Prevalence Of Vancomycin-resistant Enterococci Research Articles

Vancomycin Resistant Enterococci and Trend of Antimicrobial Susceptibility in Urine Cultures

Background: Enterococci are emerging nosocomial pathogen showing resistance to broad spectrum antibiotics. As reported by the center for disease control and prevention, enterococci (13.9%) are the second leading cause of urinary tract infection, after Escherichia coli. After the first report of vancomycin-resistant enterococci in England (1988), India reported its first vancomycin resistant enterococci isolate from New Delhi (1999). The prevalence of vancomycin resistant enterococci ranges from 1-9%, in India. To evaluate the prevalence of vancomycin resistant enterococci among urinary isolates and to check their antimicrobial resistance pattern. Methods: A retrospective observational study conducted at a tertiary care hospital. Data were analysed from November, 2017 to October, 2018. A total of 12,129 urine samples were received and subjected to culture on HiCrome UTI agar (Hi-Media laboratories, Mumbai) and incubated at 37 °C for a period of 18-24 hours. Antimicrobial susceptibility was performed using Kirby–Bauer disc diffusion method. Identification was done on the basis of colony colour and species identification was done by using biochemical test as per standard laboratory protocol. In one case automated siemens microscan walkaway identification system was used for confirmation. Results: Enterococci were isolated in 4.06% from urine cultures out of which 7.52% were vancomycin resistant. Most of the vancomycin resistant enterococci isolate (86.49%) were multi drug resistant. Conclusion: In vancomycin resistant enterococci related urinary tract infection, nitrofurantoin can be used as an appropriate first choice in uncomplicated cases and linezolid should be reserved for serious and complicated urinary tract infections.

Evaluation of Screening Results for Vancomycin-Resistant Enterococci: Three-Year Surveillance.

Enterococci are facultative anaerobic, binary, or chained Gram-positive cocci. The gastrointestinal colonization of hospitalized patients is the most important reservoir of vancomycin-resistant enterococci. We aimed to evaluate retrospectively the screening results of vancomycin-resistant enterococci, studied by the simultaneous (real-time) polymerase chain reaction method on rectal swabs of adult and pediatric patients hospitalized in our hospital in 2019-2021. Adult and pediatric patients were included in our study between Jan 2019 and Dec 2021. The results of vancomycin-resistant enterococci, studied with the real-time polymerase chain reaction method from rectal swabs sent from intensive care units and services, were analyzed retrospectively. Isolation of the samples was performed using the Fluorion VRE QLP 1.0 real-time polymerase chain reaction kit (Iontek, Turkey), and detection was performed with the Fluorion Detection System (Iontek, Turkey) real-time polymerase chain reaction device. Overall, 31,725 patients were included in our study. When evaluated in order of years, in 2019, 379 (7%) of 5,389 adults, 322 (7.4%) of 4,003 children, 234 (5.5%) of 4,185 adults in 2020, 157 (2.4%) of 6,499 children, and in 2021, vancomycin-resistant enterococci were detected in 469 (7.5%) of 6,232 adults and 224 (4.1%) of 5,417 children. The prevalence of vancomycin-resistant enterococci is greater in adults, particularly in intensive care units, compared to children. Infection control precautions and training be augmented in high-risk clinics, while the unnecessary utilization of glycopeptides should be limited.

Evaluation of Antimicrobial Resistancein Clinical Isolates of Enterococcus spp. Obtained from Hospital Patients in Latvia.

Background and Objective: Enterococci are typically found in a healthy human gastrointestinal tract but can cause severe infections in immunocompromised patients. Such infections are treated with antibiotics. This study addresses the rising concern of antimicrobial resistance (AMR) in Enterococci, focusing on the prevalence of vancomycin-resistant enterococcus (VRE) strains. Materials and Methods: The pilot study involved 140 Enterococci isolates collected between 2021 and 2022 from two multidisciplinary hospitals (with and without local therapeutic drug monitoring protocol of vancomycin) in Latvia. Microbiological assays and whole genome sequencing were used. AMR gene prevalence with resistance profiles were determined and the genetic relationship and outbreak evaluation were made by applying core genome multi-locus sequence typing (cgMLST). Results: The acquired genes and mutations were responsible for resistance against 10 antimicrobial classes, including 25.0% of isolates expressing resistance to vancomycin, predominantly of the vanB type. Genetic diversity among E. faecalis and E. faecium isolates was observed and seven potential outbreak clusters were identified, three of them containing sequence types ST6, ST78 and ST80. The prevalence of vancomycin resistance was highest in the hospital without a therapeutic drug-monitoring protocol and in E. faecium. Notably, a case of linezolid resistance due to a mutation was documented. Conclusions: The study illustrates the concerning prevalence of multidrug-resistant Enterococci in Latvian hospitals, showcasing the rather widespread occurrence of vancomycin-resistant strains. This highlights the urgency of implementing efficient infection control mechanisms and the need for continuous VRE surveillance in Latvia to define the scope and pattern of the problem, influencing clinical decision making and planning further preventative measures.

