Porcine-Origin Gentamicin-Resistant Enterococcus faecalis in Humans, Denmark

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Volume 16, Number 4–April 2010
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Porcine-Origin Gentamicin-Resistant Enterococcus faecalis in Humans, Denmark
Jesper Larsen, Henrik C. Schønheyder, Camilla H. Lester, Stefan S. Olsen, Lone J. Porsbo, Lourdes Garcia-Migura, Lars B. Jensen, Magne Bisgaard, and Anette M. Hammerum
Author affiliations: University of Copenhagen, Frederiksberg, Denmark (J. Larsen, M. Bisgaard); Aarhus University Hospital, Aalborg, Denmark (H.C. Schønheyder); Statens Serum Institut, Copenhagen, Denmark (C.H. Lester, S.S. Olsen, A.M. Hammerum); Technical University of Denmark, Søborg, Denmark (L.J. Porsbo); and Technical University of Denmark, Copenhagen (L. Garcia-Migura, L.B. Jensen)

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Abstract
During 2001–2002, high-level gentamicin-resistant (HLGR) Enterococcus faecalis isolates were detected in 2 patients in Denmark who had infective endocarditis and in pigs and pork. Our results demonstrate that these isolates belong to the same clonal group, which suggests that pigs are a source of HLGR E. faecalis infection in humans.

Infective endocarditis is a life-threatening infection that involves the endocardial surface or vascular structures in proximity to the heart. Its intrinsic resistance to a number of antimicrobial drugs makes enterococcal infective endocarditis cumbersome to treat. For decades, the mainstay has been the combination of a cell wall–active agent (ampicillin, penicillin, or vancomycin) and gentamicin (1). However, high-level resistance to gentamicin hinders the bactericidal activity of combination therapy and increases the likelihood of clinical and microbiologic failure and even death (2).

High-level gentamicin-resistant (HLGR) Enterococcus faecalis has been associated with the hospital setting and prior healthcare exposure, which suggests the existence of a healthcare reservoir (3). Nevertheless, enterococci are gut commensals in humans and warm-blooded animals; therefore, reservoirs of HLGR E. faecalis conceivably might exist in the community not directly linked to the healthcare setting.

During 2000–2002, the proportion of HLGR E. faecalis isolates increased from 2% to 6% in the pig population in Denmark (4–6), which coincided with the emergence of HLGR E. faecalis isolates among patients with infective endocarditis in North Denmark Region. We undertook this study to determine whether pigs are a source of E. faecalis infections in humans.

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Suggested Citation for this Article
Larsen J, Schønheyder HC, Lester CH, Olsen SS, Porsbo LJ, Garcia-Migura L, et al. Porcine-origin gentamicin-resistant Enterococcus faecalis in humans, Denmark. Emerg Infect Dis [serial on the Internet]. 2010 Apr [date cited]. http://www.cdc.gov/EID/content/16/4/682.htm

DOI: 10.3201/eid1604.090500