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Indian Journal of Medical Microbiology
Medknow Publications on behalf of Indian Association of Medical Microbiology
ISSN: 0255-0857 EISSN: 1998-3646
Vol. 29, Num. 1, 2011, pp. 71-72

Indian Journal of Medical Microbiology, Vol. 29, No. 1, January-March, 2011, pp. 71-72


Vancomycin-dependent Enterococcus

Department of Microbiology, Leicester Royal Infirmary, LE1 5WW, United Kingdom

Correspondence Address: R A Swann, Department of Microbiology, Leicester Royal Infirmary, LE1 5WW, United Kingdom,

Date of Submission: 24-Sep-2009
Date of Acceptance: 01-Oct-2010

Code Number: mb11018

PMID: 21304202

DOI: 10.4103/0255-0857.76531

Dear Editor,

We report two cases of vancomycin-dependent Enterococcus faecium (VDE) bacteraemia [Figure - 1] a. and b. The first case was a 76-year-old, insulin-dependent diabetic man whose coronary artery bypass grafting was complicated by small bowel infarction and renal failure. Methicillin-resistant Staphylococcus aureus and Enterococcus sp. were cultured from urine and an abdominal drain site, respectively. He had received prolonged (18 days) treatment with intravenous vancomycin along with other agents (piperacillin-tazobactam, followed by ciprofloxacin, metronidazole, fluconazole) at the time VDE bacteraemia was detected.

The second case was a 39-year-old man who developed acute respiratory distress syndrome, renal failure and lung abscess, following diesel aspiration. He received extracorporeal membrane oxygenation (ECMO) for 29 days and ventilation for 40 days and was treated with ciprofloxacin and imipenem. Vancomycin-resistant Enterococcus sp. was isolated from a left groin cannula and left internal jugular central line site. VDE was subsequently detected from blood culture. Management in both cases consisted of withdrawal of vancomycin therapy and nursing of patients in isolation side rooms.

VDE arises following therapy with vancomycin. These strains have previously been isolated from stool, urine and blood cultures in seriously ill (burns, peritonitis, pancreatitis) or immunocompromised (transplantation) patients. [1],[2] Nosocomial infection and outbreaks have been reported in bone marrow transplant units and such strains may be typed using pulsed field gel electrophoresis. [2],[3] DNA sequencing has detected DDL gene mutation (e.g. P175L) or deletion (e.g. 1 bp deletion of d-Ala:d-Ala ligase gene or 18 bp deletion of VanSB gene) among VDE strains. [2],[3],[4] The growth of these fastidious organisms can be supported by vancomycin, ristocetin, DADA (d-Ala:d-Ala), but not necessarily by teicoplanin. [5] Spontaneous revertants away from vancomycin dependence can occur at a frequency of 1 in 10 6 . [4] Awareness of the existence of these strains is important, especially in the context of long-term vancomycin therapy and suspected presence of "nutritionally deficient" organisms.


1.Bert F, Leflon-Guibout V, Le Grand J, Bourdon N, Nicolas-Chanoine MH. Emergence of vancomycin-dependent enterococci following glycopeptide therapy: case report and review. Pathol Biol (Paris) 2009;57:56-60.   Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Kirkpatrick BD, Harrington SM, Smith D, Marcellus D, Miller C, Dick J, et al. An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit. Clin Infect Dis 1999;29:1268-73.   Back to cited text no. 2    
3.San Millan A, Depardieu F, Godreuil S, Courvalin P. VanB-type Enterococcus faecium clinical isolate successively inducibly resistant to, dependent on, and constitutively resistant to vancomycin. Antimicrob Agents Chemother 2009;53:1974-82.  Back to cited text no. 3    
4.Van Bambeke F, Chauvel M, Reynolds PE, Fraimow HS, Courvalin P. Vancomycin-dependent Enterococcus faecalis clinical isolates and revertant mutants. Antimicrob Agents Chemother 1999;43:41-7.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Dever LL, Smith SM, Handwerger S, Eng RH. Vancomycin-dependent Enterococcus faecium isolated from stool following oral vancomycin therapy. J Clin Microbiol 1995;33:2770-3.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

Copyright 2011 - Indian Journal of Medical Microbiology

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