TY - JOUR AU - Leavis, Helen L. AU - Willems, Rob J.L. AU - Top, Janetta AU - Spalburg, Emile AU - Mascini, Ellen M. AU - Fluit, Ad C. AU - Hoepelman, Andy AU - de Neeling, Albert J. AU - Bonten, Marc J.M. T1 - Epidemic and Nonepidemic Multidrug-Resistant Enterococcus faecium T2 - Emerging Infectious Disease journal PY - 2003 VL - 9 IS - 9 SP - 1108 SN - 1080-6059 AB - The epidemiology of vancomycin-resistant Enterococcus faecium (VREF) in Europe is characterized by a large community reservoir. In contrast, nosocomial outbreaks and infections (without a community reservoir) characterize VREF in the United States. Previous studies demonstrated host-specific genogroups and a distinct genetic lineage of VREF associated with hospital outbreaks, characterized by the variant esp-gene and a specific allele-type of the purK housekeeping gene (purK1). We investigated the genetic relatedness of vanA VREF (n=108) and vancomycin-susceptible E. faecium (VSEF) (n=92) from different epidemiologic sources by genotyping, susceptibility testing for ampicillin, sequencing of purK1, and testing for presence of esp. Clusters of VSEF fit well into previously described VREF genogroups, and strong associations were found between VSEF and VREF isolates with resistance to ampicillin, presence of esp, and purK1. Genotypes characterized by presence of esp, purK1, and ampicillin resistance were most frequent among outbreak-associated isolates and almost absent among community surveillance isolates. Vancomycin-resistance was not specifically linked to genogroups. VREF and VSEF from different epidemiologic sources are genetically related; evidence exists for nosocomial selection of a subtype of E. faecium, which has acquired vancomycin-resistance through horizontal transfer. KW - Enterococcus faecium KW - antibiotic resistance KW - vancomycin KW - vancomycin-resistance KW - esp gene KW - ampicillin resistance KW - epidemiology KW - the Netherlands DO - 10.3201/eid0909.020383 UR - https://wwwnc.cdc.gov/eid/article/9/9/02-0383_article ER - End of Reference