First vancomycin-resistant blood isolate of Enterococcus faecium in a children's hospital and molecular analysis of the mechanism of resistance.

The first clinical isolate of vancomycin-resistant Enterococcus spp. in Hacettepe University Children's Hospital was isolated from a blood culture of a patient hospitalized in the intensive care unit. He had been on vancomycin therapy for the last four months for consecutive pneumoniae and sepsis. The isolate was identified as Enterococcus faecium (E. faecium) and minimal inhibitor concentration (MIC) values were determined as >256 microg/ml and 256 microg/ml for vancomycin and teicoplanin, respectively, with E-test. The isolate was shown to carry the vanA gene with polymerase chain reaction (PCR). Twelve colonizing strains were isolated from the surveillance cultures during the same period and identified as E. faecium, and were also shown to carry the vanA gene. However, arbitrarily-primed-PCR and pulsed-field gel electrophoresis results could not confirm the source of the resistant strain nor did they suggest a clonal spread in the hospital.