A rare case of bilateral septic arthritis of hip: in a patient of idiopathic angiodema

Enterococcal infection can lead to gastroenteritis and bacteraemia. However, osteoarticular infections caused by Enterococci are rarely encountered. We report the case of a 27-year-old female patient with bilateral hip infection caused by enterococci. This young female patient initially presented with flare up of angioedema symptoms followed by septic arthritis of one hip and then 2nd hip while patient was admitted in hospital. Thankfully this patient was successfully treated and discharge back home. Early detection and proper treatment are essential for the eradication of the infection. The use of prolonged antimicrobial therapy can be considered in the management of bilateral hip joint destruction due to delayed diagnosis of enterococci infection. The patient was informed that data from the case would be submitted for publication, and she provided his consent.

PREVALENCE AND ANTI MICROBIAL SUSCEPTIBILITY OF CLINICAL ISOLATES OF ENTEROCOCCUS SPECIES WITH SPECIAL REFERENCE TO VANCOMYCIN RESISTANCE

Background: Among enterococcus species , 80 -90% and 5-10% of human infection are caused by enterococcus faecalis and faecium respectively .The rate of isolation of Enterococcus faecium and other species is increase at recent times from various clinical samples . Enterococcus faecium showing higher degree of drug resistance. Enterococcus gallinarum and Enterococcus casseliflavus are intrinsically resistant to vancomycin thereby inappropriate treatment can be avoided. Materials and methods: The clinical samples included blood, urine and exudates (pus,tissues, sterile body fluids) were collected aseptically and processed as per standard methods for isolation and identification of organism. Antimicrobial susceptibility testing was performed using Kirby Bauer disc diffusion method. A total of 64 Enterococcus strains were isolated from clinic Result: al samples during the study period.The maximum number of Enterococcus isolates were obtained from Exudates 37(57.8%) ,urine 23(35.9%) followed by blood 4(6.2%) .Among Enterococcus species ,E.faecalis 59 (92.2%) and E.faecium 5 (7.8%) was isolated. The isolates from urine and exudates were predominantly resistance to antimicrobials like ampicillin, high level aminoglycoside, ciprofloxacin and sensitive to linezolid, vancomycin and nitrofurantoin for urine samples. Enterococcus faecalis isolates were uniformly sensitive to Ampicillin, Gentamicin, Ciprofloxacin, Linezolid and Vancomycin. Enterococcus faecium isolates were sensitive to Linezolid and Vancomycin and resistant to Ampicillin, Gentamicin, Ciprofloxacin. Conclusion: This study illustrates the prevalence and antibiotic susceptibility pattern of enterococcus species from various clinical samples . In our study Enterococci did not show resistant to vancomycin.

Isolation of Enterococcus spp. in various clinical sample and their antimicrobial resistant pattern with MIC of vancomycin in patient attending tertiary care centre, RIMS, Ranchi, Jharkhand

Introduction- Enterococci are part of normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections.it is second most common cause of nosocomial infections in gastrointestinal tract, wound and genitourinary tract. To process all the clinicalAim- samples from various department in our hospital, for isolation of Enterococci spp. To speciate the isolates & to have resistance pattern of the isolates of vancomycin total 926 sample were collected from both outMaterial & Methods- patients and in patient in all clinical departments and transported to microbiology laboratory. specimens were processed by inoculating on to blood agar, MacConkey Agar, nutrient agar, potassium tellurite agar and incubated at 37°C for24-48 hr. Enterococci were identified by their typical arrangement in and salt tolerance test Gram stain, bile esculin test and biochemical tests. Antimicrobial susceptibility patterns were determined by performing Kirby-Bauer disc diffusion method and Minimum inhibitory concentration (MIC) values were identified by tube dilution methods. Result- a total of 926 sample, 645 (69.72%) were culture positive and 281 (30.28%) were culture negative. Among 645 culture positive cases, 81(12.55%) were Enterococcus faecalis. Antimicrobial susceptibility & MIC done as per standard protocols. The E. Faecalis showed 99% sensitive to Vancomycin. the resistance to vancomycin was 1% & further confirmed by MIC via tube dilution methods. In which MIC was ?32 ?g/ml in one isolate. About 8 of Enterococcal strains showed MIC of 0.0125?g/ml. species level identification of Enterococcus is important forConclusions- epidemiological study and also for analysis of drug resistant pattern. Effective detection of vancomycin resistance helps in reducing the morbidity and mortality of VRE in hospitalized patients

