Vancomycin-resistant Enterococcus faecium in Algeria: phenotypic and genotypic characterization of clinical isolates.

Nabila Benamrouche,Kheira Rahal,Hanifa Ziane,Houcine Laouar,Djamal Tiouit,Fatma Zohra Henniche,Ferroudja Yamouni,Farida Assaous,Fazia Djennane,Chafia Bentchouala,Hassiba Tali Maamar,Badia Guettou

doi:10.3855/jidc.12482

Abstract

vancomycin-resistant Enterococcus faecium (VREfm) is a major public health problem worldwide. The aim of our study was to determine the microbiological, epidemiological and molecular characteristics of VREfm isolated in north-central, eastern and western Algeria. a collection of 48 VREfm isolated from September 2010 to April 2017 in several Algerian hospitals were studied. Minimum inhibitory concentrations (MICs) were determined by E-test method according to CLSI guidelines. the detection of van genotype of all strains was performed by PCR. Clonal relationship of five VREfm targeted by region were characterized using multilocus sequence typing (MLST). All isolates have multidrug-resistance (MDR) and were resistant to at least five classes of antibiotics; however, all were susceptible to tigecycline and daptomycin with MIC50 at 0.094 µg/mL and 2 µg/mL respectively. All strains belonged to vanA genotype and have high level of resistance to vancomycin and teicoplanin. MLST revealed two sequence types (STs): ST80 (from the four regions of Algeria) and ST789, both belonging to the former hospital-adapted clonal complex CC17. the alarming dissemination of MDR E. faecium vanA and the ST80 in several regions of Algeria suggest a clonal spread of VREfm strains, which urgently require implementation of adequate infection control measures.

Highlights

Enterococcus faecium has become an important nosocomial pathogen, involved in healthcareassociated infections (HAIs), especially among severely ill and/or immunocompromised patients and causes multiples infections [1,2,3]
From September 2010 to April 2017, 48 nonrepetitive vancomycin-resistant Enterococcus faecium (VREfm) strains were isolated from inpatients in several Algerian hospitals
VREfm strains were more frequently recovered from intensive care units (ICUs) (n = 24; 50.0%) and haematology ward (n = 15; 31.2%), and were isolated mostly from blood (n = 15; 33.3%) and urinary tract (n = 10; 20.8%) and abscesses (n = 7; 14.6%)

Summary

Introduction

Enterococcus faecium has become an important nosocomial pathogen, involved in healthcareassociated infections (HAIs), especially among severely ill and/or immunocompromised patients and causes multiples infections (e.g. urinary tract infections, surgical site infections, bacteremia and endocarditis) [1,2,3]. Multidrug-resistant (MDR) E. faecium has significantly limited therapeutic options for treating serious and sometimes deadly infections due to these pathogens. The European Antimicrobial hold Surveillance Network (EARS-Net) showed that the detection rate of VREfm from 2015 to 2018 increased from 10.5 to 17.3% [8]. According to the Korean Antimicrobial hold state Monitoring System (KARMS) from 2013 to 2015, the detection rate of VREfm grew from 29 to 31% [10]. The Algerian Antimicrobial Resistance Network (AARN) indicated that the VREfm rate from 2014 to 2017 rose from 7.1 to 16% [11,12].

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