Glycopeptide resistance in Enterococcus spp. and coagulase-negative staphylococci from hospitalised patients in Germany: occurrence, characteristics and dalbavancin susceptibility

• Published in: Journal of global antimicrobial resistance. Vol. 28; pp. 102 - 107
• Main Authors: Kresken, Michael, Klare, Ingo, Wichelhaus, Thomas A., Wohlfarth, Esther, Layer-Nicolaou, Franziska, Neumann, Bernd, Werner, Guido
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2022; Elsevier
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Coagulase; Dalbavancin; Enterococcus; Glycopeptides - pharmacology; Humans; Lipoglycopeptide; Microbial Sensitivity Tests; Staphylococcus; Teicoplanin; Teicoplanin - analogs & derivatives; Teicoplanin - pharmacology; vanA; vanB; Vancomycin; Vancomycin - pharmacology; Lipoglycopeptide; vanB; vanA; Vancomycin; Dalbavancin; Teicoplanin
• ISSN: 2213-7165; 2213-7173
• DOI: 10.1016/j.jgar.2021.12.016

•Glycopeptide resistance remains low in Enterococcus faecalis in Germany but achieved 26% in E. faecium.•More than 70% of glycopeptide-resistant E. faecium were VanB type (vancomycin-resistant but teicoplanin-susceptible).•Level of glycopeptide resistance in E. faecium was significantly lower in isolates from patients in ICUs vs. regular wards.•10.6% of CoNS were teicoplanin-resistant, with resistance only detected in S. epidermidis, S. haemolyticus and S. hominis.•Dalbavancin at ≤0.25 mg/L inhibited all VanB-type isolates and 96% of teicoplanin-resistant CoNS. The aim of this study was to evaluate the occurrence of glycopeptide resistance in enterococci and coagulase-negative staphylococci (CoNS) and to determine the susceptibilities of the identified glycopeptide-resistant isolates to dalbavancin. Twenty-two medical laboratories participated in the study conducted in 2016/17 by the Paul-Ehrlich-Society for Chemotherapy. Each laboratory was asked to collect 30 Enterococcus spp. (limited to Enterococcus faecalis and Enterococcus faecium) and 30 CoNS isolates consecutively from hospitalised patients with a proven or suspected infection. A total of 1285 isolates were collected, comprising 364 E. faecalis, 291 E. faecium and 630 CoNS. No E. faecalis isolates (0%) but 76 E. faecium isolates (26.1%) were vancomycin-resistant, of which 21 showed the VanA type and 55 the VanB type. The proportion of vancomycin-resistant strains among E. faecium isolates from patients in intensive care units (21.6%) was significantly lower than that from patients on regular wards (30.5%). Among the CoNS, 67 isolates (10.6%) were teicoplanin-resistant but none were vancomycin-resistant, with resistance only detected in Staphylococcus epidermidis (12.2%), Staphylococcus haemolyticus (17.9%) and Staphylococcus hominis (13.2%). Dalbavancin at ≤0.25 mg/L inhibited all VanB-type enterococci and 95.5% of teicoplanin-resistant CoNS. The level of glycopeptide resistance in E. faecalis remains very low in Germany but achieved 26% in E. faecium and was >10% in CoNS. Dalbavancin appears to be a feasible option for treating infections caused by VanB-type vancomycin-resistant E. faecium and teicoplanin-resistant CoNS.