Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022

Vancomycin-variable enterococci (VVE), though genetically containing <i>van</i> genes, are phenotypically sensitive to vancomycin. If VVE is undetected or does not grow on the vancomycin-resistant enterococci (VRE) selection medium, or both, it can acquire resistance upon exposure to van...

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Main Authors: Sung Young Lee, Ji-Hyun Nam, Jung Wook Kim, Soo Hyun Kim, Jung Sik Yoo
Format: Article
Language:English
Published: MDPI AG 2024-12-01
Series:Antibiotics
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Online Access:https://www.mdpi.com/2079-6382/13/12/1210
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author Sung Young Lee
Ji-Hyun Nam
Jung Wook Kim
Soo Hyun Kim
Jung Sik Yoo
author_facet Sung Young Lee
Ji-Hyun Nam
Jung Wook Kim
Soo Hyun Kim
Jung Sik Yoo
author_sort Sung Young Lee
collection DOAJ
description Vancomycin-variable enterococci (VVE), though genetically containing <i>van</i> genes, are phenotypically sensitive to vancomycin. If VVE is undetected or does not grow on the vancomycin-resistant enterococci (VRE) selection medium, or both, it can acquire resistance upon exposure to vancomycin. This characteristic is clinically important for the treatment and prevention of VRE. This study aims to analyze the prevalence and characteristics of VVE in Korea through the Global Antibiotic Resistance Surveillance System (Kor-GLASS) and emphasize the importance of VVE. A total of 3342 enterococcal bloodstream isolates were collected through the Kor-GLASS between 2017 and 2022. Antibiotic susceptibility testing, <i>van</i> gene detection, and multilocus sequence typing were conducted with all the isolates. The trends in the domestic prevalence of VVE were analyzed and compared with global prevalence data. Among the isolates, 197 (5.9%), including 124 <i>Enterococcus faecium</i> and 73 <i>E. faecalis</i>, were identified as VVE. While the VRE incidence has declined in Korea since 2020, the VVE incidence is significantly rising. In Korea, only the <i>vanA</i> gene has been detected in both VRE and VVE, and no other <i>van</i> gene variants have been identified. Most of these isolates belong to CC17 (91.3%), with ST17, ST817, and ST80 as the predominant types. We have shown that continuous surveillance is essential in Korea due to the persistently high prevalence of VRE and the potential evolution of VVE into VRE. Consequently, it is critical to evaluate <i>Enterococcus</i> species isolated from domestic clinical settings for their phenotypic vancomycin resistance and the molecular detection of <i>van</i> genes, irrespective of the strain.
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spelling doaj-art-dbb2a12d6d9e401d83e6fb28f3f373d32025-08-20T02:00:59ZengMDPI AGAntibiotics2079-63822024-12-011312121010.3390/antibiotics13121210Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022Sung Young Lee0Ji-Hyun Nam1Jung Wook Kim2Soo Hyun Kim3Jung Sik Yoo4Division of Antimicrobial Resistance Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju-si 28159, Republic of KoreaDivision of Antimicrobial Resistance Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju-si 28159, Republic of KoreaDivision of Zoonotic and Vector-Borne Disease Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju-si 28159, Republic of KoreaDepartment of Laboratory Medicine, Chonnam National University Medical School, Gwangju-si 61469, Republic of KoreaDivision of Antimicrobial Resistance Research, National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju-si 28159, Republic of KoreaVancomycin-variable enterococci (VVE), though genetically containing <i>van</i> genes, are phenotypically sensitive to vancomycin. If VVE is undetected or does not grow on the vancomycin-resistant enterococci (VRE) selection medium, or both, it can acquire resistance upon exposure to vancomycin. This characteristic is clinically important for the treatment and prevention of VRE. This study aims to analyze the prevalence and characteristics of VVE in Korea through the Global Antibiotic Resistance Surveillance System (Kor-GLASS) and emphasize the importance of VVE. A total of 3342 enterococcal bloodstream isolates were collected through the Kor-GLASS between 2017 and 2022. Antibiotic susceptibility testing, <i>van</i> gene detection, and multilocus sequence typing were conducted with all the isolates. The trends in the domestic prevalence of VVE were analyzed and compared with global prevalence data. Among the isolates, 197 (5.9%), including 124 <i>Enterococcus faecium</i> and 73 <i>E. faecalis</i>, were identified as VVE. While the VRE incidence has declined in Korea since 2020, the VVE incidence is significantly rising. In Korea, only the <i>vanA</i> gene has been detected in both VRE and VVE, and no other <i>van</i> gene variants have been identified. Most of these isolates belong to CC17 (91.3%), with ST17, ST817, and ST80 as the predominant types. We have shown that continuous surveillance is essential in Korea due to the persistently high prevalence of VRE and the potential evolution of VVE into VRE. Consequently, it is critical to evaluate <i>Enterococcus</i> species isolated from domestic clinical settings for their phenotypic vancomycin resistance and the molecular detection of <i>van</i> genes, irrespective of the strain.https://www.mdpi.com/2079-6382/13/12/1210global antibiotic resistance surveillance system in Korea<i>vanA</i> genevancomycin susceptiblevancomycin-resistant enterococcivancomycin-variable enterococci
spellingShingle Sung Young Lee
Ji-Hyun Nam
Jung Wook Kim
Soo Hyun Kim
Jung Sik Yoo
Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022
Antibiotics
global antibiotic resistance surveillance system in Korea
<i>vanA</i> gene
vancomycin susceptible
vancomycin-resistant enterococci
vancomycin-variable enterococci
title Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022
title_full Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022
title_fullStr Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022
title_full_unstemmed Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022
title_short Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017–2022
title_sort prevalence of vancomycin variable enterococci from the bloodstream in the korea global antibiotic resistance surveillance system 2017 2022
topic global antibiotic resistance surveillance system in Korea
<i>vanA</i> gene
vancomycin susceptible
vancomycin-resistant enterococci
vancomycin-variable enterococci
url https://www.mdpi.com/2079-6382/13/12/1210
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