Analysis of clinical distribution and drug resistance of vancomycin-resistant Enterococci / 中国药房

OBJECTIVE To study the characteristics of clinical distribution and drug resistance in patients with vancomycin-resistant Enterococci（VRE），and to provide reference for clinical prevention and control of infection. METHODS From May 1，2017 to May 1，2020，a total of 290 patients with Enterococci cultured from the samples submitted by inpatient department of our hospital were included. They were divided into VRE group （24 cases）and vancomycin-sensitive Enterococci （VSE）group（266 cases）according to the results of sensitivity tests. The basic information of patients （gender，age，submitting department，etc.）， basic diseases （hypertension，diabetes，chronic obstructive pulmonary disease ，etc.）， clinical events （catheterization，endotracheal intubation ，deep venous catheterization ，etc.），use of antibiotics （utilization and utilization time of antibiotics before and after detection ），clinical manifestations （abnormal inflammatory indicators ，clinical symptoms ，etc.）， clinical outcomes （length of stay ，improvement，etc.），drug sensitivity spectrum were all collected. Clinical distribution and drug resistance were compared and analyzed between 2 groups. RESULTS There were significant differences in the type of Enterococci， mixed infection strains and clinical manifestations between 2 groups（P＜0.05）. In VRE group ，two natural drug-resistant bacteria were detected in 66.7％ and 20.8％ of the patients ，i.e. Enterococcus gallinarum and E. casseliflavus . E. faecium was only sensitive to linezolid ，teicoplanin and tegacyclin （the drug resistance rate was 0），and was resistant to other antibiotics （the drug resistance rate was 100％）；E. faecalis was not detected. E. faecium and E. faecalis were detected in 51.9％ and 44.7％ of patients in VSE group. The resistance rates of E. faecium to other antibiotics were more than 55％ except linezolid ，teicoplanin and tegacyclin （resistance rate ≤0.72％）；the resistance rates of E. faecalis to clindamycin and erythromycin were all more than 60％，and the sensitivity to other antibiotics was more than 60％. CONCLUSIONS The VRE infection strains in our hospital are mainly natural drug-resistant bacteria such as E. gallinarum and E. casseliflavus ，and vancomycin-resistant E. faecium is found. The resistance rates of different strains to antibiotics are quite different.

Infección nosocomial por Cronobacter sakazakii tras cirugía de tobillo en un paciente adulto inmunocompetente / Nosocomial Cronobacter sakazakii Infection after Ankle Surgery in an Immunocompetent Adult Patient

RESUMEN Cronobacter sakazakii es una bacteria Gram negativa que pertenece a un grupo emergente de patógenos oportunistas de la familia de los Enterococos, que causa infecciones nosocomiales. Afecta típicamente a los recién nacidos de bajo peso; puede causar graves infecciones como meningitis, sepsis o enterocolitis necrotizante, potencialmente mortales, aunque la gran mayoría de las infecciones se producen en pacientes ancianos, en los que son mucho más leves. Se reporta el primer caso confirmado de infección de herida quirúrgica en España causada por C. sakazakii en un adulto inmunocompetente(AU)

ABSTRACT Cronobacter sakazakii is a Gram negative bacterium that belongs to an emerging group of opportunistic pathogens of the Enterococci family, which causes nosocomial infections. It typically affects low birth weight newborns. It can cause serious infections such as meningitis, sepsis, or life-threatening necrotizing enterocolitis, although the vast majority of infections occur in elderly patients, where they are much milder. We report the first confirmed case of surgical wound infection in Spain, caused by C. sakazakii in an immunocompetent adult(AU)

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...

