Prevalence of vancomycin resistant Enterococci and associated risk factors among clients with and without HIV in Northwest Ethiopia: a cross-sectional study.

Wondwossen Abebe,Feleke Moges,Moges Tiruneh,Mengistu Endris

doi:10.1186/1471-2458-14-185

Abstract

BackgroundEnterococci are the most important multidrug resistant organisms associated with immunocompromised patients. Data are lacking about the epidemiology of vancomycin resistant Enterococci (VRE) in Ethiopia. This study aimed to assess the prevalence of VRE, their susceptibility patterns to different antibiotics and associated risk factors in fecal samples of Human Immunodeficiency Virus (HIV) positive and HIV negative clients.MethodsA cross sectional study was carried out in a total of 226 (113 HIV positive and 113 HIV negative) clients, from July 1/2013 to September 30/2013 at the University of Gondar Teaching Hospital. Data on socio-demographic characteristics and risk factors were collected with a short interview guided by pre-tested structured questionnaire. The enterococci were isolated and identified from stool sample using standard bacteriological procedures. Kary Bauer disk diffusion method was used to determine the susceptibility patterns of Enterococci isolates. Data were entered and analyzed using SPSS version 20 statistical package.ResultsThe overall colonization of Enterococci was 88.9% (201/226) of which 11 (5.5%) were VRE. The prevalence of VRE among clients with and without HIV infections were 8(7.8%) and 3(3.1%), respectively. Ninety percent of the Enterococci isolates (181/201) were resistant to two or more antibiotics tested. Isolates of Enterococci recovered from stool samples of HIV infected patients were more resistant to amoxicillin and amoxicillin-calvulinic acid than HIV negative clients (P < 0.05). Antibiotic treatment for the last 2 weeks was found to be the risk factor that showed statistically significant association with the presence of high VRE colonization. However, the socio-demographic variables and factors such as malnutrition, leucopenia, thromobocytopenia, anaemia, duration of Highly Active Antiretroviral Therapy, CD4 cell count, stage of WHO and drinking alcohol were not associated with VRE (P > 0.05).ConclusionThe high prevalence of VRE in this study signals the emergence of VRE in the study area. Prior antibiotic treatment was associated with VRE colonization. Therefore, rational use of antibiotics and more detailed study using phenotypic and genotypic methods are needed.

Highlights

Enterococci are the most important multidrug resistant organisms associated with immunocompromised patients
Human Immunodeficiency Virus (HIV)-positive patients often receive antibiotic therapy and have frequent contact with the healthcare system, both of which are factors that have been associated with an increased risk of infection with vancomycin resistant Enterococci (VRE) in other populations [6]
The present study aimed to assess the prevalence of VRE, their susceptibility patterns to different antibiotics and associated risk factors in fecal samples of HIV positive and HIV negative clients at the University of Gondar Teaching Hospital

Summary

Introduction

Enterococci are the most important multidrug resistant organisms associated with immunocompromised patients. Enterococci cause urinary tract infections mainly followed by intra-abdominal and pelvic infections. They cause surgical wound infections, bacteraemia, endocarditis, neonatal sepsis and rarely meningitis [1]. Previous antibiotic treatment [2], duration of hospitalization (≥7 days), and duration of vancomycin use (≥7 days) [3], surgical units or intensive-care units; co-morbidities such as diabetes, renal failure; and the presence of a urinary catheter [4], are among the many risk factors for colonization or infection with vancomycin resistance Enterococci (VRE). Ill patients or those with severe underlying disease or immunosuppression such as persons who have had an intra abdominal or cardio-thoracic surgical procedure or an indwelling urinary or central venous catheter are important risk factors [5]. HIV-positive patients often receive antibiotic therapy and have frequent contact with the healthcare system, both of which are factors that have been associated with an increased risk of infection with VRE in other populations [6]

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