RESUMO
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.
RESUMO
Background: Enterococci, though commensals in adult faeces are important nosocomial pathogens. Their emergence in past two decades is in many respects attributable to their resistance to many commonly used antimicrobial agents (aminoglycosides, cephalosporins, aztreonam, semisynthetic penicillin, trimethoprim-sulphamethoxazole). Objectives: To study the prevalence of Multidrug resistant (MDR) Enterococci plus Vancomycin resistance and High Level Gentamicin Resistance (HLGR) in different enterococcal isolates. Materials and methods: Total 125 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. Enterococci resistant to more than three drugs plus high level Gentamicin (120 µg) resistance were labelled as multidrug resistant (MDR). HLGR was determined by disc diffusion method using high level Gentamicin disc (120 µg). Minimum inhibitory concentration (MIC) determination for detecting Vancomycin resistance was done by HiComb MIC Test strips and microbroth dilution method. Results: Total 125 entetococcal isolates were studied. In this study the multiple drug resistance was verified in 44 (35.20%) isolates of Enterococcus species and only 2 isolates (1.72%) were found to be VRE but HLGR was detected in 53.6% of the isolates. Conclusion: During past two decades, enterococci resistant to multiple antimicrobial agents have been recognized, including strains resistant to vancomycin, β-lactams and aminoglycosides, making it a formidable nosocomial pathogen. Such strains pose therapeutic dilemmas for clinicians. Thus, it is crucial for laboratories to provide accurate antimicrobial resistance patterns for enterococci so that effective therapy and infection control measures can be initiated.
RESUMO
Background: Enterococci causes serious infection due to its higher ability to colonize and increasing resistance to various drugs. Mutation and plasmid mediated genetic exchange are the main reason for the high rate of acquisition of antibiotic resistance. The study was aimed to determine the antibiotic resistance profile of the enterococcal isolates from various clinical samples and to detect the presence of aac (6′) Ie-aph (2″) Ia gene in the isolates which show phenotypic high level gentamicin resistance. Methods: Clinical enterococcal isolates from a tertiary care hospital in southern Delhi were subjected to antibiotic susceptibility testing. MIC for High level gentamicin was measured and the isolates were tested for presence of aac (6′) Ie-aph (2″) Ia gene by PCR. Results: Out of the total 146 Enterococcal isolates, 112 were E. fecalis, 33 were E faecium and 1 was E gallinarum. 26.02% were resistant to High level gentamicin, and 15% were resistant to streptomycin. Vancomycin resistance was 5.4%. 11 E. fecalis and 25 E. faecium isolates showed presence of aac (6′) Ie-aph (2″) Ia gene. Conclusions: High level antibiotic resistance among enterococci and the spread of vancomycin resistant is an issue of serious concern. Isolation rate of E. fecalis was much higher than E. faecium, but aac (6′) Ie-aph (2″) Ia gene was more prevalent in E.faecium. The study highlights spread of the gene aac (6′)-Ie-aph (2″)-Ia among the enterococcal isolates which can be easily transferred to other pathogenic gram positive cocci.
RESUMO
High-level gentamicin resistance (HLGR) in enterococci has increased since the 1980s, but the clinical significance of the resistance and its impact on outcome have not been established. One hundred and thirty-six patients with bacteremia caused by enterococci with HLGR (HLGR group) were compared with 79 patients with bacteremia caused by enterococci without HLGR (non-HLGR group). Hematologic malignancy, neutropenia, Enterococcus faecium infection, nosocomial infection and monomicrobial bacteremia were more common in the HLGR group than the non-HLGR group, and APACHE II scores were also higher (P<0.05, in each case). Neutropenia, monomicrobial infection, stay in intensive care at culture, and use of 3rd generation cephalosporin, were independent risk factors for acquisition of HLGR enterococcal bacteremia. Fourteen-day and 30-day mortalities were higher in the HLGR group than the non-HLGR group in univariate analysis (37% vs. 15%, P=0.001; 50% vs. 22%, P<0.001). However, HLGR was not an independent risk factor for mortality due to enterococcal bacteremia in multivariate analysis. Therefore, HLGR enterococcal bacteremia is associated with more severe comorbid conditions and higher mortality than non-HLGR enterococcal bacteremia but the HLGR itself does not contribute significantly to mortality.