Enterococci are important human pathogens that cause many infections including nosocomial infections. Some important clinical infections caused by Enterococcus species are urinary tract infections, bacterial endocarditis, genital tract infections, surgical wound infections, bacteraemia and meningitis.Around, 80 - 90% of infections are commonly caused by E. faecalis followed by E. faecium with a contribution of about 10 - 15% along with emergence of multi-drug resistance (MDR) including to vancomycin. Enterococci have developed both intrinsic and acquired resistance towards many antibiotics including to high level aminoglycosides. This short term project was undertaken to study the prevalence and antibiotic susceptibility (AST) pattern of Enterococcus species isolated from clinical specimen with special reference to high level aminoglycoside resistance (HLAR) in a rural tertiary care hospital. Methods100 Enterococci isolated from clinically relevant samples were identified according to standard procedures and AST was carried out according to CLSI guidelines. ResultsOut of 100 enterococci, 70 E. faecalis, 21 E. faecium and 09 other Enterococcus species were isolated. The results showed that majority of enterococci was isolated from >60 age group (37%), from male patients (59%), from urine samples (59%) and from medicine department (36%). AST showed overall high resistance to Penicillin (98%) Ampicillin (86%), Gentamicin (85%), Ciprofloxacin (60%), Vancomycin (12%) (VRE), high level gentamicin (42%) (HLGR) and high level streptomycin (34%) (HLSR) and 15% isolates showed resistance to HLGR + HLSR. Multi drug resistance was seen in 40 (57.1%) E. faecalis isolates and 11 (52.3%) E. faecium isolates. Minimum resistance was observed with Linezolid (3%). ConclusionsThe present study showed high prevalence of antibiotic resistance in Enterococci. Hence, Enterococcus species isolated from samples should be routinely screened for HLAR, MDR and VRE so as to prevent the spread of multi drug resistant Enterococci and for proper selection of antibiotics.

Vancomycin Resistance among Enterococci: Further Limiting Our Therapeutic Options

Introduction: Enterococci are indigenous flora of theintestinal tract, oral cavity & genitourinary tract of human.Over recent years, there is increased interest in Enterococcinot only because of their serious infections but becauseof their increasing resistance to many antimicrobials.Vancomycin being the only alternative available. But over thetime, there has been increase in Vancomycin Resistance whichhas spread globally. The aim of this study was to determinethe prevalence of Vancomycin Resistant Enterococci (VRE)isolated from various clinical specimens in a tertiary carehospital in North India.Material and methods: A cross-sectional study was conductedin the Department of Microbiology, Government MedicalCollege, Amritsar from July 1st, 2018 to June 30th, 2019. Allthe samples received were processed and identification ofEnterococci was made by using standard microbiologicaltechniques. Antimicrobial susceptibility was performed byKirby Bauer disc diffusion method as per CLSI guidelines.Results: Out of total clinical samples (11,098), 3,551 (31.9%)were found to be culture positive. Among the culture positive,91 (2.56%) isolates were identified as Enterococcus speciescomprising of 37 E.faecalis (41%) and 54 E.faecium (59%).Maximum number of Enterococci were isolated from urinesamples (54.92%) followed by pus & body fluids (38.02%) andblood (7.04%). 9.52% of E.faecium isolates were found to beresistant to vancomycin. All the strains were 100% susceptibleto Linezolid, Teicoplanin & Quinupristin-dalfopristin.Conclusion: Enterococci have become the major pathogenicbacteria that cause hospital-acquired infections due tomultiple-antimicrobial resistance. VRE has emerged asimportant nosocomial pathogen and pose serious threat topatients. Vancomycin should be cautiously used else wewould be left with very few therapeutic options.

Analysis of Demographic Profiles among Cases of Isolates of Enterococci at a Tertiary Care Teaching Hospital

Introduction: Therapy for infections due to Vancomycinresistant Enterococci presents real challenge for the clinician.Despite increasing reports of VRE from different countries,there is a paucity of information on this issue from our country.Hence, the present study aims to study of demographic profileamong cases of isolates of Enterococci from various clinicalsamples of PBM and associated group of hospital SPMC,Bikaner up to the species level.Materials and Methods: The present descriptive study wascarried out in the Department of Microbiology, S.P.M.C.Bikaner over a period of one year. 194 isolates of Enterococcalwere obtained from various clinical samples of patientsattending P.B.M. Hospital, Bikaner.Results: The maximum number of samples (30.41%) wasisolated from patients in the 0-10 year age group. It should benoted that out of the 59 patients in this group, 21 (35.59%)were <1year old. The mean age of incidence of enterococcalinfections was 31.53 years. 21 babies included in the 0-10 yearage group were <1 year old. Out of the 194 enterococcalisolates, 79 (40.72%) were from female patients, and 115(59.28%) were from male patients.Conclusion: Majority of the isolates were from the pediatricage group as the maximum number of samples was isolatedfrom patients in the 0-10 year age group The E.faecium strainsshowed a higher percentage of resistance to all the antibioticstested, as compared to the E.faecalis strains.