Prevalence of Vancomycin Resistant Enterococcus in Various Clinical Specimens in Tertiary Care Hospital

Prevalence of Vancomycin Resistant Enterococcus in Various Clinical Specimens in Tertiary Care Hospital

Antimicrobial resistance of clinical bacterial isolates in China: current status and trends.

Antimicrobial resistance surveillance systems have been established in China. Two representative national surveillance networks are the China Antimicrobial Surveillance Network (CHINET) and China Antimicrobial Resistance Surveillance System (CARSS), both of which were established in 2005. For all clinical isolates collected in both of these surveillance networks, the ratio of Gram-negative bacilli to Gram-positive cocci was approximately 7:3 during the past 18 years. Generally, Gram-negative bacilli have a higher antimicrobial resistance profile in China. The prevalence of ESBLs in Escherichia coli is as high as approximately 50%. Acinetobacter baumannii-calcoaceticus complex (ABC) has a high antimicrobial resistance profile, with a carbapenem resistance rate of approximately 66%. However, the prevalence of carbapenem-resistant ABC has also shown a decreasing trend from 2018 to 2022. The prevalence of vancomycin-resistant Enterococcus was low, and the prevalence of MRSA and carbapenem-resistant Pseudomonas aeruginosa showed decreasing trends from 2005 to 2022. CHINET surveillance data demonstrated that the prevalence of carbapenem-resistant Klebsiella pneumoniae showed a remarkable increasing trend from 2.9% (imipenem resistance) in 2005 to 25.0% in 2018, and then slightly decreased to 22.6% in 2022. The decreasing trends may reflect the antimicrobial stewardship efforts in China: a professional consensus on the rational clinical use of carbapenems was issued by the National Health Commission of China and was well implemented nationally; after that, the clinical use of carbapenems decreased slightly in China.

Treatment of Helicobacter Pylori İnfection and the Colonization of the Gastrointestinal System by Resistant Bacteria.

Helicobacter pylori (H. pylori) infections are widely treated with antibiotic regimens such as "Amoxicillin 1 gr 2 × 1 tablet, Clarithromycin 500 mg 2 × 1 tablet, and Lansoprazole 30 mg 2 × 1 tablet" for 14 days. We conducted a prospective observational study to explore whether this treatment protocol serves as a predisposing factor for the colonization of resistant gastrointestinal microflora, namely vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase Enterobacterales (ESBL-E), and carbapenem-resistant Enterobacterales (CRE). Pre- and post-treatment stool samples from 75 patients diagnosed with H. pylori, without a prior treatment history, were cultured and evaluated based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Of the 75 evaluated patients, a pronounced surge in ESBL-E positivity was observed. Before initiating antibiotic treatment, 12 patients (16%) had ESBL-E-positive strains in their gastrointestinal tract. Notably, this number surged to 24 patients (32%) after the conclusion of the 14-day treatment regimen. The change was statistically significant, with a P value of less than 0.002, indicating a clear association between treatment for H. pylori and heightened ESBL-E colonization. Notably, VRE and CRE remained undetected in patients throughout the study, suggesting that the treatment regimen may specifically amplify the risk of ESBL-E colonization without affecting VRE and CRE prevalence. As the inaugural report from Turkey on this issue, our study suggests that antibiotic regimens for H. pylori eradication contribute to the increased risk of ESBL-positive bacterial colonization in the gastrointestinal tract.

Vancomycin Resistant Enterococci Prevalence, Antibiotic Susceptibility Patterns and Colonization Risk Factors Among HIV-Positive Patients in Health-Care Facilities in Debre Berhan Town, Ethiopia.

