Antibiotic resistance of Enterococcus faecalis from persistent endodontic infections / Resistencia antibiótica de Enterococcus faecalis provenientes de infecciones endodónticas persistentes

Enterococci are important nosocomial pathogens due to their intrinsic multiresistance and the acquisition of new antibiotic resistance genes (ARG). Enterococcus faecalis has been shown to be one of the main pathogens in persistent endodontic infections, therefore, the main objective of this study was to evaluate the phenotype and resistance genotype of strains of E. faecalis isolated from teeth with persistent endodontic lesions, to the most commonly prescribed antibiotics in dentistry. Thirteen strains of E. faecalis of different pulsotype were analyzed to evaluate the susceptibility to antibiotics, amoxicillin, amoxicillin/clavulanic acid, tetracycline, erythromycin and metronidazole, using the Epsilometer test (E- test) and the presence of beta-lactamases with nitrocefin test. Finally, the detection of ARG was performed with a molecular polymerase chain reaction (PCR) technique and confirmed by the sequencing of the amplification products. Fisher's exact test was used, using 95 % confidence. Regarding the phenotype of resistance, the evaluated strains, independent of the pulsotype, were totally resistant to the action of metronidazole. Antibiotics with higher minimum inhibitory concentration (MIC) after metronidazole include tetracycline and erythromycin. In contrast, lower MIC are applied to the combination of amoxicillin with clavulanic acid. The nitrocefin test was positive only in one strain. Genotypically, two genetically distant strains isolated from a single patient, presented a genotype of resistance to erythromycin, determined by the presence of the ermB gene. No statistically significant relationship was found between phenotypic resistance and the presence of ARG in relation to erythromycin (p> 0.05). It was concluded that isolates of E. faecalis from persistent endodontic infections showed phenotypes of resistance to several antimicrobial agents, all of which were susceptible to amoxicillin/clavulanic acid. Periodic evaluation of susceptibility to antibiotics is suggested as an important practice for the surveillance of antibiotic resistance in oral strains.

Los enterococos son importantes patógenos nosocomiales debido a su multi resistencia intrínseca y la adquisición de nuevos genes de resistencia a los antibióticos (ARG). Enterococcus faecalis es uno de los principales patógenos en infecciones endodónticas persistentes, por lo tanto, el objetivo principal de este estudio fue evaluar el fenotipo y el genotipo de resistencia de cepas de E. faecalis aisladas de dientes con lesiones endodóncicas persistentes, a los antibióticos comúnmente recetados en odontología. Se analizaron 13 cepas de E. faecalis de diferentes pulsotipos para evaluar la susceptibilidad a los antibióticos, amoxicilina, amoxicilina / ácido clavulánico, tetraciclina, eritromicina y metronidazol, utilizando la prueba de Epsilometría (E-test) y la presencia de beta-lactamasas con prueba de nitrocefina. Finalmente, la detección de ARG se realizó con una técnica molecular de reacción en cadena de la polimerasa (PCR) y se confirmó mediante la secuenciación de los productos de amplificación. Se utilizó la prueba exacta de Fisher, con un 95 % de confianza. En cuanto al fenotipo de resistencia, las cepas evaluadas, independientes del pulsotipo, fueron totalmente resistentes a la acción del metronidazol. Los antibióticos con los valores más altos de concentración mínima inibitoria (CMI) después del metronidazol incluyen tetraciclina y eritromicina. En contraste, las CMI mas bajas se aplican a la combinación de amoxicilina con ácido clavulánico. La prueba de nitrocefina fue positiva solo en una cepa. Genotípicamente, dos cepas distantes genéticamente, aisladas de un mismo paciente fueron positivas para el gen ermB. No se encontró una relación estadísticamente significativa entre la resistencia fenotípica y la presencia de ARG en relación con la eritromicina (p> 0,05). Se concluyó que los aislamientos de E. faecalis de infecciones endodónticas persistentes mostraron fenotipos de resistencia a varios agentes antimicrobianos, todos los cuales fueron susceptibles a amoxicilina / ácido clavulánico. Se sugiere una evaluación periódica de la susceptibilidad a los antibióticos como una práctica importante para la vigilancia de la resistencia a los antibióticos en las cepas orales.

Frequency of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPRs) in non-clinical Enterococcus faecalis and Enterococcus faecium strains / Frequência das repetições palindrômicas curtas agrupadas e regularmente interespaçadas (CRISPRs) em cepas não-clínicas de Enterococcus faecalis e Enterococcus faecium

Abstract The fidelity of the genomes is defended by mechanism known as Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) systems. Three Type II CRISPR systems (CRISPR1- cas, CRISPR2 and CRISPR3-cas) have been identified in enterococci isolates from clinical and environmental samples. The aim of this study was to observe the distribution of CRISPR1-cas, CRISPR2 and CRISPR3-cas in non-clinical strains of Enterococcus faecalis and Enterococcus faecium isolates from food and fecal samples, including wild marine animals. The presence of CRISPRs was evaluated by PCR in 120 enterococci strains, 67 E. faecalis and 53 E. faecium. It is the first report of the presence of the CRISPRs system in E. faecalis and E. faecium strains isolated from wild marine animal fecal samples. The results showed that in non-clinical strains, the CRISPRs were more frequently detected in E. faecalis than in E. faecium. And the frequencies of CRISPR1-cas and CRISPR2 were higher (60%) in E. faecalis strains isolated from animal feces, compared to food samples. Both strains showed low frequencies of CRISPR3-cas (8.95% and 1.88%). In conclusion, the differences in the habitats of enterococcal species may be related with the results observe in distribution of CRISPRs systems.

Resumo A fidelidade dos genomas ​​é defendida por mecanismos conhecidos como sistemas de repetições palindrômicas curtas agrupadas e regularmente interespaçadas (CRISPRs). Três tipos de sistemas CRISPR II (CRISPR1-cas, CRISPR2 e CRISPR3-cas) têm sido identificados em cepas de enterococos isolados de amostras clínicas e ambientais. O objetivo deste estudo foi observar a distribuição dos CRISPR1-cas, CRISPR2 e CRISPR3-cas em cepas não-clínicas de Enterococcus faecalis e Enterococcus faecium isoladas de amostras alimentícias e fecais, incluindo animais marinhos selvagens. A presenca dos CRISPRs foi determinada por PCR em 120 cepas de enterococos, sendo 67 E. faecalis e 53 E. faecium. É o primeiro relato da presença do sistema CRISPRs nas estirpes E. faecalis e E. faecium isoladas de amostras fecais de animais marinhos selvagens. Os resultados mostraram que em cepas não-clínicas, os CRISPRs foram mais frequentemente detectados em E. faecalis do que em E. faecium. E as frequências de CRISPR1-cas e CRISPR2 foram maiores (60%) em cepas de E. faecalis isoladas de fezes de animais, quando comparadas à amostras de alimentos. Ambas as cepas apresentaram baixas freqüências de CRISPR3-cas (8,95% e 1,88%). Em conclusão, as diferenças nos habitats das espécies de enterococos podem estar relacionadas com os resultados observados na distribuição dos sistemas CRISPRs.

