Study of Prevalence and Antimicrobial Susceptibility Pattern of Enterococci Isolated from Clinically Relevant Samples with Special Reference to High Level Aminoglycoside Resistance (HLAR) in a Rural Tertiary Care Hospital (original) (raw)
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Prevalence and Antibiotic Resistance Pattern of Isolated Enterococcus by Standard Techniques
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.11\_Nov2022/IJHSR-Abstract02.html, 2022
Introduction: Enterococci have emerged as important nosocomial pathogens and appearance of resistance to many of the antimicrobials used for Gram-positive organisms has made the management of infections due to Enterococcus species difficult. Aim: Aim of the study was to observe the prevalence rate of Enterococcus species and observe its antibiotic resistance pattern in our hospital. Method: Enterococci strains were isolated from various clinical samples by culture and biochemical methods and its antibiotic susceptibility testing was seen by Kirby Bauer method as per CLSI guidelines. Minimum inhibitory concentration (MIC) determination for detecting Vancomycin resistance was done by HiMedia E strip test. Result: In 200 clinical isolates of Enterococcus, 170 were Enterococcus faecalis and 30 species were Enterococcus faecium. Out of 200 Enterococcus isolates 29 were VRE. Conclusion: The prevalence of Enterococcus species was 5.70% and vancomycin resistance among Enterococci isolates in this study was 14.5% and. Treating serious infections caused by vancomycinresistant Enterococci has emerged as one of the leading clinical challenges for physicians because of limited therapeutic options.
IJLSBPR, 2023
Background: Enterococci are one of the important causes of nosocomial urinary tract infections. The emergence of Highlevel Aminoglycoside Resistance (HLAR) and Vancomycin-Resistant Enterococci (VRE), have complicated the available treatment modalities for enterococci worldwide. Objectives: To determine the prevalence of Enterococcus species causing urinary tract infections and their antimicrobial susceptibility pattern in a tertiary care centre with special emphasis on high level aminoglycosides and vancomycin resistance. Methods: A total of 2405 urine samples were processed by standard protocol. All Enterococci identified, were further speciated and the antibiogram was determined by Kirby-Bauer disk diffusion method as per CLSIguidelines. Minimum inhibitory concentration (MIC) for vancomycin was determined by the Epsilometer test. Data were analyzed using SPSS version 20 and p≤ 0.05 was considered as significant. Results: Of 104 (4.53%) enterococcal isolates, 48 (46.1%) were identified as Enterococcus faecalis, 42 (40.4%) as Enterococcus faecium and 14 (13.5%) as Enterococcus avium. Overall, antibiogram of the isolates showed high resistance to norfloxacin (79.8%), ciprofloxacin (77.9%) and levofloxacin (74%). HLAR was observed in 53 (51%) isolates, significantly higher in E. faecium than E. faecalis (p=0.008). High-level Gentamicin resistance (HLGR) was seen in 41.3% cases and high-level Streptomycin resistance (HLSR) was seen in 34.6%. Occurrence of VRE in our setting was 1.9%. Multidrug resistance (MDR) was observed in 25.9% isolates. Conclusions: The study highlights the alarming rise in prevalence of MDR enterococci, especially to high-level aminoglycoside, which warrants immediate, adequate, and efficient surveillance program to prevent and control its spread.
