High-risk clonal complexes CC2 and CC9 are widely distributed among Enterococcus faecalis hospital isolates recovered in Spain

University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
Enfermedades Infecciosas y Microbiología Clínica (Impact Factor: 2.17). 11/2007; 25(8):513-8.
Source: PubMed


Our previously described multilocus sequence typing (MLST) scheme for Enterococcus faecalis has provided insight into the population structure and global epidemiology of this organism. Two high-risk complexes, CC2 and CC9, especially adapted to the hospital environment and widely distributed in Europe and America, were identified. The purpose of this study was to define the presence of CC2 and CC9 among E. faecalis strains isolated in Spain.
A total of 81 E. faecalis isolates recovered from several sources and geographic areas of Spain were characterized using MLST. Because of their clinical and epidemiological interest, strains were included from each of the vancomycin-resistant E. faecalis hospital outbreaks described in Spain.
Among the isolates, CC2 and CC9 were detected in the hospital setting. Included in these CC were the vancomycin-resistant E. faecalis isolates causing hospital outbreaks in La Coruña, Palma de Mallorca and Valencia, as well as vancomycin-susceptible hospital isolates. The Index of Association (Ia), which measures linkage disequilibrium between alleles, revealed an epidemic population structure on a background of high recombination rates.
High-risk complexes (CC2 and CC9) particularly adapted to the hospital environment were detected in Spain. Evolution of these CC in different areas depended on the local gene pool. Future infection control policies should be orientated to detect high-risk CC with the aim of predicting potential trends toward acquisition of specific resistance, such as to vancomycin.

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    ABSTRACT: We carried out the first study of Enterococcus faecalis clinical isolates in Cuba by multilocus sequence typing linking the molecular typing data with the presence of virulence determinants and the antibiotic resistance genes. A total of 23 E. faecalis isolates recovered from several clinic sources and geographic areas of Cuba during a period between 2000 and 2005 were typed by multilocus sequence typing. Thirteen sequence types (STs) including five novel STs were identified, and the ST 64 (clonal complex [CC] 8), ST 6 (CC2), ST 21(CC21), and ST 16 (CC58) were found in more than one strain. Sixty-seven percent of STs corresponded to STs reported previously in Spain, Poland, and The Netherlands, and other STs (ST115, ST64, ST6, and ST40) were genetically close to those detected in the United States. Prevalence of both antimicrobial resistance genes [aac(6')-aph(2''), aph(3'), ant(6), ant(3'')(9), aph(2'')-Id, aph(2'')-Ic, erm(B), erm(A), erm(C), mef(A), tet(M), and tet(L)] and virulence genes (agg, gelE, cylA, esp, ccf, and efaAfs) were examined by polymerase chain reaction. Aminoglycoside resistance genes aac(6')-Ie-aph(2'')-Ia, aph(3'), ant(6), ant(3'')(9) were more frequently detected in ST6, ST16, ST23, ST64, and ST115. The multidrug resistance was distributed to all STs detected, except for ST117 and singleton ST225. The presence of cyl gene was specifically linked to the ST64 and ST16. Presence of the esp, gel, and agg genes was not specific to any particular ST. This research provided the first insight into the population structure of E. faecalis in Cuba, that is, most Cuban strains were related to European strains, whereas others to U.S. strains. The CC2, CC21, and CC8, three of the biggest CCs in the world, were evidently circulating in Cuba, associated with multidrug resistance and virulence traits.
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