Abstract
Background and study aim: During last two decades, there has been a world-wide trend in increasing occurrence of entero-coccal infections in the hospitals. The aim of present study was to determine the spectrum of enterococcal infections, speciesprevalence, antimicrobial resistance and characteristics of vancomycin resistant enterococci (VRE) in a tertiary care hospital, Eastern India. Patients and Methods: Between January 2013 and July 2014, 152 Enterococcus species were obtained from clinical samples. Enterococci were identified using standard biochemical tests. Antimicrobial susceptibility was tested by Kirby-Bauer disk diffusion according to Clinical & Laboratory Standards Institute (CLSI) guidelines.VRE agar base was used to screen VRE isolates. Minimum inhibitory concentration (MIC) values of VRE isolates were determined using Epsilometer-test. VRE isolates were also examined by PCR to detect vanA gene. Results: From 1602 clinical samples, 961 (60%) were culture positive and 152(15.8%) enterococcal isolates were obtained. Most common species isolated was E. faecalis (63.8%) followed by E. faecium (35.5%). Majority of enterococcal infections were detected from ICUs and surgical wards and clinically presented as UTIs. Disk diffusion method showed 67.1% were resistant to penicillin, 61.2% ampicillin, 58.5% ciprofloxacin, 46.7% high-level gentamicin, 42. 8% high-level streptomycin, 7.9% teicoplanin and none to linezolid. Twenty (13.2%) enterococcal isolates were vancomycin resistant in VRE screen and disk diffusion method. Epsilometer-test of VRE isolates showed 8 (40%) isolates were resistant and 9 (45%) were intermediately resistant. From 20 VRE isolates, six showed VanA and two VanB phenotypes and all six VanA phenotypes had vanA gene cluster. Conclusion: More accurate and reliable MIC determination tests should be performedin all suspected VRE isolates. Confirmatory PCR is required for identifying resistant gene cluster.
Highlights
Gram-positive enterococci are normal commensals of the gastrointestinal tract, oral cavity, genitourinary tract and skin especially perineal area in both humans and animals [1]
The distribution of antimicrobial susceptibility patterns of isolated enterococci were summarized in Table (3)
While E. faecalis remains the predominant species in clinical infections, E. faecium isolates are increasing in proportion
Summary
Gram-positive enterococci are normal commensals of the gastrointestinal tract, oral cavity, genitourinary tract and skin especially perineal area in both humans and animals [1]. 19 species within the genus have been recognized, E. faecalis is the most predominantly isolated pathogen, followed by E. faecium [2]. The rise in prevalence of enterococcal infections in humans is influenced by the ability of enterococci to escape the action of most commonly used antibiotics. The aim of present study was to determine the spectrum of enterococcal infections, species prevalence, antimicrobial resistance and characteristics of vancomycin resistant enterococci (VRE) in a tertiary care hospital, Eastern India. Patients and methods: Between January 2013 and July 2014, 152 Enterococcus species were obtained from clinical samples. Antimicrobial susceptibility was tested by Kirby-Bauer disk diffusion according to Clinical & Laboratory Standards Institute (CLSI) guidelines.VRE agar base was used to screen VRE isolates. Minimum inhibitory concentration (MIC) values of VRE isolates were determined using Epsilometer-test. Results: From 1602 clinical samples, 961 (60%) were culture positive and 152
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