Resistencia a los β -lactámicos en enterococos / Resistance to β-lactams in enterococci

Enterococci are intrinsically resistant to several antimicrobial classes and show a great ability to acquire new mechanisms of resistance. Resistance to β-lactam antibiotics is a major concern because these drugs either alone or in combination are commonly used for the treatment of enterococcal infections. Ampicillin resistance, which is rare in Enterococcus faecium occurs in most of the hospital-associated Enterococcus faecium isolates. High-level resistance to ampicillin in E. faecium is mainly due to the enhanced production of PBP5 and/or by polymorphisms in the beta subunit of this protein. The dissemination of high-level ampicillin resistance can be the result of both clonal spread of strains with mutated pbp5 genes and resistance horizontal gene transfer.

Los enterococos son intrínsecamente resistentes a varias clases de antimicrobianos y presentan una gran capacidad para adquirir mecanismos de resistencia. La resistencia a los antibióticos p-lactámicos es preocupante porque estos fármacos solos o combinados se usan comúnmente para el tratamiento de las infecciones enterocócicas. La mayoría de los aislamientos hospitalarios de Enterococcus faecium presentan resistencia a la ampicilina, la cual es rara en Enterococcus faecalis. El alto nivel de resistencia a la ampicilina en E. faecium se debe principalmente a la hiperproducción de PBP5 y/o a polimorfismos en la subunidad beta de esta proteína. La propagación de esta resistencia puede deberse tanto a la diseminación clonal de cepas con genes pbp5 mutados como a la transferencia horizontal de genes.

Effect of broad-spectrum antibiotics on bacterial translocation in burned or septic rats / 中华医学杂志(英文版)

Background:@#Antibiotics are frequently used to treat critically ill patients, and its use is often accompanied by intestinal dysbiosis that might further lead to bacterial translocation (BT). Nevertheless, studies on the relationship between antibiotic therapy and BT are rare. In the present study, we investigated the effect of broad-spectrum antibiotics on BT in an experimental rat model of burn or sepsis injury.@*Methods:@#The septic rat model was simulated by a second insult with lipopolysaccharides after burn injury. Ninety-two male Sprague-Dawley rats were randomly divided into control, burn, and sepsis groups (n = 8 or 9, each group), and the latter two groups were then treated with imipenem or ceftriaxone for 3 or 9 days. The mesenteric lymph nodes, liver, lungs, and blood were collected at each time point under sterile conditions for quantitative bacterial culture and strain identification. The differences between the groups were compared by Fisher exact test or Mann-Whitney U test.@*Results:@#Only minimal Escherichia coli translocation to the mesenteric lymph nodes was observed in the normal control group, in which the BT rate was 12.5%. Burn injury did not affect the BT rate (Burn group vs. Control group, 12.5% vs. 12.5%, P = 1.000), whereas the BT rate showed an increased trend after the second insult with lipopolysaccharide (Sepsis group vs. Control group, 44.4% vs. 12.5%, P = 0.294), and many strains of Enterobacteria spp. were detected in distant organs (liver, lung, and blood) [Sepsis group vs. Control group, 0 (0,3) vs. 0 (0,0), U = 20, P = 0.045]. After the antibiotic treatment, BT to the distant organs was increased in burned rats [Burn IT3 group vs. Burn group, 0 (0,2) vs. 0 (0,0); Burn IT9 group vs. Burn group, 0 (0,1) vs. 0 (0,0); Burn CT9 group vs. Burn group, 0 (0,2) vs. 0 (0,0); all U = 20 and P = 0.076] but decreased in septic rats [Sepsis CT3 group vs. Sepsis group, 0 (0,0) vs. 0 (0,3), U = 20, P = 0.045]. The total amount of translocated bacteria, regardless of which antibiotic was used, was increased in burned rats [Burn IT9 group vs. Burn group, 2.389 (0,2.845) vs. 0 (0,2.301) Log10 colony-forming units (CFU)/g, U = 14, P = 0.034; Burn CT3 group vs. Burn group, 2.602 (0,3.633) vs. 0 (0,2.301) Log10 CFU/g, U = 10.5, P = 0.009], but there was a slightly decreased trend in septic rats [Sepsis IT9 group vs. Sepsis group, 2.301 (2,3.146) vs. 0 (0,4.185) Log10 CFU/g, U = 36, P = 0.721; Sepsis CT9 group vs. Sepsis group, 2 (0,3.279) vs. 0 (0,4.185) Log10 CFU/g, U = 32.5, P = 0.760]. Remarkably, the quantity of Enterococci spp. dramatically increased after broad-spectrum antibiotic treatment in both the burned and septic groups [Burn IT3 group vs. Burn group, 1 (0,5.164) vs. 0 (0,0) Log10 CFU/g, U = 16; Burn IT9 group vs. Burn group, 1 (0,2.845) vs. 0 (0,0) Log10 CFU/g, U = 16; Burn CT3 group vs. Burn group, 2.602 (0,3.633) vs. 0 (0,0) Log10 CFU/g, U = 8; Burn CT9 group vs. Burn group, 1 (0,4.326) vs. 0 (0,0) Log10 CFU/g, U = 16; Sepsis IT3 group vs. Sepsis group, 2.477 (0,2.903) vs. 0 (0,0) Log10 CFU/g, U = 4.5; Sepsis IT9 group vs. Sepsis group, 2 (0,3.146) vs. 0 (0,0) Log10 CFU/g, U = 9; Sepsis CT3 group vs. Sepsis group, 1.151 (0,2.477) vs. 0 (0,0) Log10 CFU/g, U = 18; Sepsis CT9 group vs. Sepsis group, 2 (0,3) vs. 0 (0,0) Log10 CFU/g, U = 13.5; all P < 0.05].@*Conclusions:@#Broad-spectrum antibiotics promote BT in burned rats but prevent BT in septic rats, especially preventing BT to distant organs, such as the liver and lung. Moreover, Enterococci spp. with high drug resistance and high pathogenicity translocated most after antibiotic treatment.