The majority of multidrug-resistant organisms found in immunocompromised patients are enterococci. The rise of vancomycin-resistant enterococci (VRE) poses a significant threat to public health. There is a scarcity of information regarding the prevalence of VRE in Ethiopia. This study aims to determine the prevalence of VRE in fecal samples from Human Immunodeficiency Virus (HIV)-positive individuals, to identify associated factors, and to assess their susceptibility to selected commonly prescribed medications. A cross-sectional study was conducted from April 1 to July 15, 2023, on 170 HIV-positive clients at Debre Berhan Town. A pre-tested structured questionnaire was used to collect socio-demographic and clinical data. Stool sample was collected by trained health workers, and processed by standard microbiological techniques. Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. Data entry and analysis was carried out by SPSS Version 25. Bivariate and multivariate logistic regressions were used to assess the associated factors. Variables with a p-value of <0.05 were considered to be significantly associated with the outcome variables and the results were displayed with tables. From the total of 170 study participants, colonization of Enterococcus species was observed among 95 (55.9%). Vancomycin resistance was found in 13 (13.8%) of them with 95% confidence interval (CI) 7.4-22.1. History of hospitalization Adjusted Odds Ratio (AOR): 11.9 (95% CI 1.11-127.53); habit of eating uncooked food (AOR: 15.34 (95% CI 2.36-99.63)) and invasive procedures (AOR: 23.07 (95% CI 3.54-150)) were among the predictors of VRE. MDR (multidrug resistance) was observed in 83 (87.4%) of the isolates. The highest rate of resistance was observed for ampicillin with 72 (74.6%). Vancomycin and multidrug resistance of enterococci among HIV patients are significant in ART clinics of Debre Berhan Town. These warrant applicable infection prevention guidelines in the health facilities and health education on food hygiene.

Epidemiology of vancomycin-resistant enterococci in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data.

Enterococci are usually low pathogenic, but can cause invasive disease under certain circumstances, including urinary tract infections, bacteremia, endocarditis, and meningitis, and are associated with peritonitis and intra-abdominal abscesses. Increasing resistance of enterococci to glycopeptides and fluoroquinolones, and high-level resistance to aminoglycosides is a concern. National antimicrobial resistance (AMR) surveillance data for enterococci from the Middle East and North Africa (MENA) and the Gulf region is scarce. A retrospective 12-year analysis of N = 37,909 non-duplicate diagnostic Enterococcus spp. isolates from the United Arab Emirates (UAE) was conducted. Data was generated by routine patient care during 2010-2021, collected by trained personnel and reported by participating surveillance sites to the UAE National AMR Surveillance program. Data analysis was conducted with WHONET. Enterococcus faecalis was the most commonly reported species (81.5%), followed by Enterococcus faecium (8.5%), and other enterococci species (4.8%). Phenotypically vancomycin-resistant enterococci (VRE) were found in 1.8% of Enterococcus spp. isolates. Prevalence of VRE (%VRE) was highest for E. faecium (8.1%), followed by E. faecalis (0.9%). A significant level of resistance to glycopeptides (%VRE) for these two species has been observed in the majority of observed years [E. faecalis (0-2.2%), 2010: 0%, 2021: 0.6%] and E. faecium (0-14.2%, 2010: 0%, 2021: 5.8%). Resistance to fluoroquinolones was between 17 and 29% (E. faecalis) and was higher for E. faecium (between 42 and 83%). VRE were associated with higher patient mortality (RR: 2.97), admission to intensive care units (RR: 2.25), and increased length of stay (six excess inpatient days per VRE case), as compared to vancomycin-susceptible Enterococcus spp. Published data on Enterococcus infections, in particular VRE-infections, in the UAE and MENA region is scarce. Our data demonstrates that VRE-enterococci are relatively rare in the UAE, however showing an increasing resistance trend for several clinically important antibiotic classes, causing a concern for the treatment of serious infections caused by enterococci. This study also demonstrates that VRE were associated with higher mortality, increased intensive care unit admission rates, and longer hospitalization, thus poorer clinical outcome and higher associated costs in the UAE. We recommend the expansion of current surveillance techniques (e.g., local VRE screening), stricter infection prevention and control strategies, and better stewardship interventions. Further studies on the molecular epidemiology of enterococci are needed.

