Molecular Characterization of a Widespread, Pathogenic, and Antibiotic Resistance-Receptive Enterococcus faecalis Lineage and Dissemination of Its Putative Pathogenicity Island

Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 2.112, Houston, TX 77030, USA.
Journal of Bacteriology (Impact Factor: 2.81). 09/2005; 187(16):5709-18. DOI: 10.1128/JB.187.16.5709-5718.2005
Source: PubMed


Enterococcus faecalis, a common cause of endocarditis and known for its capacity to transfer antibiotic resistance to other pathogens, has recently emerged as an important, multidrug-resistant nosocomial pathogen. However, knowledge of its lineages and the potential of particular clones of this species to disseminate and cause disease is limited. Using a nine-gene multilocus sequence typing (MLST) scheme, we identified an evolving and widespread clonal complex of E. faecalis that has caused outbreaks and life-threatening infections. Moreover, this unusual clonal complex was found to contain isolates of unexpected relatedness, including the first known U.S. vancomycin-resistant enterococcus (E. faecalis strain V583), the first known penicillinase-producing (Bla(+)) E. faecalis isolate, and the previously described widespread clone of penicillinase producers, a trait found in <0.1% of E. faecalis isolates. All members of this clonal cluster (designated as BVE for Bla(+) Van(r) endocarditis) were found to contain a previously described putative pathogenicity island (PAI). Further analysis of this PAI demonstrated its dissemination worldwide, albeit with considerable variability, confirmed its association with clinical isolates, and found a common insertion site in different clonal lineages. PAI deletions, MLST, and the uncommon resistances were used to predict the evolution of the BVE clonal cluster. The finding of a virulent and highly successful clonal complex of E. faecalis with different members resistant to the primary therapies of choice, ampicillin and vancomycin, has important implications for the evolution of virulence and successful lineages and for public health monitoring and control.

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Available from: George Weinstock, Jul 29, 2014
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    • "Penicillin resistance in E. faecalis is rare and if occurring linked to certain clonal lineages expressing beta-lactamases similar or identical to the S. aureus penicillinase (Nallapareddy et al., 2005; Ruiz-Garbajosa et al., 2006; McBride et al., 2007). Penicillin resistance in E. faecium is mediated via point mutations in the housekeeping pbp5 gene leading to reduced penicillin binding to the expressed protein (Jureen et al., 2004; Rice et al., 2004; Rice et al., 2009). "

    Antibiotic Resistant Bacteria - A Continuous Challenge in the New Millennium, 04/2012; , ISBN: 978-953-51-0472-8
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    • "Nevertheless, some E. faecalis clones, like ST6, ST9, ST28 and ST40, represented by at least 10 isolates in the database ( are clearly enriched (>70% of isolates) among hospitalized patients and are distributed world wide (McBride et al., 2007; Nallapareddy et al., 2005; Ruiz-Garbajosa et al., 2006; Freitas et al., 2009; Solheim et al., 2009; Damani et al., 2010; Lopez et al., 2010; Lester et al., 2010; Kawalec et al., 2007; Sun et al., 2009; McBride et al., 2009). "
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    ABSTRACT: Infections caused by multiresistant Gram-positive bacteria represent a major health burden in the community as well as in hospitalized patients. Staphylococcus aureus, Enterococcus faecalis and Enterococcus faecium are well-known pathogens of hospitalized patients, frequently linked with resistance against multiple antibiotics, compromising effective therapy. Streptococcus pneumoniae and Streptococcus pyogenes are important pathogens in the community and S. aureus has recently emerged as an important community-acquired pathogen. Population genetic studies reveal that recombination prevails as a driving force of genetic diversity in E. faecium, E. faecalis, S. pneumoniae and S. pyogenes, and thus, these species are weakly clonal. Although recombination has a relatively modest role driving the genetic variation of the core genome of S. aureus, the horizontal acquisition of resistance and virulence genes plays a key role in the emergence of new clinically relevant clones in this species. In this review, we discuss the population genetics of E. faecium, E. faecalis, S. pneumoniae, S. pyogenes and S. aureus. Knowledge of the population structure of these pathogens is not only highly relevant for (molecular) epidemiological research but also for identifying the genetic variation that underlies changes in clinical behaviour, to improve our understanding of the pathogenic behaviour of particular clones and to identify novel targets for vaccines or immunotherapy.
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    • "However, infections caused by E. hirae and E. casseliflavus may also occur and warrant attention [52]. In addition, enterococci are regarded as important reservoirs of antibiotic resistance and virulence genes that are often found on mobile genetic elements [22,27,30,52]. "
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