| Research Abstract |
The first report in Japan of a vaneomycin-resistant enterococcal clinical isolate was in 1996. Although outbreaks of VariA-type or VanB-type vaneomycin-resistant enterococci (VRE) at some Japanese hospitals were reported, infections or colonizations due to VRE have been rare in Japan until May 2003. In 1998, a patient colonized with VanA-type Enterococcus faecium (VREF) was hospitalized at the Okayama University Hospital (Okayama, Japan). Since then, to control one of the most important nosocomial pathogens, we have studied on detection of VRE, molecular epidemiology of VRE and a combination therapy for VRE.
We have developed a simple and reliable multiplex PCR assay for surveillance isolates of VRE. Seven primer sets targeting the genes vanA, vanB, vanCl, vanC2/C3, Enterococcus faecalis-specific, Enterococcus faecium-specific and rrs(l6SrRNA) were used in one reaction tube. The optimized multiplex PCR assay is an attractive alternative to the other methods since it provides simpler and
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more accurate analysis of the molecular epidemiology of VRE isolates.
We identified a Tn1546-like (type2) element in VREF isolated from hospitalized patients in Japan. The Tn1545-like (type2) element has previously been associated with VREF isolated from pig feces in Europe. So far, four VRE isolates in Japan possessed the unique molecular variations characteristic of Tn1546-like (type2) element, the presence of an IS1216V-IS3-like element in the left end of Tn1546and a point mutation (G to T) at position 8234 in the essential vanX gene of Tn1546.
Optical therapy for serious enterococcal infections requires the combination of a cell wall-active agent with an aminoglycoside (most commonly gentamicin) for synergistic killing. In our studies, the combination of ampicillin and arbekacin demonstrated inhibitory activity against VRE possessing aac(6')-aph(2'') or aph(2'')-Id genes. This combination may prove useful in treating infections caused by multiresistant enterococci, where treatment options are limited. Less
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