{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:07:40Z","timestamp":1792001260897,"version":"4.4.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene"},{"name":"National Reference Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The increasing prevalence of VRE necessitates their reliable detection, especially for low-level resistance mediated by vanB in Enterococcus faecium. In this prospective study we analysed if vanB-mediated vancomycin resistance can be reliably detected by Vitek2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One thousand, three hundred and forty-four enterococcal isolates from routine clinical specimens were tested by Vitek2 (bioM\u00e9rieux, N\u00fcrtingen, Germany). Additionally, a bacterial suspension (with a turbidity equivalent to that of a 0.5 McFarland standard) was inoculated on chromID VRE screening agar (bioM\u00e9rieux) and incubated for 48\u2009h. If vancomycin tested susceptible by Vitek2 but growth was detected on the screening agar, PCR for vanA\/vanB was performed (GeneXpert vanA\/B test, Cepheid, Frankfurt, Germany). For isolates that tested susceptible to vancomycin by Vitek2 but were vanA\/B positive, MICs were determined before and after cultivation in broth with increasing concentrations of vancomycin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred and fifty-six out of 491 E. faecium were VRE and were predominantly vanB positive (81.0%). Of these, Vitek2 did not identify 14 as VRE (sensitivity 91.0%). By broth microdilution 9\/14 isolates demonstrated high MICs (\u226532\u2009mg\/L) and 5\/14 showed low vancomycin MICs, which did not increase despite vancomycin exposure. Three of the 14 isolates demonstrated growth on chromID VRE; after vancomycin exposure seven additional isolates were able to grow on chromID VRE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Vitek2 fails to detect vanB-mediated vancomycin resistance consistently, especially, but not limited to, low-level resistance. As this may lead to treatment failure and further dissemination of vanB VRE, additional methods (e.g. culture on VRE screening agar or PCR) are necessary to reliably identify vanB-positive enterococci in clinical routine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkab101","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T08:11:30Z","timestamp":1615968690000},"page":"1698-1702","source":"Crossref","is-referenced-by-count":8,"title":["Failure of Vitek2 to reliably detect\n                    <i>vanB-<\/i>\n                    mediated vancomycin resistance in\n                    <i>Enterococcus faecium<\/i>"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8288-1793","authenticated-orcid":false,"given":"Sarah V","family":"Walker","sequence":"first","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany"},{"name":"DZIF (German Centre for Infection Research), Partner Site Bonn-Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Wolke","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Plum","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Division of Nosocomial Pathogens and Antibiotic Resistances, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Division of Nosocomial Pathogens and Antibiotic Resistances, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1449-5780","authenticated-orcid":false,"given":"Axel","family":"Hamprecht","sequence":"additional","affiliation":[{"name":"Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany"},{"name":"DZIF (German Centre for Infection Research), Partner Site Bonn-Cologne, Cologne, Germany"},{"name":"Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"2021070808220619100_dkab101-B1","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/nrmicro2761","article-title":"The rise of the Enterococcus: beyond vancomycin resistance","volume":"10","author":"Arias","year":"2012","journal-title":"Nat Rev Microbiol"},{"key":"2021070808220619100_dkab101-B2","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.idc.2016.02.006","article-title":"Vancomycin-resistant enterococci: therapeutic challenges in the 21st century","volume":"30","author":"Miller","year":"2016","journal-title":"Infect Dis Clin North Am"},{"key":"2021070808220619100_dkab101-B3","doi-asserted-by":"crossref","first-page":"e216\u201325.","DOI":"10.1016\/j.jhin.2018.02.016","article-title":"Recommendations for the successful control of a large outbreak of vancomycin-resistant Enterococcus faecium in a non-endemic hospital setting","volume":"100","author":"Frakking","year":"2018","journal-title":"J Hosp Infect"},{"key":"2021070808220619100_dkab101-B4","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2021070808220619100_dkab101-B5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.diagmicrobio.2012.06.020","article-title":"Performance of three chromogenic VRE screening agars, two Etest\u00ae vancomycin protocols, and different microdilution methods in detecting vanB