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Applied and Environmental Microbiology, June 2002, p. 2838-2842, Vol. 68, No. 6
0099-2240/02/$04.00+0     DOI: 10.1128/AEM.68.6.2838-2842.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

High Prevalence of Vancomycin-Resistant Enterococci in Swedish Sewage

Aina Iversen,1* Inger Kühn,1 Anders Franklin,2 and Roland Möllby1

Microbiology and Tumor Biology Center, Karolinska Institutet, SE-171 77 Stockholm,1 Department of Antibiotics, National Veterinary Institute, SE-751 89 Uppsala, Sweden2

Received 26 November 2001/ Accepted 8 March 2002

In Europe the use of the growth promoter avoparcin is considered to have selected for vancomycin-resistant enterococci (VRE). Sweden ceased using avoparcin in 1986, and only occasional cases of VRE from hospitals have been reported since 1995. Within the framework of a European study, samples from urban raw sewage, treated sewage, surface water, and hospital sewage in Sweden (n = 118) were screened for VRE. Surprisingly, VRE were isolated from 21 of 35 untreated sewage samples (60%), from 5 of 14 hospital sewage samples (36%), from 6 of 32 treated sewage samples (19%), and from 1 of 37 surface water samples. Thirty-five isolates from 33 samples were further characterized by geno- and phenotyping, MIC determination, and PCR analysis. Most isolates (30 of 35) carried the vanA gene, and the majority (24 of 35) of the isolates were Enterococcus faecium. Most of the VRE were multiresistant. The typing revealed high diversity of the isolates. However, one major cluster with seven identical or similar isolates was found. These isolates came from three different sewage treatment plants and were collected at different occasions during 1 year. All VRE from hospital sewage originated from one of the two hospitals studied. That hospital also had vancomycin consumption that was 10-fold that of the other. We conclude that VRE were commonly found in sewage samples in Sweden. The origin might be both healthy individuals and individuals in hospitals. Possibly, antimicrobial drugs or chemicals released into the sewage system may sustain VRE in the system.

* Corresponding author. Mailing address: Microbiology and Tumor Biology Center, Karolinska Institutet, Box 280, 171 77 Stockholm, Sweden. Phone: 46 8 728 71 55 or 46 8 728 71 53. Fax: 46 8 33 15 47. E-mail: aina.iversen{at}mtc.ki.se.

Applied and Environmental Microbiology, June 2002, p. 2838-2842, Vol. 68, No. 6
0099-2240/02/$04.00+0     DOI: 10.1128/AEM.68.6.2838-2842.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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Copyright © 2002 by the American Society for Microbiology. All rights reserved.