European Journal of Clinical Microbiology and Infectious Diseases

, 24:815

Spread of ampicillin/vancomycin-resistant Enterococcus faecium of the epidemic-virulent clonal complex-17 carrying the genes esp and hyl in German hospitals


    • Robert Koch Institute
  • C. Konstabel
    • Robert Koch Institute
  • S. Mueller-Bertling
    • Robert Koch Institute
  • G. Werner
    • Robert Koch Institute
  • B. Strommenger
    • Robert Koch Institute
  • C. Kettlitz
    • Robert Koch Institute
  • S. Borgmann
    • Institute of Medical Microbiology and HygieneUniversity of Tuebingen
  • B. Schulte
    • Institute of Medical Microbiology and HygieneUniversity of Tuebingen
  • D. Jonas
    • Institute of Environmental Medicine and Hospital EpidemiologyUniversity of Freiburg
  • A. Serr
    • Institute for Medical Microbiology and HygieneUniversity of Freiburg
  • A. M. Fahr
    • Department of MicrobiologyLaboratory Group Heidelberg
  • U. Eigner
    • Department of MicrobiologyLaboratory Group Heidelberg
  • W. Witte
    • Robert Koch Institute
Current Topic: Review

DOI: 10.1007/s10096-005-0056-0

Cite this article as:
Klare, I., Konstabel, C., Mueller-Bertling, S. et al. Eur J Clin Microbiol Infect Dis (2005) 24: 815. doi:10.1007/s10096-005-0056-0


The incidence of vancomycin-resistant Enterococcus faecium isolation was low (≤5%) in German hospitals before 2003. Within the second half of 2003 and the first half of 2004, however, increasing frequencies of up to 14% were noticed in several hospitals in southwestern Germany. This increase was attributed mainly to the occurrence and spread of epidemic-virulent ampicillin/vancomycin-resistant, vanA- and vanB-positive E. faecium clones, most of which exhibited the virulence factors enterococcal surface protein (esp) and bacteriocin activity and some which exhibited hyaluronidase (hyl). E. faecium possessing hyaluronidase was initially found in U.S. hospitals and recently detected in several European hospitals and, subsequently, in German hospitals as well. Ampicillin/vancomycin-resistant E. faecium clones originating mainly from southwestern German hospitals were characterized by multilocus sequence typing since different sequence types (STs) belonging to the clonal complex-17 are currently disseminated worldwide. Multilocus sequence typing revealed that, in 1998 and 1999, ampicillin/vancomycin-resistant E. faecium clone ST-117 was prevalent in various German hospitals, while in 2003 and 2004, clone ST-203 dominated in several hospitals located in southwestern Germany. Both sequence types display single-locus variants of ST-78, which was frequently recorded in various Italian hospitals between 2000 and 2003, and all of these STs belong to the clonal complex-17. Expression of linezolid resistance was observed in ampicillin/glycopeptide-resistant E. faecium strains (VanA type) from two tertiary hospitals in southwestern Germany due to mutations in domain V of the 23S rDNA (G2576T). While in one hospital the resistance emerged during linezolid therapy, in the other hospital resistance was caused by transfer of an identical linezolid/ampicillin/glycopeptide-resistant E. faecium strain. In conclusion, it is very important to monitor the occurrence of epidemic-virulent clonal complex-17 strains of E. faecium to prevent their spread in hospitals, especially if they are resistant to glycopeptides and linezolid.

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© Springer-Verlag 2005