Shorter Incubation Times for Detecting Multi-drug Resistant Bacteria in Patient Samples: Defining Early Imaging Time Points Using Growth Kinetics and Total Laboratory Automation

BACKGROUND: The transition from manual processing of patient samples to automated workflows in medical microbiology is challenging. Although automation enables microbiologists to evaluate all samples following the same incubation period, the essential incubation times have yet to be determined. We defined essential incubation times for detecting methicillin-resistant Staphylococcus aureus (MRSA), multi-drug resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). METHODS: We monitored the growth kinetics of MRSA, MDRGN, and VRE between two and 48 hours on chromogenic media to establish the time points of first growth, single colony appearance, and typical morphology for 102, 104, 106, and 108 colony forming units/mL. Subsequently, we imaged plates inoculated with 778 patient samples after 20, 24, and 36 hours. RESULTS: The first growth, single colony appearance, and typical morphology time points were inoculum-dependent. First growth appeared after 6–18 hours, 4–18 hours, and 8–48 hours for MRSA, MDRGN, and VRE, respectively, and single colonies appeared at 12–18 hours, 6–20 hours, and 12–48 hours, respectively. Typical morphology was visible at 14–22 hours and 12–48 hours for MRSA and VRE, but was not determined for MDRGN. By examining patient samples, ≥98% of MRSA and MDRGN were visible 20 hours after the start of incubation. Following 24 hours of incubation, only 79.5% of VRE were clearly visible on the respective plates. CONCLUSIONS: An incubation time of 20 hours is sufficient for detecting MRSA and MDRGN. VRE growth is much slower and requires additional imaging after 36 hours.

Infective endocarditis due to Streptococci and Enterococci: A 3-year retrospective study