2018
Enterococcus faecium and Enterococcus faecalis are among the predominant species causing hospital-acquired infections, with high mortality and morbidity rates. Enterococci which exhibit high level aminoglycoside (HLAR) and vancomycin resistance (VRE) possess a significant problem in therapeutic treatment. These resistance strains are becoming more widespread in Europe, USA and Asia. Studies have shown that the different distributions of aminoglycoside modifying enzymes (AMEs) among HLAR are based on the geographical regions. In Malaysia, however, data on the prevalence of HLAR and the distribution of AMEs are still limited. Hence, the aims of this study were to determine the antibiotic susceptibility patterns of the clinical isolates E. faecalis and E. faecium and the distribution of HLAR genes among the resistant isolates. Seventy-five clinical enterococci isolates used in this study were originally obtained from a tertiary centre, in the year 2009 and 2010. These isolates were isolated from different sources including pus (50%), blood (32%), urine (11%) and other sources such as CSF and HVS (7%). Reidentification of these isolates was carried out using several methods including sub-culturing on selective medium and Gram staining, followed by confirmatory tests using a commercial biochemical profiling (API20 strep) and 16s rRNA PCR amplification. Antimicrobial susceptibility tests were performed using disc diffusion, E-test and broth microdilution methods. The antibiotics used were aminoglycosides (gentamicin, streptomycin, kanamycin, amikacin, tobramycin) and other antibiotics which are commonly © C O P U P M ii used in the hospital to treat enterococcal infections such as ampicillin, vancomycin, erythromycin, tetracycline, chloramphenicol and linezolid. Detection of HLAR genes was performed on resistance isolates using single PCR amplifications. Out of 25 (33.3%) isolates of E. faecium, 84% and 68% showed high level gentamicin resistance (HLGR) and high level streptomycin resistance (HLSR), respectively. Resistance against erythromycin and tetracycline were 100%, while ampicillin and chloramphenicol showed 84% and 32% resistance rates, respectively. None of the E. faecium isolates showed resistance towards vancomycin and linezolid. On the other hand, all 50 (66.7%) E. faecalis isolates were resistance to all aminoglycosides tested with the following percentages; amikacin (100%), kanamycin (90%), tobramycin (70%), HLGR (36%) and HLSR (46%). These isolates were also resistance to tetracycline (98%), erythromycin (96%), chloramphenicol (46%), ampicillin (24%), linezolid (8%), and vancomycin (4%). Interestingly, the E. faecalis isolates that were resistant to vancomycin were previously reported as susceptible. In this study, E. faecium exhibited higher resistance rates to all antibiotics except vancomycin and linezolid compared to E. faecalis. Additionally, 46% of E. faecalis showed MIC of streptomycin up to 1042 μg/mL while another 36% showed MIC of gentamicin equal to 512 μg/mL. The MIC of aminoglycosides determined in this study showed similar level as observed in other countries, despite the variation of the methods used. The presence of aminoglycoside modifying enzyme (AME) genes [aac(6)-Ie-aph(2)-Ia, aph(2)-Ib, aph(2)-Ic, aph(2)-Id, aph(3)-IIIa] were detected using PCR amplification. The results demonstrated that the HLGR gene, aac(6)-Ie-aph(2)-Ia and the HLSR gene, aph(3)-IIIa were detected in 32% and 40% of E. faecalis and E. faecium resistance isolates, respectively. The spread of these genes were responsible for high level resistance to gentamicin and streptomycin among enterococci isolated in this study. As HLAR genes are highly transferable to not only among the enterococci species but also among various bacterial species, continuous antibiotic surveillance in Malaysian hospitals is warranted in future and preventive measures can be implemented accordingly.
Prevalence Of Drug Resistance Among Enterococcus Spp Isolated From A Tertiary Care Hospital
2012
Introduction: Enterococci, initially considered as normal commensal of intestinal tract, has recently emerged as a medically important pathogen causing hospital acquired infections. Incidence is significantly high in debilitated patients. One of the important causes of development of multi drug resistant enterococci is antibiotic selective pressure. This study aims to isolate enterococci from various clinical specimens of indoor patients and to find out in vitro antimicrobial activity against the isolates. Materials and methods: Samples were cultured on blood agar, MacConkey's agar and Hi chrome media for Enterococcus faecium. Blood samples were collected in blood culture bottles. Isolates were identified up to species level by various biochemical tests as per conventional methods. Antibiotic sensitivity was done on Mueller Hinton agar by Kirby Bauer disk diffusion method. Vancomycin resistant isolates were further tested for minimum inhibitory concentration by E test. Results: Total number of clinical enterococcal isolates was 544, among which 82% was Enterococcus faecalis and 18%, Enterococcus faecium. Maximum number of isolates was from urine samples. Commonest age group affected was 21-30 years. Male: Female ratio was 1: 2.2. Maximum resistance was seen against gentamicin (58%), followed by co trimoxazole (49%), tetracycline (47%) and ampicillin (43%). Nitrofurantoin showed excellent activity against uropathogenic enterococci. Newer drugs like linezolid and tigecycline have got important role against multi drug resistant enterococcal infection. Conclusion: In our study, Enterococcus faecalis is a predominant species. There is a need for routine surveillance of susceptibility pattern of enterococcal infections as they remain a significant clinical problem.
