Prevalence Of Vancomycin-resistant Enterococci Research Articles

Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis

BackgroundThe emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia.MethodsLiterature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I2 tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test.ResultsTwenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3; I2 = 74.05%; P < 0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5–19.7%) and 9.9% (95% CI, 2.8–29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9–75.0%).ConclusionThe prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.

Using VRE screening tests to predict vancomycin resistance in enterococcal bacteremia

Enterococcus causes clinically significant bloodstream infections (BSIs). In centers with a higher prevalence of vancomycin resistant enterococcus (VRE) colonization, a common clinical question is whether empiric treatment directed against VRE should be initiated in the setting of a suspected enterococcal BSI. Unfortunately, VRE treatment options are limited, and relatively expensive, and subject patients to the risk of adverse reactions. We hypothesized that the results of VRE colonization screening could predict vancomycin resistance in enterococcal BSI. We reviewed 370 consecutive cases of enterococcal BSI over a 7-year period at 2 tertiary-care hospitals to determine whether vancomycin-resistant BSIs could be predicted based on known colonization status (ie, patients with swabs performed within 30 days, more remotely, or never tested). We calculated sensitivity and specificity, and we plotted negative predictives values (NPVs) and positive predictive values (PPVs) as a function of prevalence. A negative screening swab within 30 days of infection yielded NPVs of 90% and 95% in settings where <27.0% and 15.0% of enterococcal BSI are resistant to vancomycin, respectively. In patients with known VRE colonization, the PPV for VRE in enterococcal BSI was >50% at any prevalence exceeding 25%. The results of a negative VRE screening test result performed within 30 days can help eliminate unnecessary empiric therapy in patients with suspected enterococcal BSI. Conversely, patients with positive VRE screening swabs require careful consideration of empiric VRE-directed therapy when enterococcal BSI appears likely.

511. MDRO Carriage in Patients in Two ICUs and Prevalence of Environmental Surface and Healthcare Worker Hand Contamination

BackgroundDetermining MDRO (multidrug-resistant organism) transmission routes in intensive care units (ICUs) can be complex and require the evaluation of multiple potential MDRO sources, including patients, the environment, and healthcare worker (HCW) hands. The objective of this study was to determine MDRO carriage in patients in two separate ICUs, and simultaneous environmental and HCW hand contamination from associated rooms.MethodsPatient (P), environmental (E), and HCW hand (H) samples were collected from hospital A (1183 H, 1253 E, 729 P) and hospital B (699 H, 1372 E, 437 P) over approximately 5 weeks in each unit. Environmental and HCW hand samples were collected using a cellulose sponge. HCW hand samples were collected prior to any hand hygiene. Patient samples were collected from the axilla, groin, and perianal areas with a flocked swab with patient consent. All samples were tested semi-quantitatively for Clostridium difficile (Cdiff), vancomycin-resistant enterococci (VRE), and cefotaxime-resistant Enterobacteriaceae (Cef-R-Ent) by selective culture. Cdiff isolates representative of each P/E/H cluster were tested for Cdiff toxin testing by PCR.ResultsCdiff, VRE, and Cef-R-Ent were detected in patients, patient rooms, and on HCW hands in both facilities (Table 1). Cdiff was more prevalent in Facility A, while Cef-R-Ent was more prevalent in Facility B. The prevalence of VRE was minimal in both facilities. Cdiff toxin gene testing revealed that 17% of the Cdiff isolate clusters tested positive for toxin genes. In Facility A, the prevalence of a given MDRO was similar regardless of sample type, but was more widely varied between sample types in Facility B. Prevalence of MDROs on HCW hands and in the environment was typically higher in Facility A compared with Facility B. Individual patient positives were frequently linked to positive HCW hand and environmental cultures.ConclusionWe discovered a low prevalence of all MDROs in both facilities, with most positive cultures associated with patients who were not on MDRO precautions. HCW hand and environmental MDRO prevalence was generally similar for each MDRO, regardless of patient prevalence, supporting previously reported links on HCW hand contamination and hospital room surfaces. Disclosures All authors: No reported disclosures.

Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey.

ObjectivesThe aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.DesignMulticentre descriptive and analytic cross-sectional survey.SettingEight EDs and four clinical microbiology departments in Denmark.ParticipantsAdults visiting the ED.Main outcome measuresSwabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.ResultsWe included 5117 patients in the study. Median age was 68 years (54–77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.ConclusionEvery 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.Trial registration number NCT03352167;Post-results.

Microbiological profile and antibiotic susceptibility pattern of Gram-positive isolates at a tertiary care hospital.

OBJECTIVES:Gram-positive infections such as those by Staphylococcus aureus have contributed to the disease burden by increasing the morbidity and mortality rates in India. This study aims to determine the prevalence and the antibiotic susceptibility pattern of Gram-positive pathogens at a tertiary care hospital, Mumbai, Maharashtra, India.MATERIALS AND METHODS:This retrospective cross-sectional study was carried out from January, 2015 to December, 2017, at a tertiary care hospital in Mumbai, India. The clinical isolates were cultured, and identification was done using Vitek 2 culture system. The antibiotic susceptibility testing was done as per the Clinical Laboratory Standard Institute guidelines.RESULTS:Out of 2132 (29%) Gram-positive isolates, S. aureus (49%) was the most common encountered pathogen, followed by Enterococcus spp. (24.5%) and coagulase-negative Staphylococcus (16%). Majority of the S. aureus were observed in patients with skin and soft-tissue infections (61.2%) followed by those suffering from respiratory (41%) and bloodstream infections (35%). Among the infections caused by S. aureus, the prevalence of methicillin resistance was 30%. While the MRSA isolates showed lower sensitivity toward co-trimoxazole (39%), clindamycin (30%), erythromycin (23%), and ciprofloxacin (10%), they showed higher susceptibility to linezolid (98%), vancomycin (98%), and teicoplanin (98%). All the isolates were found to be sensitive to daptomycin and tigecycline. While vancomycin-resistant enterococci (VRE) formed 7.5%, the linezolid-resistant enterococcus species was as high as 4.1%.CONCLUSION:The study showed a high prevalence of MRSA and VRE, thereby emphasizing the increasing antimicrobial resistance pattern of the Gram-positive pathogens. Therefore, there is an urgent need for novel antimicrobial stewardship to restrict the ongoing resistance rate among the isolates.

Using vancomycin-resistant Enterococcus (VRE) rectal swab screening to predict vancomycin resistance in subsequent Enterococcus faecium bacteraemia in high-risk patients

In high-risk patients, colonisation with vancomycin-resistant enterococci (VRE) can lead to invasive infections. A retrospective cohort study was done from 2009–2017 at Singapore General Hospital to study the utility of rectal swab screening in predicting vancomycin resistance in subsequent Enterococcus faecium bacteraemia. Prior VRE screening results were available for 274 episodes of E. faecium bacteraemia. 74 (27.0%) screen tests were VRE-positive. 121 (44.2%) bacteraemia episodes were vancomycin-resistant. The specificity of VRE screening in predicting vancomycin resistance of subsequent E. faecium bacteraemia was high (88.9%), regardless of time from screening to bacteraemia, or agar-based screening protocol used. Negative predictive value was highest (92.3%) when screening was done within 48 h of bacteraemia. Sensitivity (47.1%) and positive predictive value (77.0%) were low. In our institution, VRE prevalence is 4.71% among the targeted surveillance group. Patients with VRE bacteraemia received appropriate antibiotics 1 day later than with vancomycin-susceptible enterococcus (VSE) bacteraemia, and had longer hospital stays (48.8 days vs 39.6 days) and higher 30-day mortality (56.2% vs 42.2%). In our hospital, it may be reasonable to withhold empiric anti-VRE antibiotics when the most recent VRE screen is negative. Empiric VRE-active coverage should be considered if a patient was screen-positive within 48 h of bacteraemia onset.