Introduction: Infective endocarditis (IE) is an infection of the heart valves with an aggregation of bacteria in a fibrin plaque called vegetation. Aims and Objectives: This is a retrospective study of all infective endocarditis cases due to alpha haemolytic streptococci and enterococci. Methods: All cases of infective endocarditis cases due to alpha haemolytic streptococci and enterococci in a period of three years from 1st January 2010 to 31st December 2012 were included. Isolation of the same organism from more than one set of blood cultures was taken as a confirmed case of infective endocarditis. Clinical and serological parameters were recorded using a proforma. Results: Native valve endocarditis was more common with only five prosthetic valves being involved. Out of 89 clinically suspected cases of IE in the three years from Jan 2010 to Dec 2012, for which blood was sent for culture, 63(70.78%) samples were positive by culture. Of these, 42/63(66.66%) were due to alpha-lytic Streptococci, enterococci and rare gram positive cocci. The rare ones included Enterococcus gallinarum, abiotropha defective, Vagococcus fluvialis and Nutritionally Variant Streptococci(NVS). High level Aminoglycoside resistance(HLAR) was also encountered. The varied and important features of these isolates are discussed. Complications and treatment are described. Conclusion: From a clinical microbiology point of view, the major challenge faced by the microbiologist in diagnosis of IE is proper aseptic collection of sample before starting antibiotics with a need for multiple samples to detect and also to prove the causative organism. Sensitivity reporting can be a difficult task in the context of NVS, HLAR and gram positives that are slow growing. Congestive failure and embolisation occurs even when the antibiotic treatment is successful.When patients go in for complications, it is very rarely due to wrong antibiotics.

Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing

Abstract The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p < 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p < 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.

Isolation of Enterococci in Women and Antibiogram in Tertiary Care Maternity Hospital

Background: Enterococci are gram positive bacteria under family enterococcaceae which occur in pairs or short chains. Aim of the study: The study was conducted on women who are attending to antenatal outpatient department for routine Antenatal / Postnatal checkups and admitted patients with symptomatic bacteriuria and asymptomatic bacteriuria over a period of four years. Materials and methods: This study was done in GMH Sultan Bazar during year January 2011 to December 2015. Socio-demographics and other independent variables were collected from each study participants by using self-structured questionnaire. Data collection was done by principal investigator under the supervision of the advisors. Results: Out of 1544 samples of urine Enterococci was isolated in 80 samples as pure form and as mixture form along with Escherichia coli, Klebsiella and Proteus species. Age 20-30 years were most common effected. Conclusion: Though in various studies the resistance of Enterococci to glycopeptide and vancomycin is reported 1-3% and 11-13%, in our study the Enterococci are 99.75% sensitive to vancomycin which is not routinely used and they are resistant to commonly used penicillin, Methicillin and cephalosporins.

Distribution characteristics and diversity of virulence genes in clinical isolates of vancomycin-resistant enterococci / 中国人兽共患病学报

The aim of this study is to determine the diversity of virulence genes carried by different vancomycin-resistant enterococci (VRE),which will provides a basis for studying pathogenic mechanism of VRE.Microdilution-based drug sensitivity test was applied to detect the vancomycin resistance of 490 Enterococcus faecium isolates and 862 Enterococcus faecalis isolates in Zhejiang area.The seven virulence genes (ace,asa1,cylA,efaA,esp,gelE and hyl) in the isolates of VRE were detected by PCR.According to the results of drug sensitivity test,10％ of the E.faecium isolates (49/490) and 0.8％ of the E.faecalis (7/862) were identified as VRE.In the vancomycin-resistant E.faecium isolates,five isolates were negative for any of the target genes and the other 44 isolates were positive for asa1,esp,gelE and hyl genes alone,in which the esp (73.5％,36/49) and hyl (53.1％,26/49) were the predominant genes and single or double virulence genes acted as the major carrying models.Except for the hyl gene,the vancomycin-resistant E.faecalis isolates were positive for the other six pathogenic genes,and the isolates could carry 3-6 pathogenic genes.All the data indicate that E.faeciurn is the major species of VRE in the local area,and the carrying rate,types and models of virulence genes in the vancomycin-resistant E.faecium and E.faecalis isolates are obviously different.

Brain Abscess Caused by Vancomycin-Resistant Enterococci

No abstract available.

La resistencia a vancomicina más allá de los enterococos / Resistance to vancomycin beyond enterococci

La vancomicina (VAN) es un glucopéptido que inhibe la síntesis de la pared celular y con el tiempo se había transformado en la droga de elección para el tratamiento de infecciones graves por gram positivos. La resistencia observada en enterococos y la sensibilidad disminuida registrada en estafilococos hasta cierto punto han limitado su uso. La aparición de estreptococos del grupo viridans y del grupo B con marcadores de resistencia a vancomicina enciende un alerta en función de su posible pasaje a neumococos y Streptococcus pyogenes (AU)

Vancomycin (VAN) is a glycopeptide inhibiting cell-wall synthesis and has become the drug of choice for the treatment of severe gram-positive infections. Resistance observed in enterococci and decreased sensitivity in staphylococci have to a certain point limited its use. The appearance of the viridans group and group B streptococci showing markers for resistance to vancomycin have caused an alert regarding the possible passage to pneumococci and Streptococcus pyogenes (AU)

Vancomycin‑resistant enterococci in neonatal stool as a cause of septicemia: Challenges for infection control practices.