Investigação da população de Enterococcus faecalis em pacientes com pólipo e câncer colorretal em comparação a indivíduos saudáveis / Investigation of enterococcus faecalis population in patients with polyp and colorectal cancer in comparison of healthy individuals

ABSTRACT BACKGROUND: Colorectal cancer is one of the most commonly diagnosed cancers around the world. One of the factors involved in the development of colorectal cancer is the changes in the normal flora of the intestine. OBJECTIVE: In this study, the mean copy number of Enterococcus faecalis in people with polyps and people with colorectal cancer has been evaluated in comparison with healthy controls. METHODS: In this study, 25 patients with colorectal cancer and 28 patients with intestinal polyps were selected and stool specimens were taken. In addition, 24 healthy individuals were selected as control group. Extraction of bacterial DNA from the stool sample were performed. The molecular methods of PCR for confirmation of standard strain and absolute Real Time PCR (qRT-PCR) method were used to evaluate the number of Enterococcus faecalis in the studied groups. RESULTS: The results of this study indicate that the mean copy number of Enterococcus faecalis in patients with colorectal cancer was 11.2x109 per gram of stool, and in patients with polyps was 9.4x108 per gram of stool. In healthy people, this number was 9x108 per gram of stool. There was a significant difference between the implicit copy numbers in the three groups. (P<0.05). CONCLUSION: Enterococcus faecalis in faecal flora of people with colorectal cancer was significantly higher than those with polyps and healthy people. This could potentially signify the ability of this bacterium to induce colorectal cancer. More studies are needed to prove this theory.

RESUMO CONTEXTO: O câncer colorretal é um dos cânceres mais comumente diagnosticados em todo o mundo. Um dos fatores envolvidos no desenvolvimento do câncer colorretal é a mudança na flora normal do intestino. OBJETIVO: O número médio de cópias de Enterococcus faecalis em pessoas com pólipos e pessoas com câncer colorretal foram avaliados em comparação com controles saudáveis. MÉTODOS: Neste estudo, 25 pacientes com câncer colorretal e 28 pacientes com pólipos intestinais foram selecionados e amostras de fezes foram adquiridas. Além disso, 24 indivíduos saudáveis foram selecionados como grupo controle. A extração do DNA bacteriano da amostra coletada foi executada. Os métodos moleculares de PCR para confirmação da cepa padrão e o método absoluto de PCR em tempo real (qRT-PCR) foram utilizados para avaliar o número de Enterococcus faecalis nos grupos estudados. RESULTADOS: Os resultados deste estudo indicam que o número médio de cópias de Enterococcus faecalis em pacientes com câncer colorretal foi de 11,2x109 por grama de fezes, e em pacientes com pólipos foi de 9,4x108 por grama de fezes. Em pessoas saudáveis, este número foi de 9x108 por grama de fezes. Houve diferença significativa entre os números de cópia implícita nos três grupos. (P<0,05). CONCLUSÃO: Enterococcus faecalis na flora fecal de pessoas com câncer colorretal foi significativamente maior do que aqueles com pólipos e pessoas saudáveis. Isto poderia potencialmente significar a capacidade desta bactéria para induzir o câncer colorretal. Mais estudos são necessários para provar esta teoria.

Quorum sensing LuxS/autoinducer-2 inhibits Enterococcus faecalis biofilm formation ability

Abstract Objective: To investigate the relation between biofilm formation ability and quorum sensing gene LuxS/AI-2. Materials and Methods: Enterococcus faecalis (E. faecalis) standard strain ATCC 29212 was used in the study. Long flanking homology polymerase chain reaction method was used to build the LuxS gene knockout strain. Sequential culture turbidity measurement and CFU counting were used to assess the proliferation ability of E. faecalis after the depletion of LuxS. 96-well plate assay was used to quantify the biofilm formation ability; CLSM was used to observe the attached bacteria areas, while scanning electron microscopy (SEM) was performed to observe biofilm microstructure conditions. Results: LuxS gene knockout strains were successfully constructed and identified. The results showed that proliferation ability of E. faecalis was not affected by the depletion of the luxS gene, and the biofilm formation ability of ΔLuxS 29212 significantly decreased (P<0.05). Conclusions: Collectively, our studies provide the LuxS gene's key role in controlling biofilm formation of E. faecalis, which presented a negative regulation, and furthermore, providing us a possible way to conquer the persistent apical periodontitis.

Análise da influência de proteínas da matriz extracelular e fibrinogênio na formação de biofilme por cepas de Enterococcus faecalis isoladas de infecção endodôntica primária / Analysis of influence of extracellular matrix proteins and fibrinogen in biofilm formation by Enterococcus faecalis strains isolated from primary endodontic infection

Enterococcus faecalis é um patógeno oportunista com peculiar potencial para a manutenção da infecção perirradicular endodôntica após o preparo químico-mecânico do sistema de canais radiculares. Adicionalmente, possui aptidão para desenvolver-se em biofilme e apresenta em sua parede celular adesinas compatíveis com substratos colagênicos, como a composição da matriz extracelular da dentina e dos túbulos dentinários. Esse estudo propôs-se a caracterizar geneticamente 23 amostras de E faecalis isoladas de infecções endodônticas primárias através da técnica da reação em cadeia da polimerase (PCR, do inglês Polymerase Chain Reaction) e investigar a influência de COL I (colágeno tipo I), FN (fibronectina) e fibrinogênio (FBG) na formação de biofilme em superfície abiótica. Assim, após a sensibilização de ¾ dos poços de placas de poliestireno estéreis com 50 µl da solução de proteína de matriz (COL I, FN e FBG) na concentração de 1mg/ml, transferiu-se 50µl de suspensão bacteriana (1,5 x 108 bact/mL) correspondente a cada amostra, de modo a preencher tanto os poços sensibilizados como os não sensibilizados. A quantificação da formação de biofilme foi realizada por meio de leitura por densidade óptica, cujos resultados revelaram que houve formação de biofilme por todas as em superfície abiótica, porém com diferentes graus de intensidade. Todas as cepas foram identificadas geneticamente como Enterococcus faecalis e a presença do gene gelE foi dominante. Contudo, nenhuma apresentou amplificação para os genes esp e agg, e, apesar de 73,9% das amostras amplificarem para o gene ace, apenas 2 cepas (P7 e P75) isoladas de infecções endodônticas primárias tiveram aumento de formação de biofilme na presença de COL I (P<0,05). Embora a presença de FBG não forneça subsídio estatisticamente significante para a formação de biofilme, COL I e FN influenciaram na redução da formação do biofilme para a maior parte das amostras. É possível que a capacidade de formação de biofilme inerente ao E. faecalis e a afinidade para FN e COL I através da expressão gênica de ace contribuam substancialmente para a manutenção desse micro-organismo no ambiente radicular mesmo após o tratamento endodôntico minucioso.

