Abstract
BackgroundEnterococcus faecium is a multi-resistant nosocomial pathogen causing infection in debilitated patients. Vancomycin-resistant enterococcus faecium (VREfm) are a major concern and increased dramatically worldwide especially in hospitals environment. The current study focused on determining the high prevalence and distribution patterns of antibiotic resistance and also its genetic linkages among various VREfm strains isolated from indoor hospitalized patients in four major Iranian teaching hospitals of Tehran.MethodsThe clinical samples were obtained from hospitalized patients during September 2010 to June 2011 from different teaching hospitals of Tehran. Antibiotics Resistance patterns, minimum inhibition concentration (MIC) value for vancomycin, ampicillin, gentamicin and presence of genetic linkage among the isolates were determined by pulsed-field gel electrophoresis (PFGE).ResultsOverall, total of 92 (41.4%) isolates were identified as E. faecium, 45 (49%) were resistant to vancomycin with an MIC50 of ≥128 mg/L. The results showed that simultaneous resistance to teicoplanin, ampicillin, gentamicin, ciprofloxacine, tetracycline and erythromycin were observed the most frequent pattern. All the vancomycin resistant E. faecium isolates carried the vanA gene. intensive care units (ICUs) and Kidney transplantation, are most probably the wards with highest risk of infection by VRE. 17 pulsotypes were also detected by PFGE, most of the related pulsotypes belongs to the same hospitals.ConclusionsThis study shows the high alarming prevalence of Enterococcus faecium infection and similar clones of VREfm strains in Iranian hospitals with threatening resistance phenotypes.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1270863903102282
Highlights
Enterococcus faecium is a multi-resistant nosocomial pathogen causing infection in debilitated patients
41.4% (n = 92), 51.3% (n = 114) and 7.2% (n = 16) of the isolates were confirmed as E. faecium, E. faecalis and other species of enterococci respectively
Results of PCR for the ddl gene confirmed the biochemically identification in E. faecium isolates
Summary
Enterococcus faecium is a multi-resistant nosocomial pathogen causing infection in debilitated patients. The current study focused on determining the high prevalence and distribution patterns of antibiotic resistance and its genetic linkages among various VREfm strains isolated from indoor hospitalized patients in four major Iranian teaching hospitals of Tehran. Characterization of VREfm strains is crucial for the effective management of infection caused by this organism [6]. This characterization could be achieved with simple assays such as screening for resistance against antibiotics or more complex methods like Pulsed-field gel electrophoresis (PFGE) which is a powerful genotyping method used to study enterococcal distribution [7]. Different studies in Iran suggest the heterogeneity and polyclonal distribution of nosocomial infection in hospital environments [8,9,10]
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