Identification of Vancomycin Resistant Enterococcus Genes in Clinical Isolates

Vancomycin resistant enterococci (VRE) nosocomial diseases are rapidly spreading across the world. To treat these diseases is becoming a great challenge due to antibiotic resistance. The present study was aimed to estimate the prevalence of vancomycin resistant enterococci and to find out genes responsible for causing vancomycin resistance. One hundred different blood, wound and urine samples were collected from hospitalized patients at tertiary care health hospital, Lahore. On the basis of colony morphology, isolates of Enterococci were identified, Gram staining and biochemical tests including catalase test, Bile esculin test, growth in 6.5% NaCl, litmus milk reduction were performed. All the clinical isolates were checked for vancomycin resistant and 15% of all the samples were vancomycin resistant. Polymerase chain reaction (PCR) was performed for vancomycin resistance, enterococcal isolates to identify van genes responsible for resistance. In our study the presence of vanA gene was found in all 15 vancomycin resistant samples. vanB gene was not detected in any of the sample. The study highlights the increased VRE prevalence in clinicalisolates obtained from local hospital. The presence of vanA gene in all resistant samples is suggestive of its role as resistant gene. On the basis of these results there is an urgent need of establishing a rational antibiotic use policy for better management of enterococcal infections.

Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: a systematic review and meta-analysis

BackgroundVancomycin-resistant Enterococci (VRE) infections are recurrently reported in different parts of India in the last two decades. However, an up-to-date, countrywide information concerning the prevalence and the rate of VRE in India is limited and hence this study aimed to estimate the pooled prevalence of VRE in India.MethodsA literature search was performed using various databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Cross-sectional studies reporting the prevalence of VRE in India from human samples whereby at least two Enterococci were isolated between 1 January 2000 and 31 December 2022 were sought for inclusion. Data were extracted and analysed using Microsoft Excel and Comprehensive Meta-analysis version 4, respectively.ResultsNineteen studies were included in the analyses. A collective total of 3683 Enterococci isolates were examined, of which 368 were VRE strains. The pooled prevalence of VRE in India was calculated at 12.4% (95% CI: 8.6–17.5; Q = 189.69; I2 = 90.51%; p = < 0.001). E. faecalis was the most frequently isolated species (1450 [39.37%]) followed by E. faecium (724 [19.66%]). Amongst the VRE strains, E. faecium was the most prevalent (214 [58.15%]) followed by E. faecalis (134 [36.41%]). An upsurge in the rate of VRE infections was observed in India over time: VRE prevalence was estimated at 4.8% between 2000 and 2010 and 14.1% between 2011 and 2020.ConclusionThis study presents the most up-to-date information on the rate of VRE infections in India. Though lower than the findings for some less developed countries, VRE prevalence in India is notable and on the rise.

Status of Biofilm Production and Vancomycin Resistance in Enterococcus in the Rural Population of Mathura, India.

Introduction Hospital-acquired or nosocomial infections caused by the rapidly emerging bacteria vancomycin-resistant enterococci can be dangerous and even fatal. Therefore, this study aimed to investigate the presence of enterococci in various clinical specimens along with their vancomycin resistance status and biofilm-producing capabilities. Methods A total of 164 Enterococcus species were isolated and further included in this study. Isolation and identification were done by the standard bacteriological procedure, antibiotic susceptibility testingwas done by clinical laboratory standard guidelines, and biofilm production test was done by microtiter plate methods. Results Among the total of 164 isolates, Enterococcus faecalis constituted 60.97% and Enterococcus faecium constituted 39.02%. Maximum isolates were from urine samples. The prevalence of vancomycin-resistant Enterococcus was 6.70%, and 18.29% of Enterococcus isolates were biofilm producers. The sensitivity among the biofilm producers was maximum for linezolid (87.33%), followed by teicoplanin (86.43%) and vancomycin (79.64%). Conclusion High prevalence of enterococci was found in urine samples andbiofilm producers Enterococcus isolates were more antibiotic-resistant than non-biofilm producers.