The increasing reports of vancomycin‑resistant enterococci (VRE) as a cause of neonatal septicemia are of recent interest. However, in majority of the cases, the source of VRE could not be located. As a consequence, the real importance of VRE and its control measures is undermined. Herein, we report a case of neonatal septicemia due to VRE (Enterococcus faecalis) of vanA genotype with VRE carriage in stool of the neonates as a possible source of sepsis. The report put forwards some lacunae in the infection control practices that are presently followed in the country.

Detection of vancomycin resistance in enterococcus species isolated from clinical samples and feces of colonized patients by phenotypic and genotypic methods.

Background: The aim of this study was to find out the clinical correlation between the presence of vancomycin‑resistant genes (van A and van B) and their expression as detected by phenotypic tests in colonized patients and in clinical isolates. Materials and Methods: Enterococci were isolated from various clinical samples and also from fecal specimens of colonized patients at the time of admission, after 48 h and after 5 days of admission. Identification to species level was done using standard methods. Vancomycin susceptibility in Enterococci was detected by disc diffusion test. Minimum inhibitory concentration was determined by agar dilution method. Multiplex polymerase chain reaction (PCR) was used to detect the presence of van genes. Results: Out of all the clinical and fecal samples processed, 12.0% isolates were either vancomycin resistant or vancomycin intermediate. Further, these isolates carried van A or van B genes as confirmed by PCR methods. Expression of van A gene was found to be more in Enterococcus faecalis (28.3%) as compared to Enterococcus faecium (25.0%) in both clinical and fecal isolates. 16.6% strains of E. faecium and 15.0% strains each of E. faecalis and Enterococcus gallinarum were found to carry van B genes. The overall prevalence of vancomycin resistant Enterococci (VRE) in colonized patients was about 9.6%. Prior administration of antibiotics had significant effect (P = 0.001) on VRE carriage. Urinary tract infection was the most common infection caused by vancomycin susceptible Enterococci (VSE), 105/214 (49.0%) and VRE, 13/36 (36.1%). There was no significant difference (P = 0.112) in the distribution of VRE and VSE in different infection types. Both clinical and fecal VRE showed maximum resistance to penicillin, ampicillin, and piperacillin. Resistance to linezolid was 2.8% in clinically isolated VRE. Conclusion: VRE in our study were found to be resistant to a number of commonly used antibiotics. The frequency of isolation of vancomycin resistant E. faecalis (VRE.fs), which is highly virulent, and the number of strains harboring van A gene in our hospital setup is high and needs to be addressed.

Emergence of vanA gene among vancomycin-resistant enterococci in a tertiary care hospital of North - East India.

Background & objectives: Vancomycin-resistant enterococci (VRE) have become one of the most challenging nosocomial pathogens with the rapid spread of the multi-drug resistant strain with limited therapeutic options. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms. The present study was undertaken to determine the emergence of vancomycin-resistant enterococci and the vanA gene among the isolates in a tertiary care hospital of North-East India. Methods: A total of 67 consecutive enterococcal isolates from different clinical samples were collected and identified by using the standard methods. Antibiogram was done by disk diffusion method and VRE was screened by the disk diffusion and vancomycin supplement agar dilution method. The minimum inhibitory concentration (MIC) value for vancomycin was determined by E-test. The VRE isolates were analyzed by PCR for vanA gene. Results: A total of 54 (81%) Enterococcus faecalis and 13 (19%) E. faecium were detected among the clinical isolates and 16 (24%) were VRE. The VRE isolates were multidrug resistant and linezolid resistance was also found to be in three. MIC range to vancomycin was 16-32 μg/ml among the VRE. The vanA gene was found in nine of 16 VRE isolates. Interpretation & conclusions: Emergence of VRE and presence of vanA in a tertiary care hospital setting in North-East India indicate toward a need for implementing infection control policies and active surveillance.