Magnitude of Vancomycin-Resistant Enterococci (VRE) Colonization among HIV-Infected Patients Attending ART Clinic in West Amhara Government Hospitals.

Background Enterococci that colonize the intestinal tract of immunocompromised patients are an important cause of nosocomial infections. Data on the prevalence of vancomycin-resistant Enterococci (VRE) and its antimicrobial susceptibility patterns and associated factors are scarce in the present study area. Therefore, this study was conducted aimed at determining the prevalence of VRE colonization among HIV-infected patients attending ART clinic at West Amhara Government Hospitals. Methods A cross-sectional study was conducted from 1 February 2017 to 31 May 2017. A total of 349 HIV patients were included in the study. A pretested structured questionnaire was used to collect sociodemographic data and possible associated factors for VRE colonization. Identification and confirmation of Enterococci from stool sample was performed based on the standard procedures. Antimicrobial susceptibility testing was done using the Kirby–Bauer disk diffusion method on the Muller–Hinton agar plate as per the standard protocol, and resistance profile of the isolates was determined according to Clinical and Laboratory Standards Institute (CLIS). Data were analyzed using SPSS v23. Descriptive analysis was used to visualize differences within data. Moreover, the stepwise logistic regression model was done to assess factors associated with VRE colonization. P value was set at 0.05 to indicate statistical significance difference. Results The overall colonization status of Enterococci was at 63% (220/349). The VRE colonization was at 17 (7.7% (95% CI: 4.9–12.0)). Among Enterococcal isolates tested for antimicrobial susceptibility, 142 (64.5%) were found resistant to two or more antibiotics. Antibiotic treatment (for >2 weeks) and history of hospital admission in the last six month were found statistically associated for VRE colonization (AOR = 10.18, (95% CI: 1.9–53.20)) and (AOR = 20.17; (95% CI: 5.22–77.93)), respectively. Conclusions The observed VRE with multidrug resistance colonization need a periodic surveillance of antimicrobial testing to detect emerging resistance and prevent the spread of further drug resistance.

Causative Organisms and Resistance Patterns of Infection in Patients with Myelodysplastic Syndrome (MDS): A 20 Year Retrospective Analysis