Culture-dependent and molecular characterization of Vancomycin-Resistant Enterococci from clinical, food, and water samples across Osun State, Southwest Nigeria

The emergence and continuous rise in the prevalence of vancomycin-resistant Enterococci (VRE) are alarming and pose a public health threat. The factors responsible for this include intrinsic resistance, acquired resistance, and horizontal gene transfer among Enterococci. This study aimed to evaluate the current prevalence rate, phenotypic and genotypic identification of VRE strains isolated from clinical (in and out-patients), ready-to-eat (RTE) food, and water samples across three geopolitical regions of Osun State in southwestern Nigeria. A total of 466 clinical, RTE food and water samples were analyzed using conventional microbiological techniques, molecular identification of isolates, and detection of van genes using specific primers by polymerase chain reaction (PCR). Phenotypic identification revealed 69 VRE isolates; 64 of which were confirmed VRE with molecular techniques. The overall VRE prevalence rate was 13.7% (64/466), while the proportion of Enterococci that was VRE was 34.6% (64/185). The prevalence of clinical, food, and water samples from the individual sample types was 15.7% (26/166); 14.0% (21/150,) and 11.3% (17/150) respectively.The occurrence of VRE species was 45.3% for E. faecalis, 12.5% for E. hirae, 4.7% each for E. gallinarum, and E. durans; 3.1% each for E. faecium and E. casseliflavus and 1.6% for E. avium. Other unidentified species were 16 (25.0%). Additionally, 47 (73.4%) had either the vanA, vanB, or vanC genes; as detected in 10 (15.6%), 8 (12.5%), and 29 (45.3%) isolates respectively across the different sample types and species respectively. Hence, a high occurrence of vanC carriage in the recovered VRE isolates was recorded. This information is vital as continued monitoring and surveillance is crucial to provide data to clinicians and public health workers. It could serve as a key factor in managing and curtailing the spread of VRE strains, to control its growth and infections caused in hospital and community settings.

Low prevalence of antimicrobial resistant organisms (methicillin resistant Staphylococcus aureus, extended beta-lactamase producing Enterobacteriaceae, and vancomycin resistant enterococci) in bulk tank milk in New South Wales, Australia.

Estimate the presence of methicillin resistant Staphylococcus aureus (MRSA), extended beta-lactamase (ESBL) producing Enterobacteriaceae, and vancomycin resistant enterococci (VRE) in bulk tank milk in dairy herds in New South Wales (NSW), Australia. Bulk tank milk samples (n = 80) were collected from dairy farms (n = 40, i.e. 2 per farm) in NSW during 2021. Bacteria were cultured using selective chromogenic indicator media with isolate identity confirmed using biochemical testing, Gram stain, and MALDI-TOF mass spectroscopy. Antimicrobial resistance (AMR) was confirmed using antibiotic disk diffusion. No samples tested positive to the targeted AMR organisms. The prevalence of MRSA, ESBL-producing Enterobacteriaceae, and VRE is low in NSW dairy herds.

Determine phenotypical patterns of resistance to antibiotics in COVID-19 patients with associated bacterial infection: largest medical center in Iran.

Antibacterial resistance (AMR) is a serious threat and major concern, especially in developing countries. Therefore, we aimed to determine phenotypical patterns of resistance to antibiotics in COVID-19 patients with associated bacterial infection in intensive care units. In this cross-sectional study, 6524 COVID-19 patients admitted for more than 48 h in the ICUs of Imam Khomeini Complex Hospital (IKCH) in Tehran from March 2020 to January 2022 were included in the study with initial diagnosis of COVID-19 (PCR test and chest imaging). Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, length of ICU and hospital stay, microbial type, and antibiotic resistance. In this study, the pattern of antibiotic resistance was determined using the Kirby-Bauer disk diffusion method. In this study, 439 (37.5%) were ventilator-related events (VAEs), and 46% of all hospitalized patients had an underlying disease. The most common microorganisms in COVID-19 patients were carbapenem resistant Klebsiella pneumoniae (KPCs) (31.6%), Escherichia coli (E. coli) (15.8%), and Acinetobacter baumannii (A. baumannii) (15.7%), respectively. Prevalence of vancomycin-resistant enterococci (VRE) and KPCs were 88% and 82%, respectively. A study on AMR surveillance is the need of the hour as it will help centers to generate local antibiograms that will further help formulate national data. It will guide doctors to choose the appropriate empiric treatment, and these studies will be the basis for establishing antimicrobial surveillance and monitoring and regulating of the use of antimicrobials.

