Abstract
BackgroundEnterococcus faecalis is a ubiquitous member of the gut microbiota and has emerged as a life- threatening multidrug-resistant (MDR) nosocomial pathogen. The aim of this study was to survey the prevalence of multidrug-resistant and epidemiologically important strains of E. faecalis in the western region of Saudi Arabia using phenotypic and whole genome sequencing approaches.MethodsIn total, 155 patients positive for E. faecalis infection were included in this study. The isolates were identified by MALDI-TOF, and screen for antimicrobial resistance using VITEK-2 system. Genome sequencing was performed with paired-end strategy using MiSeq platform.ResultsSeventeen sequence types (STs) were identified through multilocus sequence typing (MLST) analysis of the E. faecalis genomes, including two novels STs (ST862 and ST863). The most common STs in the Saudi patients were ST179 and ST16 from clonal complex 16 (CC16). Around 96% (n = 149) isolates were MDR. The antibiotics quinupristin/dalfopristin, clindamycin, and erythromycin demonstrated almost no coverage, and high-level streptomycin, gentamycin, and ciprofloxacin demonstrated suboptimal coverage. Low resistance was observed against vancomycin, linezolid, and ampicillin. Moreover, 34 antimicrobial resistance genes and variants, and three families of insertion sequences were found in the E. faecalis genomes, which likely contributed to the observed antimicrobial resistance. Twenty-two virulence factors, which were mainly associated with biofilm formation, endocarditis, cell adherence, and colonization, were detected in the isolates.ConclusionsDiverse STs of E. faecalis, including strains associated with common nosocomial infections are circulating in the healthcare facility of Saudi Arabia and carried multi-drug resistance, which has important implications for infection control.
Highlights
Enterococcus faecalis is a ubiquitous member of the gut microbiota and has emerged as a lifethreatening multidrug-resistant (MDR) nosocomial pathogen
Demographic and clinical characteristics The majority of the isolates were recovered from inpatients (n = 102, 65.8%)
Isolates were recovered from patients with various diseases, which were broadly classified as malignancy, renal and kidneyassociated disease, urinary tract infection (UTI), gastrointestinal tract infection, respiratory tract infection, and pregnancy (Additional file 1: Figure S1)
Summary
Enterococcus faecalis is a ubiquitous member of the gut microbiota and has emerged as a lifethreatening multidrug-resistant (MDR) nosocomial pathogen. Genotyping of E. faecalis and E. faecium by multilocus sequence typing (MLST) and other methods revealed that distinct clones of these species are associated with hospital infections/ outbreaks; these clones are referred to as high-risk enterococcal clonal complexes [8, 9]. In recent years, these species have shown increasing resistance to several antibiotics, including penicillin, aminoglycosides, and glycopeptides, which limits antimicrobial therapeutic options [10]. The mobile genetic elements from enterococci have recently been shown to be able to transfer vancomycin resistance to more pathogenic bacteria such as S. aureus [13]. Monitoring the antimicrobial resistance (AMR) in enterococci from clinical specimens is essential for controlling the spread of resistance genes against vancomycin and other antibiotics
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