genotype Enterococcus faecium with varying vancomycin MICs","volume":"74","author":"Klare","year":"2012","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2021070808220619100_dkab101-B6","year":"2019"},{"key":"2021070808220619100_dkab101-B7","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1093\/cid\/ciw828","article-title":"Gram-positive bacterial infections: research priorities, accomplishments, and future directions of the Antibacterial Resistance Leadership Group","volume":"64 Suppl 1","author":"Doernberg","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2021070808220619100_dkab101-B8","doi-asserted-by":"crossref","first-page":"2926","DOI":"10.1093\/jac\/dkz310","article-title":"Comparison of VITEK\u00ae 2, three different gradient strip tests and broth microdilution for detecting vanB-positive Enterococcus faecium isolates with low vancomycin MICs","volume":"74","author":"Klare","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2021070808220619100_dkab101-B9","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.mimet.2015.08.019","article-title":"Evaluation of DiversiLab\u00ae, MLST and PFGE typing for discriminating clinical Enterococcus faecium isolates","volume":"118","author":"Werner","year":"2015","journal-title":"J Microbiol Methods"},{"key":"2021070808220619100_dkab101-B10","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1128\/AAC.04490-14","article-title":"Vancomycin-variable enterococci can give rise to constitutive resistance during antibiotic therapy","volume":"59","author":"Thaker","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"2021070808220619100_dkab101-B11","doi-asserted-by":"crossref","first-page":"e0193926.","DOI":"10.1371\/journal.pone.0193926","article-title":"Prevalence of vancomycin-variable Enterococcus faecium (VVE) among vanA-positive sterile site isolates and patient factors associated with VVE bacteremia","volume":"13","author":"Kohler","year":"2018","journal-title":"PLoS One"},{"key":"2021070808220619100_dkab101-B12","doi-asserted-by":"crossref","first-page":"4119","DOI":"10.1128\/AAC.00286-16","article-title":"A silenced vanA gene cluster on a transferable plasmid caused an outbreak of vancomycin-variable enterococci","volume":"60","author":"Sivertsen","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"2021070808220619100_dkab101-B13","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.1128\/AAC.01737-09","article-title":"Specificity of induction of the vanA and vanB operons in vancomycin-resistant enterococci by telavancin","volume":"54","author":"Hill","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"2021070808220619100_dkab101-B14","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/lam.13121","article-title":"Highly variable vancomycin-resistant enterococci in the north-eastern part of the Czech Republic","volume":"69","author":"Oravcova","year":"2019","journal-title":"Lett Appl Microbiol"},{"key":"2021070808220619100_dkab101-B15","doi-asserted-by":"crossref","first-page":"213.","DOI":"10.1186\/s12866-018-1342-1","article-title":"Dissemination and genetic analysis of the stealthy vanB gene clusters of Enterococcus faecium clinical isolates in Japan","volume":"18","author":"Hashimoto","year":"2018","journal-title":"BMC Microbiol"},{"key":"2021070808220619100_dkab101-B16","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1128\/JCM.03544-13","article-title":"Performance of the EUCAST disk diffusion method, the CLSI agar screen method, and the Vitek 2 automated antimicrobial susceptibility testing system for detection of clinical isolates of Enterococci with low- and medium-level VanB-type vancomycin resistance: a multicenter study","volume":"52","author":"Hegstad","year":"2014","journal-title":"J Clin Microbiol"},{"key":"2021070808220619100_dkab101-B17","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/2047-2994-1-21","article-title":"Vancomycin-resistant vanB-type Enterococcus faecium isolates expressing varying levels of vancomycin resistance and being highly prevalent among neonatal patients in a single ICU","volume":"1","author":"Werner","year":"2012","journal-title":"Antimicrob Resist Infect Control"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/76\/7\/1698\/38693623\/dkab101.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/76\/7\/1698\/38693623\/dkab101.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T13:03:10Z","timestamp":1625749390000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/76\/7\/1698\/6225960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,14]]},"references-count":17,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4,14]]},"published-print":{"date-parts":[[2021,6,18]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkab101","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.11.11.379180","asserted-by":"object"}]},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,7,1]]},"published":{"date-parts":[[2021,4,14]]}}}