Introduction: Although infections are a leading cause of morbidity and mortality in MDS patients, there is limited evidence on causative organisms and resistance patterns in this patient population. This study, the largest series of infection in MDS patients, seeks to comprehensively analyse infection in this cohort.Method: CT scan, microbiology results and hospital admission ICD codes from January 1999 to April 2017 were analysed for 657 MDS patients enrolled in the South Australian MDS (SA-MDS) registry. Cox regression analysis was performed to ascertain risk factors for developing infection.Results: There were 531 primary and 126 therapy-related myeloid neoplasm (t-MN) patients with median age of 69.2 (18-97) years. According to Revised International Prognostic Scoring System (IPSS-R), 44.7% of patients were classified as Intermediate, High and Very High risk. The majority of the cohort (377/657; 57.3%) received best supportive care and 265 had disease modifying therapy including azacitidine (n=142), chemotherapy (n=74) and stem cell transplantation (SCT) (n=25).There were 2450 hospital admissions and 1312(53.5%) were infection-related, in 464/657 patients. The most common sites of infection were lower respiratory tract infections (LRTI) n=449(33.2%), fever with no known source n=356(26.3%) and skin and soft tissue (SSTI; 235, 17.3%).During the study period, 1613/16176 (10%) of microbiology tests were positive. The most common positive tests were blood cultures (494, 30.6%), respiratory viral PCR (227, 14.0%) and bacteriology (other sites; 216, 13.4%).The most common isolates were bacteria (67.3%) followed by viruses (28.1%) and fungi (4.6%). The most common bacteria were gram negative bacilli (GNB); E. coli n=81(12%), Pseudomonas spp. n=64(9%) and Klebsiella spp. n=56(8%), and the most common gram-positive isolates were Staphylococcus aureus n=114(20%) and Enterococcus spp. (37, 7%).There were 192 episodes of bacteraemia in 179 patients. The most common causative organisms were E. coli n=32(16.7%), Klebsiella spp. n=18(9.4%) Pseudomonas spp. n=25(13%), coagulase negative staphylococci n=26(14%), Streptococcus spp. n=22(11%) and Enterococcus spp. n=14(11%). The proportion of GNB bacteremias significantly increased over time (45.8% 1999-2005; 40.0% 2006-2011 and 59.4% 2012-2017 [p=.004]) without increased resistance to commonly used antibiotics. There were 21 enterococcal bacteremias with significant increase in proportion of vancomycin resistant Enterococcus (VRE) after 2011 (p<0.001).The most commonly isolated respiratory viruses were rhinovirus (98, 43.2%), influenza (34, 15%) and parainfluenza (34, 15%), Cytomegalovirus was identified in 154 specimens from 31 patients, all following SCT.70 patients had probable or confirmed fungal infection, with 52 (74.3%) patients having positive fungal cultures or CT findings. The most common sites of fungal infection were chest n=21(76.9%), followed by skin n=5(9.6%), urine n=4(7.7%) and blood n=3(5.8%). Aspergillus n=17(44.7%) was most commonly isolated, followed by Candida spp. n=15(39.5%) and Rhizopus n=3(7.9%).We performed a Cox regression analysis of the risk factors for development of infection requiring hospitalisation, specifically with LRTI, fungal infection and bacteraemia (Table I). Significant predictors were increased age, t-MN, higher IPSS-R score and being transfusion dependent at diagnosis. Receiving disease modifying therapy was a significant risk factor for hospitalisation with fungal infection (p=0.022).Additionally, patients who had hospitalisations for infections had poorer overall survival compared to hospitalised patients without infection (p=0.002, Figure 1).Conclusions: Greater than 50% of hospital admissions in MDS patients were complicated by infection and this was associated with a significant reduction in survival. The most common sites were LRTI, followed by bacteraemia and SSTI.Bacteraemia from GNBs increased over the study period without significant change in resistance patterns, while prevalence of VRE increased since 2011. Respiratory viruses, including influenza, caused significant morbidity, suggesting a role for routine vaccination.RBC transfusion dependency, t-MN and disease modifying therapy are independent risk factors for fungal disease. This highlights a cohort of patients that would benefit from anti-fungal prophylaxis. [Display omitted] DisclosuresHiwase:Celgene: Research Funding; Novartis: Research Funding.

Current Status and Trends of Antibacterial Resistance in China.

The bacterial resistance surveillance system is relatively well established at the national, provincial, and hospital levels in China. Two representative national surveillance networks for bacterial resistance are the China Antimicrobial Resistance Surveillance System (CARSS) and the China Antimicrobial Surveillance Network (CHINET), both established in 2005. CARSS data show the different bacterial resistance rates among different provinces and autonomous regions for each specific bacterium. CHINET data mainly represent the bacterial resistance profiles of teaching hospitals and show the changing trends of bacterial resistance in China. For clinical isolates, the ratio of gram-negative bacilli to gram-positive cocci is approximately 7 to 3. In general, gram-negative bacilli have higher antimicrobial resistance profiles in China. Regarding different bacterial species, antimicrobial resistance is multifaceted. The prevalence of extended-spectrum β-lactamases is high; Acinetobacter baumannii has a high antimicrobial resistance profile; and, notably, the prevalence of CRKP has been showing a marked increase since 2005. In addition, the prevalence of vancomycin-resistant Enterococcus is low, and the prevalence of methicillin-resistant Staphylococcus aureus and antimicrobial resistance in Pseudomonas aeruginosa showed decreasing trends from 2005 to 2017.

Practical methods for effective vancomycin-resistant enterococci (VRE) surveillance: experience in a liver transplant surgical intensive care unit.

We evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling. Prospective, patient-level surveillance program of incident VRE colonization. Liver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.PatientsAll patients admitted to the SICU from June to August 2015. We conducted a point-prevalence estimate followed by admission and weekly surveillance by perirectal swabbing and/or stool sampling. Incident colonization was defined as a negative screen followed by positive surveillance. VRE was detected by culture on Remel Spectra VRE chromogenic agar. Microbiologically-confirmed VRE bloodstream infections (BSIs) were tracked for 2 months. Statistical analyses were calculated using the McNemar test, the Fisher exact test, the t test, and the χ2 test. In total, 91 patients underwent VRE surveillance testing. The point prevalence of VRE colonization was 60.9%; VRE prevalence on admission was 30.1%. Weekly surveillance identified an additional 7 of 28 patients (25.0%) with incident colonization. VRE BSIs were more common in VRE-colonized patients than in noncolonized patients (8 of 43 vs 2 of 48; P=.028). In a direct comparison, perirectal swabs were more sensitive than stool samples in detecting VRE (64 of 67 vs 56 of 67; P=.023). Compliance with perirectal swabbing was 89% (201 of 226) compared to 56% (127 of 226) for stool collection (P≤0.001). We recommend weekly VRE surveillance over admission-only screening in high-burden units such as liver transplant SICUs. Perirectal swabs had greater collection compliance and sensitivity than stool samples, making them the preferred methodology. Further work may have implications for antimicrobial stewardship and infection control.

Similarities and Differences in Risk Factors for Vancomycin-resistant Enterococcus Colonization between an Acute Hospital and its affiliated Intermediate- and Long-term care facilities

Background: Vancomycin-resistant Enterococci (VRE) infections in acute hospitals (AHs) are increasing, but little is known in intermediate- and long-term care facilities (ILTCs). Patients often transfer between AHs and ILTCs. We sought to compare risk factors for VRE colonization between an AH and ILTCs in a healthcare network. Methods & Materials: Two cross-sectional studies were conducted in a 1600-bed tertiary-care AH and its six affiliated ILTCs in June-July 2014 and June-July 2015. Rectal swabs or stool were cultured for VRE. Clinical data were obtained from medical records and associations with colonization made. To control for confounding, multivariable logistic regression models were constructed. Results: Of 3469 patients screened, 11.4% were colonized with VRE. VRE prevalence was higher in the AH(16.9%) than ILTCs(4.4%)(OR 2.75, 95%CI 1.96-3.86, P < 0.001). After adjusting for age, gender, screening year, and co-morbidities, risk factors for VRE colonization in the AH included length of stay(LOS) >14 days(OR 1.67, 95%CI 1.27-2.21, P < 0.001), number of beds in hospital room(OR 1.08 95%CI 1.02-1.15, P = 0.009), presence of wounds(OR 1.82 95%CI 1.39-2.39, P < 0.001), as well as prior admission to the AH(OR 1.42, 95%CI 1.07-1.88, P = 0.014), prior VRE carriage(OR 4.92 95%CI 2.74-8.83, P < 0.001), and prior antibiotics exposure in the preceding 12 months(OR 4.51, 95%CI 2.15-9.44, P < 0.001). For ILTCs, prior admission to AHs(OR 6.73, 95%CI 1.58-28.71, P = 0.010) and prior antibiotics exposure(OR 5.53, 95%CI 1.66-18.40, P = 0.005), presence of indwelling urinary catheter(OR 1.97, 95%CI 1.14-3.40, P = 0.014), and LOS >14 days(OR 0.47, 95%CI 0.26-0.83, P = 0.010) were associated with VRE colonization. Conclusion: Antibiotics exposure and hospitalization in an AH in the preceding 12 months were common risk factors for VRE colonization in the AH and ILTCs. Prior VRE carriage and LOS >14 days increased the risk of colonization in the AH. Presence of indwelling urinary catheter increased but LOS >14 days decreased the risk in ILTCs. Pre-emptive contact precautions and targeted screening could be implemented for these high-risk patients at AHs and ILTCs.

