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Regional spread and control of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Kyoto, Japan

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Abstract

The purpose of this investigation was to control the post-outbreak prevalence of vancomycin-resistant enterococci (VRE) in the affected Kyoto region. The study period was from 2005 to 2010. Faecal samples were subjected to VRE screening, and vancomycin resistance genes were detected by polymerase chain reaction (PCR). The genotype was determined by pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SmaI and by multilocus sequence typing (MLST). A VRE control programme was established in 2006, consisting of a laboratory-based faecal VRE screening system, annual surveillance of hospital inpatients and the promotion of adequate infection control measures. vanA-Enterococcus faecium, vanB-E. faecium and vanB-E. faecalis were detected at 35, 12 and 5 hospitals, respectively. Genotype analysis revealed that all of the vancomycin-resistant E. faecium isolates obtained since 2005 belonged to ST78, and that clonally related vanB-E. faecalis of ST64 had spread to three hospitals. The rate of faecal VRE carriage among the patients enrolled in the annual surveillance increased until 2007, when it reached 24 (1.2%) of the 2,035 enrolled patients. The rate began to decrease in 2008 and, by 2010, reached a low of 4 (0.17%) of the 2,408 enrolled patients. While VRE did spread within the Kyoto region, the VRE control programme succeeded in controlling the overall VRE spread.

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Acknowledgements

We thank Kyoto City and the Kyoto Prefecture for their practical support. We also appreciate the study and manuscript advice offered by Drs. Yasuyoshi Ike, Haruyoshi Tomita and Yoshichika Arakawa.

Aki Matsushima has received research funding from the Kurozumi Medical Foundation.

Shunji Takakura has received research funding from the Japanese Ministry of Education, Culture, Sports, Science and Technology (Kiban B, 18390172).

Yoshitsugu Iinuma has received research funding from the Japanese Ministry of Health, Labour and Welfare (the Research Grant for Longevity Sciences 21A-20).

Satoshi Ichiyama has received research funding from Kyoto City and the Kyoto Prefecture.

Conflicts of interest

None of the authors have any financial relationships with the organisation that sponsored the research.

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Authors and Affiliations

  1. Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 6068507, Japan

    A. Matsushima, S. Takakura, M. Yamamoto, Y. Matsumura, M. Shirano, M. Nagao & S. Ichiyama

  2. Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 6068507, Japan

    A. Matsushima, S. Takakura, M. Yamamoto, Y. Matsumura, M. Shirano, M. Nagao & S. Ichiyama

  3. Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo, Kyoto, 6068507, Japan

    Y. Ito

  4. Department of Infection Diseases, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 9200293, Japan

    Y. Iinuma

  5. Department of Infectious Diseases, Kyoto City Hospital, 1-2 Mibu-Higashitakadacho, Nakagyo, Kyoto, 6048845, Japan

    T. Shimizu

  6. Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo, Kyoto, 602-8566, Japan

    N. Fujita

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  1. A. Matsushima
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  2. S. Takakura
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  10. N. Fujita
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Correspondence to A. Matsushima.

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Matsushima, A., Takakura, S., Yamamoto, M. et al. Regional spread and control of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Kyoto, Japan. Eur J Clin Microbiol Infect Dis 31, 1095–1100 (2012). https://doi.org/10.1007/s10096-011-1412-x

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  • DOI: https://doi.org/10.1007/s10096-011-1412-x

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