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

High Gastrointestinal Colonization Rate of Vancomycin-Resistant Enterococci among Hospitalized Patients: Potential Source for Resistant Gene

Background

Vancomycin-resistant Enterococci (VRE) is a global health problem and responsible for healthcare-associated infections (HAIs) in patients with prolonged hospital stay, severe underlying disease, and previous broad-spectrum antibiotic therapy. These bacteria can cross-resist and transfer drug-resistant genes to other potentially pathogenic bacteria. Therefore; this study was aimed to determine the gastrointestinal colonization rate of VRE, its antimicrobial susceptibility profile, and associated factors among hospitalized patients.

Methods

Prospective cross-sectional study was conducted using stool samples from 223 patients admitted to different wards at Hawassa University Comprehensive Specialized Hospital, from April 1 to June 30, 2021. Patients admitted to the hospital for more than 48 hours for various medical conditions were included. Sociodemographic and clinical characteristics were collected using a structured questionnaire. Fecal specimens were cultured on Enterococci selective media. Enterococcus species were identified using their growth and mannitol fermentation properties. Vancomycin resistance was screened using both the Kirby-Bauer disk diffusion method and a vancomycin E-test strip. Data were entered and analyzed using SPSS version 25. Descriptive and logistic regressions were used to determine the frequency and association of factors with the VRE colonization rate. A p value of <0.05 was considered statistically significant.

Results

A total of 223 fecal specimens were collected and processed, and 141 (63.2%) them were positive for Enterococci. The predominant species was E. faecalis 65 (46.1%) followed by E. faecium 76 (53.9%). In this study, the gastrointestinal colonization rate of VRE was 15 (6.7%) and all the species belong to E. faecium. Study participants who had no formal education (AOR = 4.26, 95% CI: 1.01, 18.06), hospitalized patients for >2 weeks (AOR = 4.10, 95% CI: 1.08, 15.57), and those who had a history of treatment with vancomycin (AOR = 4.77, 95% CI: 1.26, 18.09) were more likely to be colonized with vancomycin-resistant Enterococci. More than 95% of Enterococci isolates were susceptible to linezolid, whereas 70.2%, 63.1%, 56.7%, and 53.9% were resistant to tetracycline, erythromycin, penicillin, and ampicillin, respectively. Among the total Enterococci isolated, 141 (54.6%) were multidrug resistant.

Conclusions

In our study, high proportion of vancomycin-resistant Enterococci was found. Previous exposure to antibiotics and hospital stay were significant factors for VRE gut colonization. The isolated Enterococci showed variable degrees of resistance to commonly prescribed antibiotics which leads to a worldwide problem multidrug resistance. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics, and implementing infection prevention protocols may reduce colonization by VRE.

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

Background

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.

Purpose

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.

Patients and Methods

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.

Results

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%).

Conclusion

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.

Antibiotic Susceptibility Patterns and Virulence-Associated Factors of Vancomycin-Resistant Enterococcal Isolates from Tertiary Care Hospitals

This study explored the prevalence of multi-drug resistance and virulence factors of enterococcal isolates obtained from various clinical specimens (n = 1575) including urine, blood, pus, tissue, catheter, vaginal wash, semen, and endotracheal secretions. Out of 862 enterococcal isolates, 388 (45%), 246 (29%), 120 (14%), and 108 (13%) were identified as Enterococcus faecalis, Enterococcus faecium, Enterococcus durans, and Enterococcus hirae, respectively, using standard morphological and biochemical methods. The antibiotic resistance profile of all these enterococcal isolates was checked using the disc diffusion technique. High-level resistance was observed for benzylpenicillin (70%) and vancomycin (43%) among E. faecalis and E. faecium isolates, respectively. This study also revealed the prevalence of 'multi-drug resistance (resistant to 3 antibiotic groups)' among the vancomycin-resistant enterococcal strains, and this was about 11% (n = 91). The virulence determinants associated with vancomycin resistance (VR) were determined phenotypically and genotypically. About 70 and 39% of E. faecalis and E. faecium isolates showed to be positive for all four virulence factors (gelatinase, protease, hemolysin, and biofilm). Among the several virulence genes, gelE was the most common virulence gene with a prevalence rate of 76 and 69% among E. faecalis and E. faecium isolates, respectively. More than 50% of VRE isolates harbored other virulence genes, such esp, asa, ace, and cylA. Similarly, the majority of the VR enterococcal isolates (n = 88/91) harbored vanA gene and none of them harbored vanB gene. These results disclose the importance of VR E. faecalis and E. faecium and the associated virulence factors involved in the persistence of infections in clinical settings.