Development of a Statewide Antibiogram to Assess Regional Trends in Antibiotic-Resistant ESKAPE Organisms

Background: Hospitals and other facilities utilize antibiograms as tools for optimal antibiotic selection. Currently, no measures compare broad trends on the regional level, despite interest for more comprehensive data, particularly for antibiotic-resistant ESKAPE organisms. Objective: To collect and compare regional health-care facility antibiogram data for ESKAPE organisms to form a cumulative antibiogram. Methods: Health-care facilities were identified using the publicly accessible Pennsylvania Department of Health web site. Facilities were contacted by phone from June 2015 to 2016 to ascertain participation/consent for the study. An electronic questionnaire ascertained baseline facility characteristics. Facilities provided quantitative antibiotic susceptibility data via antibiograms. Antibiogram data were synthesized as cumulative susceptibilities, stratified by urban/suburban versus rural location. Results: Forty-five facilities were included in the study (n = 18 urban/suburban, n = 27 rural). The overall prevalence of methicillin-resistant S aureus was 41.5%, stratified at 40.6% and 43.3% in urban/suburban and rural facilities, respectively (P < .001). Vancomycin-resistant Enterococcus prevalence was 18.8% overall, with 27.7% in urban/suburban and 14.0% in rural facilities (P < .001). Generally, lower susceptibility rates were found for high-utilization beta-lactams across gram-negative organisms in urban/suburban facilities. Conclusions: Development of a regional cumulative antibiogram that targets key ESKAPE pathogens is feasible, while observed trends may help aid future antimicrobial stewardship efforts.

Epidemiology of Extended-Spectrum β-Lactamase-Producing E. coli and Vancomycin-Resistant Enterococci in the Northern Dutch-German Cross-Border Region.

Objectives: To reveal the prevalence and epidemiology of extended-spectrum β-lactamase (ESBL)- and/or plasmid AmpC (pAmpC)- and carbapenemase (CP) producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) across the Northern Dutch–German border region.Methods: A point-prevalence study on ESBL/pAmpC/CP producing Enterobacteriaceae and VRE was carried out in hospitalized patients in the Northern Netherlands (n = 445, 2012–2013) and Germany (n = 242, 2012). Healthy individuals from the Dutch community (n = 400, 2010–2012) were also screened. In addition, a genome-wide gene-by-gene approach was applied to study the epidemiology of ESBL-Escherichia coli and VRE.Results: A total of 34 isolates from 27 patients (6.1%) admitted to Dutch hospitals were ESBL/pAmpC positive and 29 ESBL-E. coli, three pAmpC-E. coli, one ESBL-Enterobacter cloacae, and one pAmpC-Proteus mirabilis were found. In the German hospital, 18 isolates (16 E. coli and 2 Klebsiella pneumoniae) from 17 patients (7.7%) were ESBL positive. In isolates from the hospitalized patients CTX-M-15 was the most frequently detected ESBL-gene. In the Dutch community, 11 individuals (2.75%) were ESBL/pAmpC positive: 10 ESBL-E. coli (CTX-M-1 being the most prevalent gene) and one pAmpC E. coli. Six Dutch (1.3%) and four German (3.9%) hospitalized patients were colonized with VRE. Genetic relatedness by core genome multi-locus sequence typing (cgMLST) was found between two ESBL-E. coli isolates from Dutch and German cross-border hospitals and between VRE isolates from different hospitals within the same region.Conclusion: The prevalence of ESBL/pAmpC-Enterobacteriaceae was similar in hospitalized patients across the Dutch–German border region, whereas VRE prevalence was slightly higher on the German side. The overall prevalence of the studied pathogens was lower in the community than in hospitals in the Northern Netherlands. Cross-border transmission of ESBL-E. coli and VRE seems unlikely based on cgMLST analysis, however continuous monitoring is necessary to control their spread and stay informed about their epidemiology.

