Abstract
Vancomycin-resistant enterococci (VRE) have emerged as an important nosocomial infection. Three important vancomycin resistance types namely, VanA, VanB, VanC are very commonly found in enterococci. VanA and VanB are plasmid-encoded, transferable types of resistance and VanC is chromosomally mediated nontransferable resistance. So for infection control purpose, it is important to know the type of vancomycin resistance to prevent the spread of drug resistance. Enterococci isolated from clinical samples were tested for vancomycin resistance by disc diffusion and macro broth dilution (MIC) method. Vancomycin resistance gene was detected by the polymerase chain reaction (PCR) method. Antimicrobial susceptibility for penicillin, erythromycin, ciprofloxacin, high-level gentamicin, nitrofurantoin, tetracycline, teicoplanin and linezolid was performed by disc diffusion method. Antibiotyping of VRE strains was done based on their antimicrobial susceptibility pattern. Over a period of one year out of 246 clinical isolates of enterococci, seven (2.8%) isolates showed vancomycin resistance. Based on MICs and PCR, all the isolates demonstrated VanA type of resistance. Analysis of antibiogram showed three different antibiotype patterns for VRE labelled as 1,2,3. The majority of VRE isolates (72%) belonged to “Pattern 1”. Also clustering of cases of “Pattern 1” was observed in medicine ICU and medicine ward. These areas were identified as a potential reservoir for VRE infection and appropriate infection control measures were taken to curtail the spread of infection. The present study recommends a macro broth dilution method for detection of the type of vancomycin resistance in enterococci and “antibiotyping” as a basic typing method for VRE in resource-poor health care settings specifically in outbreak situations.
Highlights
Enterococci are part of normal microbial flora of oral cavity, gut and genitourinary tract.[1]
Vancomycin resistance gene was detected by the polymerase chain reaction (PCR) method
Clustering of cases of “Pattern 1” was observed in medicine ICU and medicine ward. These areas were identified as a potential reservoir for Vancomycin-resistant enterococci (VRE) infection and appropriate infection control measures were taken to curtail the spread of infection
Summary
Enterococci are part of normal microbial flora of oral cavity, gut and genitourinary tract.[1] They are ubiquitously found in different environments such soil, water, sewage and plants.[2] Being opportunistic pathogens enterococci cause infections in susceptible host. Enterococci E. faecium has inherent tendency to acquire resistance against multiple group of antibiotics, which makes enterococci an important cause of nosocomial infections.[3]. Vancomycin is the high end antibiotic which can be used for treatment of infections caused by multidrug resistant enterococci.[4,5] Enterococci have developed resistance against vancomycin known as Vancomycin resistant enterococci (VRE). Emergence of VRE is largely related to inappropriate use of antibiotics mainly vancomycin in health care settings.[6] Different infections caused by VRE includes endocarditis, septicemia, urinary tract infections, wound infections, intraabdominal infections mainly in hospitalized patients.[7]
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