Asymptomatic Carriage Rate, Multidrug Resistance Level, and Associated Risk Factors of Enterococcus in Clinical Samples among HIV-Positive Patients Attending at Debre Birhan Comprehensive Specialized Hospital, North Showa, Ethiopia

Background

Enterococci are facultative anaerobic, Gram-positive bacteria found in pairs and short chains that exist as normal microflora both human and animal. Enterococci have become a substantial source of nosocomial infections in immunocompromised patients, such as urinary tract infection (UTI), bacteremia, endocarditis, and wound infection. Earlier antibiotic therapy, length of hospital stays, and length of earlier vancomycin treatment, surgical wards, or intensive care units are all risk factors. Additionally, the presence of coinfections such as diabetes and renal failure and the presence of a urinary catheter were aggravated factors to develop infections. Data on the prevalence, antimicrobial susceptibility patterns, and associated factors of enterococcal infection among HIV-positive patients are scarce in Ethiopia.

Objective

To determine the asymptomatic carriage rate, multidrug resistance pattern, and risk factors of enterococci in clinical samples among HIV-positive patients attending at Debre Birhan Comprehensive Specialized Hospital, North Showa, Ethiopia.

Methods

A hospital-based cross-sectional study was conducted from May to August 2021, at Debre Birhan Comprehensive Specialized Hospital. To obtain sociodemographic data and possible associated factors of enterococcal infections, a pretested structured questionnaire was utilized. During the study period, clinical samples such as urine, blood, swabs, and other bodily fluids from participants sent to the bacteriology section for cultures were included. The study comprised a total of 384 HIV-positive patients. Enterococci were identified and confirmed using bile esculin azide agar (BEAA), Gram stain, catalase response, growth in broth containing 6.5% NaCl, and growth in BHI broth at 45°C. Data were entered and analyzed using SPSS version 25. P values < 0.05 with 95% confidence interval were considered statistically significant.

Result

The overall asymptomatic carriage rate of enterococcal infection was 8.85% (34/384). Urinary tract infections were the most common, followed by wounds and blood. The vast majority of the isolate was found in urine, blood, and wound and fecal, 11 (32.4%), 6 (17.6%), and 5 (14.7%), respectively. Overall, 28 (82.35%) bacterial isolates were resistant to three and more than three antimicrobial agents. Duration of hospital associated with >48-hour hospital stays (AOR = 5.23, 95% C.I: 3.42-24.6), previous history of catheterization (AOR = 3.5, 95% C.I: 5.12-44.31), WHO clinical, stage IV (AOR = 1.65, 95% C.I: 1.23-3.61), andCD4 count < 350(AOR = 3.5, 95% C.I: 5.12-44.31) (P < 0.05). All were associated with higher level of enterococcal infection than their respective groups. Conclusion and Recommendation. Patients with UTIs, sepsis, and wound infection had a greater rate of enterococcal infection than the rest of the patients. Clinical samples in the research area yielded multidrug-resistant enterococci, including VRE. The presence of VRE suggests that multidrug-resistant Gram-positive bacteria have fewer antibiotic treatment options.

A Retrospective Analysis of Culture-Confirmed Enterococci Bloodstream Infections in South Africa, 2016-2020: A Cross-Sectional Study

(1) Background: The emergence of multidrug resistance enterococci is a major public health concern. This study aimed to determine the prevalence and antimicrobial resistance of enterococci isolated from blood cultures over a five-year period (2016−2020) at public hospitals in South Africa. (2): Methods: A retrospective analysis of clinical enterococci isolated from bloodstream infection samples at the South African public hospitals was conducted. The ESKAPE dataset from January 2016 to December 2020 was obtained from the central data warehouse (CDW) at the National Health Laboratory Service (NHLS). (3): Results: Following de-duplication, a total of 130,352/306,592 organisms isolated from blood cultures were identified as ESKAPE pathogens. In this study, K. pneumoniae (25%; 33,082/130,352), was the most frequently isolated pathogen from blood cultures, followed by S. aureus (23%; 29,922/130,352) and enterococci (16%; 21,339/130,352). Of the enterococci cases, about 43% (9132/21,339) of cases were from the infants aged (<1-year old) and 32% (6745/21,339) from the adult patients. No changes observed in vancomycin, teicoplanin, and linezolid susceptibility; however, E. faecium and E. faecalis blood culture isolates remained highly susceptible (>97%) to these antibiotics. (4): Conclusions: The current study revealed a significant increase of E. faecalis and E. faecium blood culture isolates as compared to the previous national ESKAPE data. Low vancomycin resistance was observed. Continuous monitoring of antimicrobial resistant Enterococcus species is warranted in South Africa.