Two-tier approach combining molecular and culture-based techniques for optimized detection of vancomycin-resistant enterococci

Given constantly high or even rising incidences of both colonization and infection with vancomycin-resistant enterococci (VRE), timely and accurate identification of carriers in high-risk patient populations is of evident clinical importance. In this study, a two-tier approach consisting of PCR-based screening and cultural confirmation of positive results is compared to the conventional approach solely based on culture on selective media. The 2-tier strategy was highly consistent with the conventional approach, and was found to possess high sensitivity and specificity (93.1% and 100%, respectively). The introduction of the PCR-based combined VRE screening approach significantly (P<0.0001) reduced median overall time to result by 44.3hours. The effect was found to be most pronounced in VRE negative samples. Positive vanA PCR was highly consistent with culture (PPV: 92.0%, 95% CI: 72.5–98.6%, NPV: 99.6%, 95% CI: 98.9–99.6%), thus allowing for preliminary reporting of VRE detection. In contrast, a vanB positive PCR does not allow for preliminary reporting (PPV: 58.5%, 95% CI: 44.2–71.6%, NPV: 99.8%, 95% CI: 99.2–100%). The introduction of a molecular assay for rapid detection of VRE from rectal swabs combined with cultural confirmation proved to be reliable and time saving, especially in a setting of low VRE prevalence and predominance of vanA positive strains.

Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing.

The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p < 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p < 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.

Prevalence of vancomycin-resistant enterococci from three tertiary care hospitals and role of esp gene in biofilm formation

Prevalence of vancomycin-resistant enterococci from three tertiary care hospitals and role of esp gene in biofilm formation

Emergence of Vancomycin-resistant Enterococci at a Teaching Hospital, Saudi Arabia.

Background:Vancomycin-resistant enterococci (VRE) are a major and emerging hospital-acquired pathogen associated with high mortality, particularly among the critically ill and Intensive Care Units (ICUs) patients. This study aimed to determine the prevalence and demographic and clinical characteristics of VRE among patients admitted to a university hospital in Riyadh, Saudi Arabia.Methods:A study was conducted during the period from September 2014 to November 2015 at King Khalid University Hospital, a tertiary care hospital in Riyadh, Saudi Arabia, including in-patients with VRE infection. Data were collected using laboratory results and the medical records of admitted patients and were analyzed using SPSS version 19.0 statistical software.Results:In a one-year period, 231 enterococci were isolated from blood, urine, exudates, sputum, stool, and body fluid. There were 191 (82.7%) vancomycin-sensitive enterococci (VSE) and 40 (17.3%) isolates were VRE. The Enterococcus species included E. faecalis 168 (72.7%), E. faecium, 53 (22.8%) E. gallinarum 5 (2.2%), and E. avium 5 (2.2%). VRE were more significant from blood specimens (P < 0.0001) while VSE were significantly more predominant from urine specimens (P < 0.0001). VRE were more commonly isolated from patients in ICUs and oncology unit (P = 0.0151 and P < 0.001, respectively) while VSE were more predominant in the medical and surgical areas (P = 0.0178 and P = 0.0178, respectively).Conclusions:This study highlights the high prevalence of VRE in the hospital and the association of enterococcal infections with high-risk areas and oncology units, which warrant more studies looking for better management of these infections.

Antibiotic Resistance Profiling and Genotyping of Vancomycin-Resistant Enterococci Collected from an Urban River Basin in the Provincial City of Miyazaki, Japan

The distribution characteristics of vancomycin-resistant enterococci (VRE) and the resistance of enterococcus isolates to various antibiotics were investigated in Yae River, which flows through Miyazaki city, Japan. The prevalence of VRE among specimens collected from the urban river basin using mEI agar was 0.9% (2 of 226 enterococcal isolates). In the 333 enterococcal isolates obtained using mEI agar or vancomycin-supplemented mEI agar, the possession of the vancomycin-resistant genes (vanA, vanB, vanC1, and vanC2/C3) was examined using multiplex PCR analysis. Although VRE possessing vanA and vanB were not detected in any isolates, isolates possessing vanC2/C3 were detected at all sampling sites and on all days. All isolates (101 strains) possessing vanC2/C3 that were obtained on vancomycin-supplemented mEI agar were identified as E. casseliflavus and analyzed for genotypes using pulse-field gel electrophoresis (PFGE) analysis. These E. casseliflavus isolates revealed them to be genetically highly divergent strains, suggesting that many contamination sources were present in this study area. Many of the enterococcal isolates obtained were resistant to erythromycin, ciprofloxacin, and tetracycline; enterococci distributed in the studied urban river basin are resistant to universally applicable antibiotics. These results indicate that VRE carrying vanC2/C3 are distributed in Yae River, and the sources of VRE are scattered across the river basin.