Enterococcus faecalis is an opportunistic pathogen with peculiar potential to maintain the periradicular endodontic infection even after chemical-mechanical preparation of the root canal system. In addition, it has the ability to develop into biofilms and presents in your cell wall adhesins compatible with collagenous substrates, as the composition of the extracellular matrix of the dentine and dentinal tubules. This study aims to characterize genetically 23 samples of E. faecalis isolated from primary endodontic infections by Polymerase Chain Reaction (PCR) technique and investigate the influence of collagen type I (COL I), fibronectin (FN) and fibrinogen (FBG) in biofilm formation on abiotic surface. Thus, after the sensitization of ¾ the wells of sterile microtiter plates with 50 ul of matrix protein solution (COL I and FN FBG) at a concentration of 1mg / ml, was transferred 50mL of bacterial suspension (1.5 x 108 bact / ml) corresponding to each sample in order to fill both wells sensitized and non-sensitized. Quantification of biofilm formation was performed by optical density, so the results showed that there were biofilm formation by all strains on abiotic surface, but with different degrees of intensity. All strains were genetically identified as Enterococcus faecalis and the presence of gelE gene was prevalent. However, none showed amplification for the esp and agg gene, and, while 73.9% of the samples for amplifying ace gene, only 2 strains (P7 and P75) isolated from primary endodontic infections they had increased biofilm formation in the presence of COL I (P <0.05). Although the presence of FBG no provides significant support for the biofilm formation, COL I and FN were relevant influence in the reduction of biofilm formation for most of the samples. It is possible that the biofilm-forming ability inherent in E. faecalis and affinity for FN and COL I through ace gene expression contribute substantially to maintain of this microorganism in the root environment even after thorough endodontic treatment.

Clonal diversity and antimicrobial resistance of Enterococcus faecalis isolated from endodontic infections

Background Enterococcus faecalis is considered to be one of most prevalent species in the oral cavity, particularly in endodontic infections. The aim of the present study was to investigate the prevalence of E. faecalis in dental root canals, clonal diversity by restriction fragment length polymorphism (RFLP) and randomly amplified polymorphic DNA (RAPD-PCR) analysis, and the antibiotic susceptibility of E. faecalis isolates. Results Among the bacterial strains isolated from dental root canal specimens (n = 82), E. faecalis was determined to have the highest prevalence followed by Streptococcus viridians, Leuconostoc mesenteroides, Staphylococcus aureus, Streptococcus mitis, and Pediococcus pentosaceus. Cluster analysis of RAPD-PCR and RFLP patterns of the E. faecalis isolates discriminated five and six different genotypes, respectively. Among the tested strains, 43%, 52% and 5% were susceptible, intermediate resistant, and resistant to erythromycin, respectively. In addition, one strain (E-12) was intermediate resistant to linezolid, and one isolate (E-16) was resistant to tetracycline. Interestingly, many of the intermediate resistant/resistant strains were grouped in clusters 5 and 6, according RAPD and to RFLP, respectively. Conclusions E. faecalis demonstrated the highest prevalence in the tested dental root canal specimens collected from Saudi patients and were grouped into five to six different genotypes. Different levels of antimicrobial susceptibility were observed in the tested E. faecalis strains, which clearly indicated that although bacterial strains may be similar, point mutations can result in extreme susceptibility or resistance to various antibiotics. This phenomenon is a cause for concern for clinicians in the treatment of dental infections caused by E. faecalis.

The first report of the vanC1 gene in Enterococcus faecium isolated from a human clinical specimen

The vanC1 gene, which is chromosomally located, confers resistance to vancomycin and serves as a species marker for Enterococcus gallinarum. Enterococcus faecium TJ4031 was isolated from a blood culture and harbours the vanC1gene. Polymerase chain reaction (PCR) assays were performed to detect vanXYc and vanTc genes. Only the vanXYc gene was found in the E. faecium TJ4031 isolate. The minimum inhibitory concentrations of vancomycin and teicoplanin were 2 µg/mL and 1 µg/mL, respectively. Real-time reverse transcription-PCR results revealed that the vanC1and vanXYc genes were not expressed. Pulsed-field gel electrophoresis and southern hybridisation results showed that the vanC1 gene was encoded in the chromosome. E. faecalis isolated from animals has been reported to harbour vanC1gene. However, this study is the first to report the presence of the vanC1gene in E. faecium of human origin. Additionally, our research showed the vanC1gene cannot serve as a species-specific gene of E. gallinarum and that it is able to be transferred between bacteria. Although the resistance marker is not expressed in the strain, our results showed that E. faecium could acquire the vanC1gene from different species.

Enterococcus faecium AND Enterococcus faecalis IN BLOOD OF NEWBORNS WITH SUSPECTED NOSOCOMIAL INFECTION / Enterococcus faecium e Enterococcus faecalis no sangue de recém-nascidos com suspeita de infecção nosocomial

Enterococci are Gram-positive cocci saprophyte of the human gastrointestinal tract, diners who act as opportunistic pathogens. They can cause infections in patients hospitalized for a long time or who have received multiple antibiotic therapy. Enterococcus faecalis and Enterococcus faecium are the most common species in human infections. To evaluate the possibility of rapid detection of these species and their occurrence in the blood of newborns with suspected nosocomial infection, blood samples were collected from 50 newborns with late infections, admitted to the Neonatal Care Unit of the University Hospital Federal de Mato Grosso do Sul (UFMS-HU), from September 2010 to January 2011. The samples were subjected to conventional PCR and real time PCR (qPCR) to search for Enterococcus faecium and Enterococcus faecalis, respectively. The PCR results were compared with respective blood cultures from 40 patients. No blood cultures were positive for Enterococci, however, eight blood samples were identified as genomic DNA of Enterococcus faecium by qPCR and 22 blood samples were detected as genomic DNA of Enterococcus faecalis by conventional PCR. These findings are important because of the clinical severity of the evaluated patients who were found positive by conventional PCR and not through routine microbiological methods.

