Molecular characterisation of outbreak-related strains of vancomycin-resistant Enterococcus faecium from an intensive care unit in Beijing, China.

We investigated an outbreak of vancomycin-resistant Enterococcus faecium affecting 14 patients in a 20-bed intensive care unit (ICU) between September 2006 and August 2007 (incidence: 3.56 cases per 1000 ICU patient days). Eighteen isolates of vanA type E. faecium were analysed by pulsed field gel electrophoresis, which showed 14 types overall. Multilocus sequence typing (MLST) identified eight different sequence types (STs) (ST78, ST117, ST203, ST316, ST362, ST363, ST364 and ST365), including four new types (ST362, ST363, ST364 and ST365) and 17 strains belonged to clonal complexes CC17. Sixteen of these carried the esp gene. Eighteen Tn1546-like elements encoding vanA-type VRE were classified into three types (types I to III) and all of them contained both IS1216V and IS1542 insertions. Vancomycin resistance of 14 vanA type E. faecium isolates was transferred at a frequency of 1.3 x 10(-6) to 6.4 x 10(-5) between E. faecium strains during filter mating. Our findings indicate that conjugative dissemination of Tn1546-like elements among CC17 E. faecium occurred during the outbreak in this ICU.