Epidemiology of antimicrobial resistance in enterococci in France

Since the mid-70s, enterococci have become one of the major causes of nosocomial infection. Enterococcus faecalis isolates remain susceptible to ampicillin. The prevalence of high-level resistance to gentamicin is stable around 15 %. Resistance to vancomycin is rare and detected in only 0.2 % of isolates from blood cultures. However, co-resistance to gentamicin is recently increasing (55 %) and the few isolates responsible for outbreaks have been reported as belonging to the CC 2 clonal complex. The most worrying enterococcal outbreaks are due to Enterococcus faecium strains that belong to the clonal complex CC17 spreading worldwide. These hospital-adapted clones accumulate ampicillin-, fluoroquinolone-, vancomycin- and high-level resistance to gentamicin. In France, less than 2% of E. faecium isolated from blood cultures are resistant to vancomycin (71 % with the VanA phenotype). Vancomycin-resistant E. faecium isolates are significantly more resistant to ampicillin (95% versus 50% of vancomycin-susceptible isolates), lincomycin (98 % versus 57.5 %) and erythromycin (96 % versus 88.5 %). Noteworthy, a high proportion of VRE isolates is also levofloxacin- and cotrimoxazole-resistant, but remain susceptible to linezolid, rifampin, fusidic acid and tigecycline. Spread of particularly epidemic and multiresistant E. faecium and to a less extent E. faecalis isolates, deserves prospective surveillance. (C) 2010 Elsevier Masson SAS. All rights reserved.