Os enterococos são cocos Gram-positivos saprófitas do trato gastrointestinal humano, atuam como patógenos oportunistas. Podem causar infecções em pacientes: hospitalizados por um longo tempo ou que receberam antibioticoterapia múltipla. Enterococcus faecalis e Enterococcus faecium são as espécies mais comuns em infecções humanas. Para avaliar a possibilidade de detecção rápida dessas espécies e sua ocorrência no sangue de recém-nascidos com suspeita de infecção hospitalar, foram coletadas amostras de sangue de 50 recém-nascidos, com infecção tardia, internados na Unidade de Terapia Neonatal do Hospital Universitário da Universidade Federal de Mato Grosso do Sul (UFMS-HU), no período de setembro de 2010 a janeiro de 2011. As amostras foram submetidas a PCR convencional e PCR em tempo real (qPCR) para pesquisa de Enterococcus faecium e Enterococcus faecalis, respectivamente. Os resultados da PCR foram comparados com culturas de sangue respectivos de 40. Nenhuma hemocultura foi positiva para enterococos, no entanto, em oito amostras de sangue foi identificado DNA genômico de Enterococcus faecium através da técnica de reação em cadeia da polimerase em tempo real, e em 22 amostras de sangue, foram detectados DNA genômico de Enterococcus faecalis, através de PCR convencional. A descoberta é importante por causa da gravidade clínica dos pacientes avaliados que foram positivos por PCR convencional e não foram detectados na rotina por métodos microbiológicos.

Molecular detection of virulence factors among food and clinical Enterococcus faecalis strains in South Brazil

The present report aimed to perform a molecular epidemiological survey by investigating the presence of virulence factors in E. faecalis isolated from different human clinical (n = 57) and food samples (n = 55) in Porto Alegre, Brazil, collected from 2006 to 2009. In addition, the ability to form biofilm in vitro on polystyrene and the β-haemolytic and gelatinase activities were determined. Clinical strains presented a higher prevalence of aggregation substance (agg), enterococcal surface protein (esp) and cytolysin (cylA) genes when compared with food isolates. The esp gene was found only in clinical strains. On the other hand, the gelatinase (gelE) and adherence factor (ace) genes had similar prevalence among the strains, showing the widespread occurrence of these virulence factors among food and clinical E. faecalis strains in South Brazil. More than three virulence factor genes were detected in 77.2% and 18.2% of clinical and food strains, respectively. Gelatinase and β-haemolysin activities were not associated with the presence of gelE and cylA genes. The ability to produce biofilm was detected in 100% of clinical and 94.6% of food isolates, and clinical strains were more able to form biofilm than the food isolates (Student's t-test, p < 0.01). Results from the statistical analysis showed significant associations between strong biofilm formation and ace (p = 0.015) and gelE (p = 0.007) genes in clinical strains. In conclusion, our data indicate that E. faecalis strains isolated from clinical and food samples possess distinctive patterns of virulence factors, with a larger number of genes that encode virulence factors detected in clinical strains.

Detection of vanC 1 gene transcription in vancomycin-susceptible Enterococcus faecalis

Here we report the presence and expression levels of the vanC 1 and vanC 2/3 genes in vancomycin-susceptible strains of Enterococcus faecalis. The vanC 1 and vanC 2/3 genes were located in the plasmid DNA and on the chromosome, respectively. Specific mRNA of the vanC 1 gene was detected in one of these strains. Additionally, analysis of the vanC gene sequences showed that these genes are related to the vanC genes of Enterococcus gallinarum and Enterococcus casseliflavus. The presence of vanC genes is useful for the identification of E. gallinarum and E. casseliflavus. Moreover, this is the first report of vanC mRNA in E. faecalis.

Detección de genes de virulencia en cepas de Enterococcus faecalis susceptibles y resistentes a aminoglucósidos / Detection of virulence genes in aminoglycoside susceptible and resistant Enterococcus faecalis

Background: Enterococcus spp. is an important cause of nosocomial infections A number of virulence factors that may enhance its ability to colonize have been described. Enterococcus is capable of acquiring resistance genes, including high-level resistance (HLR) to aminoglycoside antibiotics. Aim: to investigate the prevalence of genes encoding virulence factors in aminoglycosides susceptible and resistant E. faecalis. Materials and Methods: A total of 80 E. faecalis isolates from clinical (n: 52) and poultry samples (n: 28) were included in this study. Bacterial identification was performed by biochemical tests and phenotypificationwas done using the Phene-PlateTM system. Susceptibility to different antimicrobial agents was determined by the agar dilution method. Virulence genes aceI, agg, gelE and efaA were detected by multiplex PCR. Results: All isolates were susceptible to vancomycin and ampicillin. HLR to gentamicin (13.5%) and streptomycin (9.6%) was detected only in clinical isolates. The phenotyping revealed a great diversity of PhP-types, but only one clone with 7 strains of similar characteristics was found. The efaA gen was detected in 100% of the isolates. aceI gene was present in 94.2% and 75%, agg gene in 73.1%, and 67.9%, and gelE gene in 57.5% and 28.6% of the clinical and chicken isolates, respectively. Only 6 strains with HLR to aminoglycosides, belonging to the same phenotype, had the aceI, agg, gelE and efaA genes. Conclusions: E. faecalis with virulence genes and HLR to aminoglycosides were isolated from clinical and chicken samples in Antofagasta. More studies will be necessary to establish an association.

