supports the urgent need for improved and early adequate infection control measures to avoid VRE spread in North African hospitals.

KEYWORDS:

MLST; PFGE; genotyping; molecular epidemiology; outbreak; rep-PCR

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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