{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:04:00Z","timestamp":1790834640867,"version":"4.1.0"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2007,1,1]],"date-time":"2007-01-01T00:00:00Z","timestamp":1167609600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2007,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Glycopeptides such as vancomycin are the treatment of choice for infections due to methicillin-resistant\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    . This study describes the identification of high-level vancomycin-resistant\n                    <jats:italic>S. aureus<\/jats:italic>\n                    (VRSA) isolates in a polymicrobial biofilm within an indwelling nephrostomy tube in a patient in New York.\n                    <jats:italic>S. aureus<\/jats:italic>\n                    ,\n                    <jats:italic>Enterococcus faecalis<\/jats:italic>\n                    ,\n                    <jats:italic>Enterococcus faecium<\/jats:italic>\n                    ,\n                    <jats:italic>Micrococcus<\/jats:italic>\n                    species,\n                    <jats:italic>Morganella morganii<\/jats:italic>\n                    , and\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    were isolated from the biofilm. For VRSA isolates, vancomycin MICs ranged from 32 to &gt;128 \u03bcg\/ml. VRSA isolates were also resistant to aminoglycosides, fluoroquinolones, macrolides, penicillin, and tetracycline but remained susceptible to chloramphenicol, linezolid, rifampin, and trimethoprim-sulfamethoxazole. The\n                    <jats:italic>vanA<\/jats:italic>\n                    gene was localized to a plasmid of \u223c100 kb in VRSA and\n                    <jats:italic>E. faecium<\/jats:italic>\n                    isolates from the biofilm. Plasmid analysis revealed that the VRSA isolate acquired the 100-kb\n                    <jats:italic>E. faecium<\/jats:italic>\n                    plasmid, which was then maintained without integration into the MRSA plasmid. The tetracycline resistance genes\n                    <jats:italic>tet<\/jats:italic>\n                    (U) and\n                    <jats:italic>tet<\/jats:italic>\n                    (S), not previously detected in\n                    <jats:italic>S. aureus<\/jats:italic>\n                    isolates, were identified in the VRSA isolates. Additional resistance elements in the VRSA isolate included a multiresistance gene cluster,\n                    <jats:italic>ermB-aadE-sat4-aphA-3<\/jats:italic>\n                    ,\n                    <jats:italic>msrA<\/jats:italic>\n                    (macrolide efflux), and the bifunctional aminoglycoside resistance gene\n                    <jats:italic>aac(6<\/jats:italic>\n                    \u2032\n                    <jats:italic>)-aph(2\")-Ia<\/jats:italic>\n                    . Multiple combinations of resistance genes among the various isolates of staphylococci and enterococci, including\n                    <jats:italic>vanA<\/jats:italic>\n                    ,\n                    <jats:italic>tet<\/jats:italic>\n                    (S), and\n                    <jats:italic>tet<\/jats:italic>\n                    (U), illustrate the dynamic nature of gene acquisition and loss within and between bacterial species throughout the course of infection. The potential for interspecies transfer of antimicrobial resistance genes, including resistance to vancomycin, may be enhanced by the microenvironment of a biofilm.\n                  <\/jats:p>","DOI":"10.1128\/aac.00576-06","type":"journal-article","created":{"date-parts":[[2006,12,20]],"date-time":"2006-12-20T13:32:51Z","timestamp":1166621571000},"page":"231-238","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":201,"title":["High-Level Vancomycin-Resistant\n                    <i>Staphylococcus aureus<\/i>\n                    Isolates Associated with a Polymicrobial Biofilm"],"prefix":"10.1128","volume":"51","author":[{"given":"Linda M.","family":"Weigel","sequence":"first","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney M.","family":"Donlan","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hyeon","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bette","family":"Jensen","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancye C.","family":"Clark","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda K.","family":"McDougal","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenming","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberlee A.","family":"Musser","sequence":"additional","affiliation":[{"name":"Wadsworth Center, New York State Department of Health, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Thompson","sequence":"additional","affiliation":[{"name":"Wadsworth Center, New York State Department of Health, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Kohlerschmidt","sequence":"additional","affiliation":[{"name":"Wadsworth Center, New York State Department of Health, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nellie","family":"Dumas","sequence":"additional","affiliation":[{"name":"Wadsworth Center, New York State Department of Health, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Limberger","sequence":"additional","affiliation":[{"name":"Wadsworth Center, New York State Department of Health, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.5.1281-1287.2002"},{"key":"e_1_3_2_3_2","first-page":"565","volume":"51","year":"2002","unstructured":"Centers for Disease Control and Prevention. 2002. 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