Antecedentes: Enterococcus spp. es una causa importante de infecciones nosocomiales, tanto en Chile como internacional. Se han descrito una serie de factores de virulencia en este microorganismo, que pueden, por ejemplo, aumentar su habilidad para colonizar. Enterococcus tiene capacidad de adquirir genes de resistencia, entre ellos la resistencia de alto nivel (RAN) a los antimicrobianos aminoglucósidos. Objetivo: Investigar la prevalencia de genes de virulencia en cepas de E. faecalis susceptibles y resistentes a aminoglucósidos. Material y Métodos: Un total de 80 cepas de E. faecalis aisladas de muestras clínicas (n: 52) y pollos (n: 28) se incluyeron en este estudio. La identificación se hizo por pruebas bioquímicas y se tipificaron por el sistema Phene-PlateMR. La susceptibilidad a diferentes antimicrobianos fue realizada por test de dilución en agar. Los genes de virulencia aceI, agg, gelE y efaA fueron investigados por RPC múltiple. Resultados: Todas las cepas de E. faecalis fueron susceptibles a vancomicina y ampicilina. Un 13,5% de las cepas clínicas presentaron resistencia de alto nivel a gentamicina y 9,6% a estreptomicina. La tipificación reveló una gran diversidad de fenotipos, pero se encontró un clon con 7 cepas de características similares. El gen efaA estaba presente en 100% de las cepas, gen aceI en 94,2 y 75%, gen agg 73,1 y 67,9% y gen gelE 57,5 y 28,6% de las cepas clínicas y de pollos, respectivamente. Seis cepas con resistencia de alto nivel a aminoglucósidos, que pertenecían a un mismo fenotipo exhibieron los genes efaA, aceI, agg y gelE juntos. Conclusiones: Cepas de E. faecalis que albergan genes de virulencia y con resistencia de alto nivel a aminoglucósidos fueron aisladas de muestras clínicas y de pollos en Antofagasta. Se requieren mayores estudios para establecer una asociación entre estos factores.

Perfil genético de Enteroccocus faecalis isolados de infecção endodôntica primária no Brasil comparados a isolados orais e não-orais do Reino Unido e do Japão / Genetic profile of Enterococcus Faecalis isolated from primary edndodontic infecyion in Brazil compared to isolates from oral and non-oral infection from United Kingdom and Japan

Enterococcus faecalis (E. faecalis), conhecidamente patógeno oportunista, tem sido frequentemente associado a infecções sistêmicas graves. É também encontrado na cavidade oral, com destaque em infecção endodôntica refratária. O objetivo deste estudo foi avaliar características moleculares de E. faecalis isolados de infecção endodôntica primária no Brasil e comparar com isolados orais e não orais de pacientes do Reino Unido e do Japão, assim como E. faecalis resistentes à vancomicina. O presente estudo também investigou o relacionamento entre E. faecalis de diferentes origens (oral e não oral) e de diferentes áreas geográficas para obter uma melhor compreensão do envolvimento dos diferentes reservatórios no surgimento e propagação de clones virulentos, aqueles que possuem genes que conferem infectividade e virulência, assim como resistência aos antibióticos. Para tal, foram estudados E. faecalis isolados em infecções endodônticas no Brasil (n = 20) e orais no Reino Unido (n = 10), e em infecções não orais no Japão (n = 9). Além disso, 20 E. faecalis isolados ambientais do Hospital Universitário de Gales (Cardiff, Reino Unido), classificados como Enterococcus resistentes à vancomicina (VRE) também foram examinados. A Concentração Inibitória Mínima (CIM) dos isolados do Brasil foi obtida pelo método de diluição em agar de acordo com as recomendações do Clinical and Laboratory Standards Institute (CLSI). Reação em cadeia da polimerase (inglês - PCR) foi a técnica empregada para detectar os genes de virulência e aqueles associados à resistência aos antibióticos, enquanto Reação de Amplificação Aleatória de DNA Polimórfico (inglês - RAPD-PCR) foi escolhida para a tipagem molecular. Dentre os genes de virulência examinados, o gene que codifica a gelatinase gelE foi o mais prevalente entre os isolados (77-100%). Entre isolados orais, foram detectados os genes agg de substâncias de agregação, esp de proteína de evasão imune, cylB de ...

Enterococcus faecalis is an opportunistic pathogen known to cause serious systemic infection. It is also encountered in the oral cavity and has been implicated in persistent root canal infection. The aim of this study was to evaluate a range of molecular characteristics of E. faecalis isolated from primary endondontic infections in Brazil and compare to isolates from oral and non-oral infections in patients from UK and Japan, as well as isolates of vancomycin resistant E. faecalis, VRE, from a hospital environment. The present study was undertaken to explore the relatedness of E. faecalis from different origins, oral and non oral, and from different geographic areas to gain a better understanding of the involvement of the different reservoirs in the emergence and spread of virulent clones, those that acquired a number of genes conferring infectivity and virulence and in addition antibiotic resistance. To do this, E. faecalis from oral infections in Brazilian (n=20) and UK patients (n=10), and non-oral infection in japanese patients (n=9) were studied. In addition, 20 environmental VRE isolates from the University Hospital of Wales (Cardiff, UK) were also examined. For braziliam isolates, antimicrobial susceptibility was ascertained by agar dilution, using the recommendations of the Clinical and Laboratory Standards Institute (CLSI). For all isolates, PCR with validated primers was used to detect genes associated with antibiotic resistance and virulence, whilst RAPD-PCR was used to fingerprint isolates. Of the virulence genes examined, gelatinase gene gelE was most prevalent amongst isolates (77-100%). In the case of oral isolates, the genes of aggregation substances agg, immune evasion protein esp, cytolysin cylB, tetracycline resistance tetM and tetL and erythromycin resistance ermB were detected with varying prevalence. Japanese hospital isolates had a similar genetic profile to oral isolates but with higher prevalence of ...

Perfil genético de Enteroccocus faecalis isolados de infecção endodôntica primária no Brasil comparados a isolados orais e não-orais do Reino Unido e do Japão / Genetic profile of Enterococcus Faecalis isolated from primary edndodontic infecyion in Brazil compared to isolates from oral and non-oral infection from United Kingdom and Japan