PREVALENCE AND ANTIMICROBIAL RESISTANCE IN ENTEROCOCCUS SPECIES

Objectives: The study was conducted to determine the prevalence of vancomycin-resistant Enterococci (VRE) isolated from various clinical samples received from the indoor patients of all age groups admitted in Government Medical College and Hospital, Amritsar. Methods: A prospective cross-sectional study was conducted in the Department of Microbiology, Government Medical College, Amritsar, for a period of 4 years (July 1, 2018–June 30, 2022). All the samples (pus, urine, blood, body fluids, sputum, etc.) received from the indoor patients of all age groups admitted in Government Medical College and Hospital, Amritsar, were included in the study. Results: During the study period of 4 years, among the culture positive samples, 1815 (6.62%) isolates were identified as Enterococcus species. Among 1815 isolates, 1089 isolates were Enterococcus faecalis (60%) and 726 were Enterococcus faecium (40%). Both E. faecalis and E. faecium isolates showed the maximum resistance to ciprofloxacin while linezolid, teicoplanin, and quinupristin/dalfopristin showed the maximum sensitivity. Conclusion: Our study reports the prevalence of Enterococci isolates as well of VRE isolates. To reduce the VRE prevalence worldwide, appropriate use of antibiotics according to antimicrobial susceptibility testing should be encouraged. Efforts should be made to reduce the transmission of VRE isolates.

Cumulative Antibiogram: A Rapid Method to Hinder Transmission of Resistant Bacteria to Oral Cavity of Newborn Babies.

A rapid bacterial diagnostic is needed more and more in the treatment of patients, because of the emergence of antibiotic resistance. The cumulative antibiogram, an annual report that monitors antimicrobial resistance trends in health care facilities, may provide a profile of empirical therapy useful in diverse emergency situations, such as transmission of resistant bacteria to oral cavity of newborn babies. We aimed to draw a profile of antibiotic resistance encountered. We assessed the antibiotic resistance (ABR) profile in childbearing women and newborn babies in Ploiesti Obstetrics and Gynecology Hospital by the disk diffusion method characterizing the multidrug-resistant organisms after isolation and identification by phenotypic tests. Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E), Carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Group B Streptococcus (VR-GBS) were detected. The prevalence of antibiotic resistance was 11.32% (53/468), while the prevalence of the ESBL-E, MRSA, VRE and VR-GBS strains was 8.34% (39/468). Within the bacteria isolated from fifty-three childbearing women, the prevalence of ESBL-E, MRSA, VRE and VR-GBS was 22.64% (12/53), 32.08% (17/53), 11.32% (6/53) and 7.55% (4/53). In the whole studied group, the prevalence was 2.56% (12/468), 3.63% (17/468), 1.28% (6/468) and 0.86% (4/468). Resistant bacteria were detected at birth in the oral cavity of the newborn babies in all cases. Maternal and neonatal isolates shared similar characteristics. Cumulative antibiogram is useful in case of empiric treatment needed in diverse emergencies, such as transmission of resistant bacteria to oral cavity of newborn babies.

Vancomycin Resistant Enterococcal Urinary Tract Infection: A Potential Threat

Introduction: Enterococci are considered less virulent organisms, but have incurred recognition for being notorious for their acquisition and transfer of resistance. The greatest potential threat posed by enterococci is vancomycin resistance. The transfer of enterococcal vancomycin resistance to Staphylococcus aureus has been achieved making scientists apprehensive of its consequences. Aim: To find the prevalence of Vancomycin-Resistant Enterococci (VRE) and to determine the antimicrobial resistance pattern in enterococcal urinary isolates. Materials and Methods: A cross-sectional study was carried out on all urinary samples suspected of Urinary Tract Infection (UTI) received for duration of one year from April 2021 to March 2022 in the Department of Microbiology at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh. Enterococci were isolated and identified with a VITEK-2® COMPACT (bioMérieux) automated system. The antibiotic susceptibility pattern was determined by Kirby-Bauer disc diffusion method. Further, confirmation of VRE was done by Minimum Inhibitory Concentration (MIC) E-test. Results: A total of 128 urinary enterococcal isolates were identified with the male-to-female ratio 1.37:1 and mean age of patients was 37.18±22.64 years. Out of total, 71.87% were identified as Enterococcus faecalis followed by 24.21% Enterococcus faecium and the rare species (4%) including E.durans, E.hirae, E.raffinosus. The prevalence of VRE was found to be 8.6%. Maximum resistance by isolates has been shown against ampicillin, erythromycin, ciprofloxacin, and doxycycline. All isolates were sensitive to linezolid. Nitrofurantoin resistance was observed in 4.34% and 25.80% of E.faecalis and E.faecium isolates respectively. Conclusion: In this study, it was revealed that the emergence of VRE in urinary isolates with antimicrobial resistance was higher among E. faecium. All this puts pressure on strict compliance with a multidimensional approach with collaboration of antibiotic stewardship, educational and surveillance programs.

