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Case Reports
. 2015 Dec;53(12):3951-3.
doi: 10.1128/JCM.02046-15. Epub 2015 Sep 30.

Vancomycin-Variable Enterococcal Bacteremia

M A Downing  1 , J Xiong  2 , A Eshaghi  3 , A McGeer  4 , S N Patel  5 , J Johnstone  6
Affiliations
Case Reports

Vancomycin-Variable Enterococcal Bacteremia

M A Downing et al. J Clin Microbiol. 2015 Dec.

Abstract

Vancomycin-variable enterococcus (VVE) is an emerging pathogen. VVE isolates initially appear phenotypically susceptible to vancomycin but possesses the vanA gene and can develop in vitro and in vivo resistance to vancomycin. We report a case of VVE bacteremia and describe how VVE poses diagnostic and therapeutic dilemmas.

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Figures

FIG 1
FIG 1
PFGE of isolates from the index patient bacteremic with VVE (patient 1; isolate 1a was obtained prior to vancomycin use, and isolate 1b was obtained while she was receiving vancomycin) and two patients colonized with VVE (patients 2 and 3). Isolates a, b, c, and e are labeled A since they are genetically identical to each other, whereas isolate d is labeled A1 because it is genetically closely related to the isolates above.
See this image and copyright information in PMC

References

    1. Coburn B, Low DE, Patel SN, Poutanen SM, Shahinas D, Eshaghi A, Willey BM, McGeer A. 2014. Vancomycin-variable Enterococcus faecium: in vivo emergence of vancomycin resistance in a vancomycin-susceptible isolate. J Clin Microbiol 52:1766–1767. doi:10.1128/JCM.03579-13. - DOI - PMC - PubMed
    1. Szakacs TA, Kalan L, McConnell MJ, Eshaghi A, Shahinas D, McGeer A, Wright GD, Low DE, Patel SN. 2014. Outbreak of vancomycin-susceptible Enterococcus faecium containing the wild-type vanA gene. J Clin Microbiol 52:1682–1686. doi:10.1128/JCM.03563-13. - DOI - PMC - PubMed
    1. Clinical and Laboratory Standards Institute. 2014. Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. CLSI document M100-S24. Clinical and Laboratory Standards Institute, Wayne, PA.
    1. Ontario Agency for Health Protection and Promotion Provincial Infectious Diseases Advisory Committee. 2012. Routine practices and additional precautions in all health care settings, 3rd edition Queen's Printer for Ontario, Toronto, ON, Canada.
    1. Ontario Agency for Health Protection and Promotion Provincial Infectious Diseases Advisory Committee. 2013. Annex A—screening, testing and surveillance for antimicrobial resistant organisms (AROs). Annexed to: routine practices and additional precautions in all health care settings, 3rd edition Queen's Printer for Ontario, Toronto, ON, Canada.

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