Enterococcus faecalis (E. faecalis), conhecidamente patógeno oportunista, tem sido frequentemente associado a infecções sistêmicas graves. É também encontrado na cavidade oral, com destaque em infecção endodôntica refratária. O objetivo deste estudo foi avaliar características moleculares de E. faecalis isolados de infecção endodôntica primária no Brasil e comparar com isolados orais e não orais de pacientes do Reino Unido e do Japão, assim como E. faecalis resistentes à vancomicina. O presente estudo também investigou o relacionamento entre E. faecalis de diferentes origens (oral e não oral) e de diferentes áreas geográficas para obter uma melhor compreensão do envolvimento dos diferentes reservatórios no surgimento e propagação de clones virulentos, aqueles que possuem genes que conferem infectividade e virulência, assim como resistência aos antibióticos. Para tal, foram estudados E. faecalis isolados em infecções endodônticas no Brasil (n = 20) e orais no Reino Unido (n = 10), e em infecções não orais no Japão (n = 9). Além disso, 20 E. faecalis isolados ambientais do Hospital Universitário de Gales (Cardiff, Reino Unido), classificados como Enterococcus resistentes à vancomicina (VRE) também foram examinados. A Concentração Inibitória Mínima (CIM) dos isolados do Brasil foi obtida pelo método de diluição em agar de acordo com as recomendações do Clinical and Laboratory Standards Institute (CLSI). Reação em cadeia da polimerase (inglês - PCR) foi a técnica empregada para detectar os genes de virulência e aqueles associados à resistência aos antibióticos, enquanto Reação de Amplificação Aleatória de DNA Polimórfico (inglês - RAPD-PCR) foi escolhida para a tipagem molecular. Dentre os genes de virulência examinados, o gene que codifica a gelatinase gelE foi o mais prevalente entre os isolados (77-100%). Entre isolados orais, foram detectados os genes agg de substâncias de agregação, esp de proteína de evasão imune, cylB de...

Enterococcus faecalis is an opportunistic pathogen known to cause serious systemic infection. It is also encountered in the oral cavity and has been implicated in persistent root canal infection. The aim of this study was to evaluate a range of molecular characteristics of E. faecalis isolated from primary endondontic infections in Brazil and compare to isolates from oral and non-oral infections in patients from UK and Japan, as well as isolates of vancomycin resistant E. faecalis, VRE, from a hospital environment. The present study was undertaken to explore the relatedness of E. faecalis from different origins, oral and non oral, and from different geographic areas to gain a better understanding of the involvement of the different reservoirs in the emergence and spread of virulent clones, those that acquired a number of genes conferring infectivity and virulence and in addition antibiotic resistance. To do this, E. faecalis from oral infections in Brazilian (n=20) and UK patients (n=10), and non-oral infection in japanese patients (n=9) were studied. In addition, 20 environmental VRE isolates from the University Hospital of Wales (Cardiff, UK) were also examined. For braziliam isolates, antimicrobial susceptibility was ascertained by agar dilution, using the recommendations of the Clinical and Laboratory Standards Institute (CLSI). For all isolates, PCR with validated primers was used to detect genes associated with antibiotic resistance and virulence, whilst RAPD-PCR was used to fingerprint isolates. Of the virulence genes examined, gelatinase gene gelE was most prevalent amongst isolates (77-100%). In the case of oral isolates, the genes of aggregation substances agg, immune evasion protein esp, cytolysin cylB, tetracycline resistance tetM and tetL and erythromycin resistance ermB were detected with varying prevalence. Japanese hospital isolates had a similar genetic profile to oral isolates but with higher prevalence of...

Emergence and characterisation of vanB vancomycin-resistant Enterococcus faecalis in Rio de Janeiro, Brazil

Here we describe the detection and characterisation of three isolates of vancomycin-resistant VanB-type Enterococcus faecalis. Sequence analysis suggested that these isolates harboured the vanB1 gene. The isolates were susceptible to the majority of antimicrobial agents tested, with the exception of chloramphenicol, erythromycin and vancomycin, and showed distinct profiles of high-level resistance to aminoglycosides. Analysis of the clonal relatedness of the vanB E. faecalis isolates showed similar pulsed-field gel electrophoresis profiles. To our knowledge, this is the first report of the occurrence of enterococcal strains carrying vanB genes in Brazil.

Genes de virulencia y bacteriocinas en cepas de Enterococcus faecalis aisladas desde diferentes muestras clínicas en la Región del Maule, Chile / Virulence genes and bacteriocins in Enterococcus faecalis strains isolated from different clinical samples in Maule Region, Chile

The presence of virulence genes (VG) and bacteriocins from different clinical samples was studied in Enterococcus faecalis isolated from urinary tract infections (UTI), bacteremia and endodontitis and was correlated with haemolysin and gelatinase activity. We evaluated the presence of VG by PCR in 150 strains of E. faecalis including cylA, aggA, efaA, eep, gelE, esp, as-48, bac31, entL50A/B, entA, entP, entB, enlA andentl071. Haemolysin and gelatinase activity was studied. gelE and cylA genes expressed hemolysin and gelatinase, respectively. This activity was observed in some strains of bacteremia, UTI and endodontitis. The highest number of VG was detected in bacteremic strains, being aggA and entA genes the most frequent. efaA, esp, entA, entL50A/B were associated with their clinical origin (p < 0.05). The most common genetic profile was aggA-eep-enlA-entL50A/B. E. faecalis from UTI, bacteremia and endodontitis presented different gene combinations. Some of the genes studied were related to their clinical origin. The results obtained in this study are similar to those reported in other countries.

Desde diferentes muestras clínicas se determinó la presencia de genes codificantes de factores de virulencia (FV) y bacteriocinas en Enterococcus faecalis aislados desde infecciones del tracto urinario (ITU), bacteriemias y endodontitis, correlacionándose con la actividad hemolisina y gelatinasa. En 150 cepas de E. faecalis fue evaluada mediante RPC la presencia de cylA, aggA, efaA, eep, gelE, esp, as-48, bac31, entL50A/B, entA, entP, entB, enlA, y ent1071 determinándose actividad hemolisina y gelatinasa. Los genes cylA y gelE expresaron hemolisina y gelatinasa, respectivamente. Esta actividad fue observada en algunas de las cepas causantes de bacteriemia, ITU y endodontitis. El mayor número de genes estudiados se detectó en cepas bacteriémicas. Los genes aggA y entA, fueron los más frecuentes. Los genes efaA, esp, entL50/AB y entA se asociaron a su origen clínico (p < 0,05). El perfil genético más recurrente fue aggA-eep-enlA-entL50A/B. Enterococcusfaecalis de ITU, bacteriemias y endodontitis presentaron distintas combinaciones génicas. AAlgunos de los genes estudiados se relacionaron con su origen clínico. Los resultados obtenidos son similares a los reportados en otros países.