Detection of Genes Related to Linezolid Resistance (poxtA, cfr, and optrA) in Clinical Isolates of Enterococcus spp. from Humans: A First Report from Iran.

Enterococci may develop resistance to linezolid through chromosomal mutations that involve specific linezolid resistance genes, such as cfr, optrA, and poxtA. The objective of this study was to evaluate the antibiotic susceptibility of enterococcal isolates and identify cfr, optrA, and poxtA genes in MDR isolates. Enterococcal isolates were collected from various clinical specimens at Al-Zahra, Amin, and Khorshid Hospitals in Isfahan. The Enterococcus isolates were identified as belonging to the E. faecalis and E. faecium species by using specific gene (D alanine D alanine ligase ddl) sets in PCR. To detect cfr, optrA, and poxtA genes among the species, a multiplex-PCR assay was performed. Out of 175 isolates, E. faecalis predominated 129/175 (73.7%). Furthermore, the prevalence of vancomycin-resistant Enterococci (VRE) and linezolid-resistant Enterococci (LRE) was 29.7% and 4%, respectively. The overall prevalence of MDR was 91.1%, 68.9%, and 66.6% of E. faecium, E. faecalis, and other Enterococcus spp., respectively. Interestingly, the frequency of optrA (71.4%) in E. faecium and poxtA and crf (42.8%) in E. faecalis were detected among LRE species. A statistically significant relationship (P < 0.05) was found between the presence of the three genes and the occurrence of LRE. This is the first study to report the detection of linezolid resistance genes (cfr, optrA, and poxtA) in clinical Enterococcus spp. isolates from Iran, conducted at Isfahan University of Medical Sciences hospitals. The emergence of enterococcal strains that resist linezolid is concerning as it can lead to the spread of resistant strains among patients, resulting in treatment failure.

Does the Hooded Crow (Corvus cornix) harbour vancomycin-resistant enterococci in Hungary?

Vancomycin resistant enterococci (VRE) are high priority nosocomial bacteria with a potential for zoonotic transmission. Thus, its emergence outside health establishments is a major concern. In order to study the prevalence of VRE in wildlife, we collected 221 faecal samples from free-ranging Hooded Crow (Corvus cornix) from urban and rural habitats in Hungary, from March to August 2020. The screening for resistant enterococci was done using bile esculin azide (BEA) agar supplemented with Vancomycin, specific to the screening of VRE. None of the samples from either habitat types yielded VRE. It seems that Hooded Crows from Hungary do not necessarily constitute a reservoir of VREs at present. Nonetheless, a continuous surveillance of VRE in wildlife would be judicious.

Prevalence of Vancomycin-Resistant Enterococcus in a Teaching Hospital in Kashan, Iran

Background: Enterococci bacteria are part of the intestinal microbial flora of humans and animals. However, the widespread use of antibiotics causes antibiotic resistance among these bacteria, making it necessary to identify effective antimicrobial agents against them. Objectives: This study aimed to investigate the phenotypic prevalence of vancomycin-resistant enterococci (VRE) in the clinical samples of patients admitted to Beheshti hospital in Kashan. Materials and Methods: This cross-sectional descriptive study was performed on 110 enterococci isolated from the clinical samples of hospitalized patients during 2017-2018. Vancomycin-resistant cases were identified and recorded after recording clinical and demographic information. Finally, the groups were statistically compared using chi-square and Fisher’s exact tests. Results: The present study findings demonstrated that the prevalence of VRE was 37.3%. There was a significant association between the prevalence of VRE and older age, diabetes, history of antibiotic use, and more extended hospital stays. Conversely, no significant relationship was found between VRE prevalence and gender, blood pressure, heart disease, year of sampling, and type of clinical sample. Conclusion: Overall, the incidence of vancomycin resistance in enterococci is increasing, which can be reduced by identifying effective antimicrobial agents and providing appropriate training to the medical staff and the general public.