Preliminary Report: Prevalence of vancomycin-resistantEnterococcus faecalisin public restrooms in central Kentucky

Enterococci are complex Gram positive cocci found in the intestines of humans and animals. For over 30 years, Enterococcus has shown increased resistance to vancomycin and other antimicrobials as seen in nosocomial infections in the United States. Vancomycin-resistant Enterococcus (VRE) in the community was first reported in the United States in 2010, but Europe has seen these organisms in the community for over 20 years. This study examined the prevalence of VRE in public restrooms from three locations in Woodford and Fayette counties in central Kentucky. Restrooms varied in size, location, and user type (male, female or unisex). The public restrooms tested were in a college auditorium, a college student center, a small cafe, and a hospital. Ninety-eight samples from eight restrooms were collected from surfaces including the door handle exiting the entire restroom, the lock on the stall door, the soap dispenser, the floor of the stall, the sink, the paper towel dispenser, the urinal, and the feminine napkin disposal system. Prevalence of Enterococcus faecalis, Enterococcus faecium and VRE was determined. Enterococcus species were identified by conventional biochemical physiologic testing, and vancomycin resistance was determined by the vancomycin agar screen test. VRE was isolated from four out of 98 (4%) of the samples collected. VRE was found on two exit door handles, one soap dispenser, and one feminine napkin disposal system. All of the VRE were found in hospital public (visitors') restrooms. VRE found in public restrooms may be a place for the possible spread of VRE to community members.

Prevalence of Vancomycin Resistant Enterococci in Different Food Samples

Background: Enterococci are known to be a leading cause of nosocomial infections. The threat of enterococcus infections becomes more serious in light of its increasing antimicrobial resistance especially to vancomycin and quinupristin-dalfopristin that are often considered the last treatment available in serious multi-drug resistant infections. Enterococci also can transfer resistance determinants to other bacterial genera. Objectives: The aim of this study was to evaluate the prevalence of vancomycin resistant enterococci in different food samples of animal and plant origin collected from different supermarkets and groceries. Methodology: Two hundred and fifty different food samples (100 meat and fish, 100 vegetables and 50 pasteurized milk and cheese) were processed and cultured on CATC agar a selective medium for detection of enterococci. API 20 Strep kit was used for species identification. All isolates were tested for antibiotic susceptibility by ATB ENTEROC 5 commercial kit. Vancomycin resistant genes were investigated by PCR among vancomycin non susceptible isolates. Results: Enterococci were isolated from 61.2% of the studied samples (153/250). Unpacked cheese showed the highest frequency (93.3%) followed by meat (80.7%), fish (70.5%) and vegetables (60%). Neither pasteurized milk nor packed cheese was positive for enterococci. E.faecium, was the most prevalent species identified among all isolates 86/153 (56.2 %), followed by E. avium 32/153 (21%), E. faecalis 28 /153 (18.3 %) and E.gallinarum E.casseliflavus 7/153 (4.5%). E.faecium was the most prevalent species detected in meat, fish and vegetable {45/67 (67%), 7/12 (58.3%) and 33/60 (55%)} respectively, while E.avium was the most predominant species detected in cheese 7/14 (50%). Isolated Enterococcus species were found to be resistant to erythromycin, tetracycline, rifampicin, chloramphenicol, ciprofloxacin, quinupristin-dalfopristin and vancomycin. Vancomycin resistance was detected in 10/153 (6.5%) of enterococcus isolates. Three vancomycin resistance genes were detected by PCR including vanA, vanC1 and vanC2 genes. Conclusion: our results point out to the fact that raw products of animal origin are possible reservoirs of multi-drug resistant enterococci in the food chain.