Avaliação da comunidade microbiana, com ênfase para a espécie Enterococus faecalis, em dentes decíduos com necrose pulpar através de técnicas fenotípicas e moleculares / Evaluation of microbiota with emphasis on species of Enterococcus faecalis, in primary teeth root canals with pulp necrosis, using conventional and molecular microbiological techniques

Infecção endodôntica em dentes decíduos tem sido pouca avaliada, apesar da influência destes sobre a dentição permanente. No presente estudo foi avaliada a microbiota, com ênfase na espécie de Enterococcus faecalis, de canais radiculares de dentes decíduos com diagnóstico de necrose pulpar, utilizando-se técnicas microbiológicas convencionais e moleculares. Para tanto, um estudo do tipo seccional, clínico e laboratorial foi desenvolvido, sendo a coleta do material endodôntico realizada na clínica de Odontopediatria da Faculdade de Odontologia da UFRJ. Para o estudo, 244 crianças saudáveis foram examinadas no período de um ano, e destas, 43 se enquadravam nos critérios de inclusão. O material foi coletado do canal radicular utilizando-se cones estéreis de papel, dos quais dois foram inoculados em caldo seletivo-indicador Enterococcosel e os outros dois em TSB-DMSO sob congelamento a -20º C. A identificação de E. faecalis foi realizada a partir do cultivo inicial no caldo e subcultivo em agar sangue para observação de colônias bacterianas características. Testes bioquímicos e enzimáticos e a Reação em Cadeia da Polimerase (PCR) para o gene do rRNA 16S também foram utilizados para identificação da espécie. A técnica de Eletroforese em Gel com Gradiente Desnaturante (DGGE) foi utilizada para avaliação do perfil da comunidade microbiana presentes nos espécimes clínicos. Os resultados mostraram que dos 43 espécimes clínicos obtidos, 18 foram excluídos devido à contaminação no controle. Entre os 25 casos estudados, 10 foram positivos no caldo de enterococcosel, sendo cinco (20%) positivos para a espécie E. faecalis nos testes fenotípicos e na PCR. Outros cinco espécimes foram positivos no caldo, mas as amostras bacterianas não apresentaram bioquímica compatível com a espécie E. faecalis, e foram então submetidas ao seqüenciamento de um fragmento do gene do rRNA 16S. Foram identificados Lactobacillus plantarum (4 amostras) e Lactobacillus rhamnosus (1 amostra). Não houve relação dos dados clínicos com a presença de E. faecalis (p > 0,05). A técnica de DGGE mostrou uma comunidade polimicrobiana nos 25 espécimes analisados e, considerando-se o número de bandas no gel, um número ≥ 20 foi relacionado com pacientes com idade ≤ 4 anos e  20 bandas com pacientes com mais de 4 anos de idade (p  0,05). Relação significativa também foi observada entre idade  4 anos e cárie em dente posterior, assim como entre idade  4 anos e cárie em dente anterior. Trauma como causa de infecção endodôntica foi significativa entre crianças com 4 anos de idade. Os resultados demostram a presença de E. faecalis em infecções endodônticas com necrose pulpar em dentição decídua, confirmando sua presença na cavidade oral destes pacientes. Adicionalmente, a técnica de DGGE mostrou uma comunidade polimicrobiana, indicando associação entre idade do paciente e doença cárie.

Endodontic infections in primary teeth have been poorly evaluated despite their influence on permanent dentition. In the present study we assessed the microbiota, with emphasis on species of Enterococcus faecalis, in primary teeth root canals with pulp necrosis, using conventional and molecular microbiological techniques. Thus, a cross-sectional study of clinical and laboratory data was developed. The material was collected at the endodontic clinic of Pediatric Dentistry, Faculty of Dentistry, UFRJ. For the study, 244 healthy children were examined during one year, and of these, 43 met the inclusion criteria. Material was collected from root canals using sterile paper cones. Four paper cones were used for each canal: two were inoculated in the selective broth indicator Enterococcosel and anothers two placed in TSB-DMSO and frozen at -20 ° C until required. Identification of E. faecalis was initially made using culture in broth and subculture on blood agar for observational characteristics of bacterial colonies. Biochemical and enzymatic analysis as well as Polymerase Chain Reaction (PCR) for the 16S rRNA gene were also used for species identification. The Gradient Gel Electrophoresis Agents denaturants (DGGE) technique was used to assess the profile of the microbial communities present in the clinical specimens. Eighteen (18) of the 43 clinical specimens obtained were excluded due to contamination. Among the 25 cases studied, 10 were positive for the species E. faecalis in Enterococcosel broth, five (20%) were positive in the phenotypic tests and PCR. Another five specimens were positive in the broth medium, but the bacterial samples showed no biochemical species compatible with E. faecalis, and so were subjected to sequencing of a fragment of the 16S rRNA gene. Lactobacillus plantarum were identified (4 samples) and Lactobacillus rhamnosus (1 sample). There was no statistically significant correlation of clinical data with the presence of E. faecalis (p> 0.05). The DGGE analysis showed a community polymicrobial. About 20 bands or more were associated with patients ≤ 4 years old and that lesser 20 bands were associated with patients over 4 years old (p  0,05). A significant relationship was also found between patients > 4 years old and caries in posterior teeth, as well as between patients  4 years and anterior tooth caries. Trauma as the cause of endodontic infection was significant among children  4 years old. The results show the presence of E. faecalis in endodontic infections with pulp necrosis in the primary dentition, confirming its presence in the oral cavity of patients. Additionally, DGGE showed a polymicrobial community in 25 samples obtained, suggesting an association between patient age and tooth decay.

Susceptibilidad antimicrobiana y bases genéticas de la resistencia de cepas de Enterococcus causantes de infecciones en Cuba / Antimicrobial susceptibility and genetic bases for resistance of infectioncausingEnterococcus strains in Cuba

Objective. To identify infection-causing Enterococcus species in Cuban hospitalsand determine their susceptibility to antimicrobial drugs, as well as their resistance mechanisms. Methods. A total of 687 Enterococcus isolates from 30 Cuban hospitals in nine provinces of the country were studied over the period 2000–2009. The species were identified using both the conventional method and the automatic API® system.The minimum inhibitory concentration was determined for 13 antimicrobial drugs following the standards recommended by the Clinical Laboratory and Standards Institute. The polymerase chain reaction technique was used to characterize the genes that were resistant to aminoglycosides, erythromycin, tetracycline, andglucopeptides. The presence of beta-lactamase was determined by the chromogenic cephalosporin test. Results. The most prevalent species were Enterococcus faecalis (82.9%) and E. faecium (12.2%). Resistance to glucopeptides (1.0%) was mediated by the vanA and vanB genes. The strains resistant to ampicillin (6%) did not produce beta-lactamases. A high percentage of resistance to aminoglycosides was observed. Gentamicin (31.0%) and streptomycin and amikacin (29.1%) were mediated by the aac(6’)Ie-aph(2”)Ia, aph(3’)-IIIa, ant(6)Ia, and ant(3”)(9) genes. A correlation was found between resistance to tetracycline (56.0%) and presence of the tet(M) (75.1%) and tet(L) genes (7.0%), while resistance to erythromycin (34.1%) was due to the erm(B) gene (70.9%). Conclusions. Resistance to vancomycin is infrequent in Cuba, as opposed to a high level of resistance to aminoglycosides, which may be indicative of treatment failures. The microbiology laboratory is a cornerstone of Enterococcus infectionsurveillance, along with ongoing monitoring of the susceptibility of these infections to antimicrobial drugs at a time when resistance of this microorganism is on the rise.