Prevalence of Multidrug Resistant Enterococci in a Tertiary Care Hospital in India: A Growing Threat
Open Journal of Medical Microbiology, 2014
Introduction: Enterococci are members of the healthy human intestinal flora, but are also leading causes of highly antibiotic-resistant infections. Serious enterococcal infections are often difficult to treat since the organisms have a tremendous capacity to acquire resistance to penicillin, high concentration of aminoglycoside & vancomycin. Careful review of in vitro susceptibility data is required to treat infections caused by MDR Enterococci. Therefore we conducted the study to find out prevalence of MDR Enterococci. Aims & Objectives: To study the prevalence of Vancomycin resistance, High Level Streptomycin Resistance (HLSR) & High Level Gentamicin Resistance (HLGR) in different enterococcal isolates. Materials & Methods: Total 180 enterococcal isolates were studied. Identification was done by conventional biochemical methods. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller-Hinton agar and results were interpreted as per CLSI guidelines. HLSR & HLGR was determined by disc diffusion method using high level Gentamicin disc (120 µg) & Streptomycin (300 µg) discs. Minimum inhibitory concentration (MIC) determination for Vancomycin was done by vancomycin E test strips. Results: Total 180 entetococcal isolates were studied. E. faecalis was 60%, E. faecium was 32.2%, E. durans and E. raffinosus were 4.4% & 3.3% respectively. Enterococcus fecium showed resistance in high percentage as compared to E. faecalis. 15 isolates were found to be vancomycin resistant. Conclusion: Resistance to aminoglycoside is of great concern. Regular screening of enterococcal isolates for vancomycin resistance detection should be implemented. It is very important to implement infection control measures, screening of health care workers, surveillance cultures in intensive care units which can control spread of multidrug resistant enterococci.
2009
This study investigated the antibacterial resistance among enterococci isolated in Tehran hospitals. A total of 277 Enterococcus faecalis, 123 Enterococcus faecium and 13 isolates of other enterococcal strains were collected from 1 March 2002 to 15 April 2004 from three teaching hospitals of Tehran University of Medical Sciences. The minimum inhibitory concentrations (MIC) of tested antibiotics were determined by agar dilution method. Susceptible and resistant isolates were defined according to the speciesrelated MIC breakpoints of the Clinical and Laboratory Standards Institute (CLSI) guidelines. Sixty-three percent of isolates were resistant to rifampicin (MIC 90 64 µg/ml), 44% to ciprofloxacin (MIC 90 16≤ µg/ml), 43% to erythromycin (MIC 90 512 µg/ml), 32% to cefazolin (MIC 90 256≤ µg/ml), 25% to penicillin (MIC 90 32 µg/ml), 21% to ampicillin (MIC 90 128≤ µg/ml), 8% to vancomycin (MIC 90 ≤ 8 µg/ml), and 8% to teicoplanin (MIC 90 16≤ µg/ml). All of the vancomycin-resistant strains carried the vanA phenotype and genotype. High level resistance to gentamicin and streptomycin were found in 52% and 83% of the isolates, respectively. The results indicated that a significant percentage of isolates are resistance to different antibiotics, pointing out the need for control strategies to avoid dissemination of resistant isolates and for continuous surveillance for the detection of emerging resistance traits.
Antimicrobial resistance in Enterococcus faecalis at a tertiary care centre of northern India
The Indian journal of medical research, 2003
Multiresistant enterococci are emerging as a leading nosocomial pathogen. Knowledge of the profile of antimicrobial resistance is essential to formulate treatment guidelines for infections caused by enterococci. This study reports the antimicrobial sensitivity of enterococci isolated during a one year period from clinical samples of patients admitted to a teriary care hospital of Delhi. A total of 444 isolates of Enterococcus faecalis were screened for antimicrobial susceptibility by the disk diffusion technique as recommended by the National Committee for Clinical Laboratory Standards (NCCLS). Screening for vancomycin resistance was done by the vancomycin screen agar method recommended by NCCLS, which was confirmed by determination of minimum inhibitory concentration (MIC) using microbroth dilution and E-test methods. Vancomycin resistance phenotypes were determined by polymerase chain reaction. A total of 115 (26%) isolates had high level aminoglycoside resistance, 293 (66%) were ...
