Detection of vanA genes in vancomycin susceptible E. faecium isolates; implications for additional testing
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To assess the frequency of silent vancomycin resistance, phenotypically susceptible E. faecium isolates underwent genotypic testing using Cepheid’s Xpert vanA/vanB PCR. 6% of isolates had silent vanA genes. However, the clinical relevance of silent van genes, and the lack of rapid, random-access genotypic methods poses an ongoing challenge to laboratories.
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Dear Victoria Jordan, The manuscript entitled "Detection of vanA genes in vancomycin susceptible E. faecium isolates; implications for additional testing" illustrates an important matter for antimicrobial treatment: the correlation between the detection of resistance genes and the existence of resistant phenotypes. Although the paper is of interest, a few amendments are necessary before the paper proceeds to peer-review. First, more details about the isolation and preservation of the isolates are necessary. How were the bacteria frozen? Were these isolates cultured before freezing? In what media? Also, it would be useful to have more details on the patient material from where the bacteria were isolated (which 'fluid' and which "tissue'?). Moreover, ideally the origin of each isolate would be described; if this is absolutely not …
Dear Victoria Jordan, The manuscript entitled "Detection of vanA genes in vancomycin susceptible E. faecium isolates; implications for additional testing" illustrates an important matter for antimicrobial treatment: the correlation between the detection of resistance genes and the existence of resistant phenotypes. Although the paper is of interest, a few amendments are necessary before the paper proceeds to peer-review. First, more details about the isolation and preservation of the isolates are necessary. How were the bacteria frozen? Were these isolates cultured before freezing? In what media? Also, it would be useful to have more details on the patient material from where the bacteria were isolated (which 'fluid' and which "tissue'?). Moreover, ideally the origin of each isolate would be described; if this is absolutely not possible, the 'health district' covered in this study should be delineated. Also, please clarify if vancomycin susceptibility was determined directly on the isolates. Regarding the results, it would be useful to have a better description of the vancomycin-resistant (vanA positive) E. faecium that was later isolated from one patient. How was resistance to vancomycin determined? Did it respond to treatment? Also, please do not abbreviate the name of the species in the title and make sure the full specific name is given when the organism is first mentioned in the text. Best regards, Gustavo
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