4 vana, vanb, vanc1, vanc2

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1 77 1) 2) 2) 3) 4) 5) 1) 2) 3) 4) 5) Enterococcus 5 Enterococcus faecalis 1 Enterococcus avium 1 Enterococcus faecium 2 5 PCR E. faecium 1 E-test MIC 256 mg/ml vana MRSA MRSA vana VRE 4 4 vana, vanb, vanc1, vanc2 VRE Key words: VRE Enterococcus ( ) TEL: FAX: yamaoka@u-gitu-ms.ac.jp (VRE) 3 Enterococcus vana, vanb, vanc1, vanc2 vana Vol. 15 No

2 78 1) Enterococcus ) Enterococcus Enterococcus (BD) 378 Vitec II 194 MIC (VCM) S MIC 4 mg/ml I MIC 8 16 mg/ml R MIC 32 mg/ml E-test 3) 3 I R PCR VCM ,000 rpm 10 DNA PCR 1 vana, vanb, vanc1, vanc PCR 1), 2) 1) Enterococcus 1,138 Enterococcus faecalis 790 Enterococcus faecium 200 Enterococcus avium E. faecalis E. faecium E. avium VRE PCR 1 vana 732 bp A1 5 -GGGAAAACGACAATTGC-3 A2 5 -GTACAATGCGGCCGTTA-3 vanb 635 bp B1 5 -ATGGGAAGCCGATAGTC-3 B2 5 -GATTTCGTTCCTCGACC-3 vanc1 822 bp C1 5 -GGTATVAAGGAAACCTA-3 C2 5 -CTTCCGCCATCATAFCT-3 vanc2 439 bp C3 5 -CTCCTACGATTCTCTTG-3 C4 5 -CGAGCAAGACCTTTAAG-3 2 Enterococcus E. faecalis E. faecium E. avium Vol. 15 No

3 79 2) 3 E. faecalis 1 GP1 E. faecalis 1 GP2 MIC 32 mg/ml VCM E. avium1 GP3 MIC 8 16 mg/ml VCM E. faecium1 GU1 MIC 8 16 mg/ml VCM 1 MIC 32 mg/m VCM GU2 3) 5 PCR E. faecium GU2 E-test MIC 256 mg/ ml vana 1 52 MRSA MRSA vana VRE 2 2 VRE 4 GP1, 2, 3 GU1 1 PCR vana M Lane 1: Lane 2: GU2 VRE Lane 3: GU1 Lane 4: GP1 Lane 5: GP2 3 E. faecalis (n 275) E. faecium (n 29 E. avium (n 28) GP1, GP3 E. faecalis (n 151) E. faecium (n 25 E. avium (n 9) E. faecalis (n 364) E. faecium (n 146 E. avium (n 64) GU1 GP1, 2, 3 GU1 S MIC 4 mg/ml GU2 MIC : 256 mg/ml E-test 1 GU2 64 S MIC 4 mg/ml I MIC 8 16 mg/ml R MIC 32 mg/ml Vol. 15 No

4 80 vana, vanb, vanc1, vanc2 (VRE) 1988 vana E. faecium 3) 4) 5 7 5) 6) VRE VRE vana VRE vanb VRE R I 5 1 vana VRE 4 VRE 7) NCCLS 6 mg/ml 24 Weissella confusa, Pediococcus acidilactici 8) VRE VRE E-test 7), 9) VRE vana, vanb 10) VRE VRE VRE 2 VRE 1) Duka-Malen, S., S. Evers, P. Courvalin Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevent enterococci by PCR. J. Clin. Microbiol. 33: ) 1999 (VRE) 26: ) Leclercq, R., E. Derlot, J. Duval, P. Courvalin Plasmid mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N. Eng. J. Med. 319: ) 1997 (vana) (E. faecium) ) 2000 VRE Vancomycin Resistant Enterococci: IDWR 20: ) 2003 RAISUS JARMAM 14: ) 2004 VRE VanA VanB 31: Vol. 15 No

5 81 8) 2003 Weissella confusa Pediococcus acidilactici ) Farrag, N., I. Eltringham, H. Liddy Vancomycin-dependent Enterococcus faecalis, Lancet 348: ) 2001 Enterococcus (VRE) 45 75: Incidence of Vancomycin-resistant Enterococcus (VRE) in Gifu Prefecture: Evalution of the Validity of Fully Automated Microbiology Systems Kazukiyo Yamaoka 1),Ikuyo Iwata 2),Kiyoyasu Okuda 2),Youko Matukawa 3), Haruki Sawamura 4),Kazue Ueno 5) 1) Gifu College of Medical Technology 2) Clinical Laboratory of Gifu Prefectural Gifu Hospital 3) Clinical Laboratory of Gifu Prefectural Tajimi Hospital 4) Clinical Laboratory of Gifu University General Hospital 5) Professor emeritus of Gifu University Five strains of enterococci with reduced susceptibility to Vancomycin (VCM) were isolated from three hospitals in Gifu Prefecture between January 2003 and July These five strains were retested in identification and susceptibility with the same fully automated microbiology systems, with PCR detection of VRE genes. Identification of all strains produced the same results, however, susceptibility of four strains showed VCM-susceptible. Only one strain showed VCM-resistance with MIC of 256 mg/ml or over in gradient di#usion test (E-test), carrying a vana gene. The patient who had VRE was 52-year-old man with long-term use of VCM for the treatment of MRSA septicemia and MRSA pneumonia. VRE were isolated from stool sample for screening culture. When VRE is detected using fully automated microbiology system, identification and susceptibility shoud be rested before final reporting. Screening culture may be recommended in patients with long-term use of VCM to prevent the spread of VRE in the hospital. Vol. 15 No

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