77 1) 2) 2) 3) 4) 5) 1) 2) 3) 4) 5) 16 12 7 17 4 8 2003 1 2004 7 3 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 ( 501 3892) 795 1 TEL: 0575 22 9401 FAX: 0575 23 0884 E-mail: yamaoka@u-gitu-ms.ac.jp (VRE) 3 Enterococcus vana, vanb, vanc1, vanc2 vana Vol. 15 No. 2 2005. 15
78 1) Enterococcus 2003 1 2004 7 2) Enterococcus 2003 1 12 Enterococcus (BD) 378 Vitec II 194 MIC2000 580 3 (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 100 10 12,000 rpm 10 DNA PCR 1 vana, vanb, vanc1, vanc2 94 2 94 1 54 1 72 1 30 72 10 PCR 1), 2) 1) 2 2003 1 2004 7 3 Enterococcus 1,138 Enterococcus faecalis 790 Enterococcus faecium 200 Enterococcus avium 101 3 E. faecalis E. faecium E. avium 2 239 111 80 61 1 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 2003. 1 2004. 7 E. faecalis 188 71 7 77 51 15 17 426 E. faecium 24 7 10 2 6 5 54 E. avium 11 5 12 5 1 3 37 16 2 3 12 3 1 12 49 239 80 15 111 61 23 37 566 16 Vol. 15 No. 2 2005.
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) 2003. 1 2004. 7 273 2 GP1, 2 29 27 1 GP3 E. faecalis (n 151) E. faecium (n 25 E. avium (n 9) 2003. 1 2004. 7 151 25 9 E. faecalis (n 364) E. faecium (n 146 E. avium (n 64) 2003. 1 12 364 144 1 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. 2 2005. 17
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. 1995. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevent enterococci by PCR. J. Clin. Microbiol. 33: 24 27. 2) 1999 (VRE) 26: 111 120 3) Leclercq, R., E. Derlot, J. Duval, P. Courvalin. 1988. Plasmid mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N. Eng. J. Med. 319: 157 161. 4) 1997 (vana) (E. faecium) 52 174 5) 2000 VRE Vancomycin Resistant Enterococci: IDWR 20: 8 10 6) 2003 RAISUS JARMAM 14: 151 158 7) 2004 VRE VanA VanB 31: 437 444. 18 Vol. 15 No. 2 2005.
81 8) 2003 Weissella confusa Pediococcus acidilactici 13 192. 9) Farrag, N., I. Eltringham, H. Liddy. 1996. Vancomycin-dependent Enterococcus faecalis, Lancet 348: 1581 1582. 10) 2001 Enterococcus (VRE) 45 75: 541 550. 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 2004. 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. 2 2005. 19