Antibiotic Resistance in Enterococcus faecalis Isolated from Hospitalized Patients
Journal of dental research, dental clinics, dental prospects, 2013
Enterococci are Gram-positive cocci that often occur in pairs (diplococci) or short chains. Be-side developing high level of antibiotic resistance, these bacteria can cause wide range of disease in human, thus to help provide an effective treatment for infections caused by this genus, this study was conceived to provide information on Enterococcus faecalis Antibiotic resistance to widely used antibiotics in hospitalized patients. Disk diffusion agar and Broth dilution methods were used to perform Antibiogram test on isolated Enterococcus faecalis. Culture medium used for Disk diffusion agar test was Muller Hinton agar, and for Broth dilution methods, Muller Hinton broth culture medium was utilized. In disk diffusion agar method, different commercial antibiotics disks produced by Pharmaceutical companies were used. Microsoft Excel software was used to perform statistical analysis. Based on antibiograms of 105 cases, a high resistance to Synercid, Nalidixic acid, Oxacillin and Teofili...
Khon Kaen University Journal (Graduate Studies), 2007
A total of 300 clinical isolates of enterococci, collected from patients admitted at Srinagarind hospital, were investigated for antimicrobial resistance and species distribution. Antimicrobial susceptibility to 10 antimicrobial agents was performed by disc diffusion method. Screening for vancomycin resistance was performed by the agar plate method and minimal inhibitory concentration of vancomycin was determined for vancomycin resistant strains by microbroth dilution method. Enterococcus faecalis was found to be predominant species (58.7%) followed by E. faecium (35.7%) and the rest species (5.7%) including E. hirae, E. gallinarum, E. durans and E. dispar. The isolates were resistant to penicillin (51.3%), ampicillin (43.3%), high level gentamicin (57.7%), azithromycin (100%), chloramphenicol (16.3%), doxycycline (48%), quinupristin/dalfopristin (53%) and linezolid (8%). None of the isolates were resistant to teicoplanin. Five (1.7%) strains were resistant to vancomycin. The minimal inhibitory concentrations of vancomycin for vancomycin-resistant enterococci strains were 16µg/ml. E. faecium was more resistant to penicillin, ampicillin and high level gentamicin than E. faecalis. Two hundred and seventy four (91.3%) strains showed multidrug resistance. Our study showed low prevalence of vancomycin resistance. However, there is a need to carry-out regular surveillance of antimicrobial resistance of enterococci to monitor changes in their patterns to prevent the spreading of resistant isolates.
Iranian Journal of Medical Microbiology
Background and Aim: Vancomycin resistant Enterococci (VRE) and high level aminoglycoside resistant (HLAR) Enterococci have complicated the available treatment modalities for Enterococci worldwide. The existing study was planned to evaluate the occurrence of HLAR and VRE strains in a tertiary care center in India and to study the association of HLAR with vancomycin sensitive Enterococci (VSE) and VRE. Materials and Methods: A total of 50 enterococcal isolates from various clinical specimens were incorporated in the study. Speciation was done on the basis of standard biochemical tests. HLAR was tested by the disc diffusion method using 150µg gentamicin disc and 200 µg streptomycin discs. Vancomycin susceptibility patterns were reported using vancomycin disc and agar dilution methods. Results & Conclusion: Pus samples comprised of the majority for the isolation of enterococcal strains (40%). 54% isolated strains were HLGR, 32% were HLSR and 14% isolates were positive for both HLGR and HLSR. 61.7% of Enterococcus faecium isolates demonstrated resistance for high-level gentamicin (HLGR) and 43.75% Enterococcus faecalis isolates were resistant to high-level streptomycin (HLSR). When VRE was compared to VSE, the rate of HLSR was detected to be 4.64% in VRE, while it was 32.55% in VSE; the rate of HLGR was noted to be 11.62% in VRE and it was 41.87% in VSE. The association of HLGR with HLSR (HLAR) was 2.32% in VRE and 13.95% in VSE strains. Enterococci strains are showing an increase in their antimicrobial resistance patterns. The increment of such strains in health care settings has to be reserved and controlled to avert complicated infections.