Analysis of clonality and antibiotic resistance among early clinical isolates of Enterococcus faecium in the United States.

BACKGROUND: The Enterococcus faecium genogroup, referred to as clonal complex 17 (CC17), seems to possess multiple determinants that increase its ability to survive and cause disease in nosocomial environments. METHODS: Using 53 clinical and geographically diverse US E. faecium isolates dating from 1971 to 1994, we determined the multilocus sequence type; the presence of 16 putative virulence genes (hyl(Efm), esp(Efm), and fms genes); resistance to ampicillin (AMP) and vancomycin (VAN); and high-level resistance to gentamicin and streptomycin. RESULTS: Overall, 16 different sequence types (STs), mostly CC17 isolates, were identified in 9 different regions of the United States. The earliest CC17 isolates were part of an outbreak that occurred in 1982 in Richmond, Virginia. The characteristics of CC17 isolates included increases in resistance to AMP, the presence of hyl(Efm) and esp(Efm), emergence of resistance to VAN, and the presence of at least 13 of 14 fms genes. Eight of 41 of the early isolates with resistance to AMP, however, were not in CC17. CONCLUSIONS: Although not all early US AMP isolates were clonally related, E. faecium CC17 isolates have been circulating in the United States since at least 1982 and appear to have progressively acquired additional virulence and antibiotic resistance determinants, perhaps explaining the recent success of this species in the hospital environment.

The eight hours day for wage earning women: United States Supreme Court upholds the California law : List of eight hours laws

National Consumers' League.

Academic growth of high school age Hispanic students in the United States /

"CS 87-359c."

Impact of commuter aliens along the Mexican and Canadian borders : hearings.

Hearings held in various cities Jan. 26-Mar. 8, 1968.

Foreign agricultural trade of the United States.

Mode of access: Internet.

Improving math and science assessment : report on the Secretary's third conference on mathematics and science education /

"PIP 94-1201"--P. [4] of cover.

The National Institute on Alcohol Abuse and Alcoholism.

Mode of access: Internet.

Ethical guidelines for the delivery of health services by DHEW : report and recommendations /

Includes bibliographical references

The National Labor Relations Board and its work /

Caption title.

Tables of organization and equipment, United States Army, 1918.

Mode of access: Internet.

Intergovernmental regulation of telecommunications : a Commission report.

"A-115."

State laws governing local government structure and administration.

"M-186."

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"October 1993."

Preventing drug use among children and adolescents : a research-based guide /

"Printed March, 1997"--P. 4 of cover.

Classification outline for decisions of the National Labor Relations Board and related court decisions.

The outline, together with the Classified index of National Labor Relations Board decisions and related court decisions, comprises a legal research system for Board and court decisions.