Objetivo. Identificar las especies de Enterococcus causantes de infecciones en hospitales cubanos, su susceptibilidad a los antimicrobianos y sus mecanismos de resistencia.Métodos. Se estudiaron 687 aislamientos de Enterococcus procedentes de 30 hospitalescubanos de nueve provincias del país durante el período de 2000 a 2009. La identificación de las especies se realizó mediante el método convencional y sistema automatizado API®. Laconcentración inhibitoria mínima se determinó para 13 antimicrobianos según las recomendaciones del Instituto de Estándares Clínicos y de Laboratorio. Se determinaron los genes de resistencia a aminoglucósidos, eritromicina, tetraciclina y glucopéptidos mediante reacciónen cadena de la polimerasa. La presencia de betalactamasa se determinó por el método de lacefalosporina cromógena. Resultados. Las especies más prevalentes fueron Enterococcus faecalis (82,9%) y Enterococcus faecium (12,2%). La resistencia a los glucopéptidos (1,0%) estuvo mediada por los genes vanA y vanB y las cepas resistentes a ampicilina (6%) no produjeron betalactamasas. Se observó un alto porcentaje de resistencia a los aminoglucósidos: gentamicina (31,0%) y estreptomicina y amikacina (29,1%) mediada por los genes aac(6’)Ie-aph(2”)Ia, aph(3’)-IIIa, ant(6)Ia, ant(3”)(9). Hubo correlación entre la resistencia a tetraciclina (56,0%) y la presencia de los genes tet(M) (75,1%) y tet(L) (7,0%), mientras que la resistencia a eritromicina (34,1%) obedeció al gen erm(B) (70,9%).Conclusiones. La resistencia a vancomicina es infrecuente en Cuba, a diferencia del alto nivel de resistencia a los aminoglucósidos, que sugiere posibles fracasos terapéuticos. El laboratorio de microbiología constituye un pilar fundamental de la vigilancia de las infecciones por cepas de Enterococcus y el monitoreo continuo de su susceptibilidad a los antimicrobianos,dado el incremento de la resistencia de ese microorganismo en el tiempo.

Antibacterial & antiplasmid activities of Helicteres isora L.

Background & objectives: The multiple drug resistance (MDR) is a serious health problem and major challenge to the global drug discovery programmes. Most of the genetic determinants that confer resistance to antibiotics are located on R-plasmids in bacteria. The present investigation was undertaken to investigate the ability of organic extract of the fruits of Helicteres isora to cure R-plasmids from certain clinical isolates. Methods: Active fractions demonstrating antibacterial and antiplasmid activities were isolated from the acetone extracts of shade dried fruits of H. isora by bioassay guided fractionation. Minimal inhibitory concentration (MIC) of antibiotics and organic extracts was determined by agar dilution method. Plasmid curing activity of organic fractions was determined by evaluating the ability of bacterial colonies (pre treated with organic fraction for 18 h) to grow in the presence of antibiotics. The physical loss of plasmid DNA in the cured derivatives was further confirmed by agarose gel electrophoresis. Results: The active fraction did not inhibit the growth of either the clinical isolates or the strains harbouring reference plasmids even at a concentration of 400 μg/ml. However, the same fraction could cure plasmids from Enterococcus faecalis, Escherichia coli, Bacillus cereus and E. coli (RP4) at curing efficiencies of 14, 26, 22 and 2 per cent respectively. The active fraction mediated plasmid curing resulted in the subsequent loss of antibiotic resistance encoded in the plasmids as revealed by antibiotic resistance profile of cured strains. The physical loss of plasmid was also confirmed by agarose gel electrophoresis. Interpretation & conclusions: The active fraction of acetone extract of H. isora fruits cured R-plasmids from Gram-positive and Gram-negative clinical isolates as well as reference strains. Such plasmid loss reversed the multiple antibiotic resistance in cured derivatives making them sensitive to low concentrations of antibiotics. Acetone fractions of H. isora may be a source to develop antiplasmid agents of natural origin to contain the development and spread of plasmid borne multiple antibiotic resistance.

First report of vancomycin-resistant Enterococcus faecalis in Uberaba, Minas Gerais state

In this study we report the first isolation of VanA-type vancomycin-resistant Enterococcus faecalis strains from two different patients hospitalized in the same intensive care unit at the hospital of Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.

Detection of Vancomycin-resistant Enterococci using Multiplex Real-time PCR Assay and Melting Curve Analysis / 대한진단검사의학회지

BACKGROUND: We developed and evaluated the utility of a multiplex real-time PCR assay that uses melting curve analysis and allows simultaneous identification of vancomycin-resistant genotypes and clinically relevant enterococci. METHODS: The specificity of the assay was tested using 4 reference strains of vancomycin-resistant enterococci (VRE) and 2 reference strains of vancomycin-susceptible enterococci. Ninety-three clinical isolates of enterococci with different glycopeptide-resistant phenotypes were genotyped and identified using a multiplex real-time PCR assay and melting curve analysis. RESULTS: Representative melting curves were obtained for Enterococcus faecium, Enterococcus faecalis, vanA-containing E. faecium, vanB-containing E. faecalis, Enterococcus gallinarum, and Enterococcus casseliflavus. Phenotypic and genotypic analysis of the isolates revealed same results for 82 enterococcal isolates, while in 4 isolates, the glycopeptide-resistant phenotypes were inconsistent with the glycopeptide-resistant genotypes and in the 4 other isolates, species could not be accurately identified. Three isolates with mixed strains, which were detected by the PCR assay, could not be correctly identified using phenotypic methods. CONCLUSIONS: VRE genotyping and identification of clinically relevant enterococci were rapidly and correctly performed using multiplex real-time PCR assay and melting curve analysis.