Prevalence of multidrug-resistant bacteria associated with polymicrobial infections

BACKGROUND

Wounds remain the most important cause of postoperative mortality and morbidity and generate considerable additional social and healthcare costs. Most wounds are caused by various coliforms, Enterococcus fecalis, Proteus sp., and multidrug resistant Staphylococcus aureus. Wound is one of the leading cause of infections in the under developed and developing countries than developed nations.

METHODS

A total of 43 samples associated with bacteremia and wound infection were collected. Biochemical characterization and culture characteristics of the drug resistant isolates were studied using MacConkey agar, blood agar and mannitol-salt agar. Antibiotic susceptibility analysis of the isolated strains was performed by disc diffusion method using various antibiotics. Prevalence of dug resistance among bacteria isolated from the wound was studied. The ability of Beta lactamase antibiotic producing bacterial strains were analyzed.

RESULTS

A total of 168 bacterial strains were isolated showed high resistant towards ampicillin (89%), ciprofloxacin (90.8), cefepine (90.5), piperacillin (91.8), oxacillin (92.5), and imipenem (96.5). The isolated bacterial strains showed monobacterial as well as polybacterial growth on the surface of the wound. The isolated bacterial strains revealed 89% sensitivity against norfloxacin and 94.9 sensitivity against vancomycin. About 26% of bacterial strains degraded quinolones, whereas only 14% clinical isolates showed their ability to degrade aminoglycosides. A total of 27% bacteria degraded tetracycline and 51% of isolates degraded carbapenems compounds. Interestingly, E. faecalis was resistant against antibiotics such as, Oxacillin, Nalidic acid, Ofloxacin, Erythromycin, Norfloxacin, Ciprofloxacin, Ampicillin, Tetracycline, Cefepine, Amikacin, Cefurooxime, Vancomycin, Piperacillin, Imipenem and Gentamycin. Moreover, Proteus species was resistant against certain numbers of antibiotics namely, Ampicillin, Piperacillin, Oxacillin, Nalidic acid, Tetracycline, Erythromycin, Cefurooxime, Nitrofurantoin, Vancomycin and Imipenem.

CONCLUSIONS

The isolated bacterial strains were resistant against various drugs including vancomycin. Staphylococci, and E. faecalisis strains showed resistance against various classes of antibiotics.

Vancomycin resistant Enterococci and its associated factors among HIV infected patients on anti-retroviral therapy in Ethiopia

BACKGROUND

The emergence of vancomycin resistant Enterococci (VRE) has alarmed the global community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the incidence of vancomycin resistant Enterococci and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART).

METHODS

Institution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. Bivariable and multivariable logistic regression model was used to analyze the association between dependent and independent variables. P-values in the multivariable analysis, adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. P-value ≤0.05 was considered as significant.

RESULTS

Enterococci spp was isolated on 123/200 (61.50%) patients. Among these isolates, the incidence of vancomycin resistant Enterococci was 11.4% [95% CI: (6.0-17.0)]. Antimicrobial susceptibility patterns against Enterococci showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibioticexposurer more than two weeks [AOR = 7.35; 95% CI: (1.2144.64)] and hospitalization for the last six months [AOR = 5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci.

CONCLUSIONS

In our study high incidence of vancomycin resistant Enterococci was found. Previous exposure to antibiotics for more than two weeks and hospitalization for more than six months were significantly associated with vancomycin resistant Enterococci. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.

Prevalence, Antimicrobial Susceptibility Patterns, and Risk Factors Associated with Enterococci among Pediatric Patients at Dessie Referral Hospital, Northeastern Ethiopia

BACKGROUND

Enterococcus species, which is previously considered as medically not important, now becomes one of the leading causes of nosocomial infections. Even though it becomes the most public health concern and emerging multidrug-resistant pathogen, there is no enough data in the study area.

OBJECTIVE

To determine the prevalence, antimicrobial resistance pattern, and associated risk factors of enterococci infection in pediatric patients.

METHODS

A hospital-based cross-sectional study was conducted from February to May 2019 at Dessie Referral Hospital, Northeastern Ethiopia. A total of 403 pediatric patients were included in the study, and a pretested structured questionnaire was used to collect sociodemographic and risk factor-related data. Clinical samples such as urine, blood, wound swabs, discharges, and other body fluids were collected aseptically and inoculated on to Bile Esculin Azide Agar, and colony characteristics, Gram stain, catalase, salt, and temperature tolerance tests were employed for bacterial identification. Antimicrobial sensitivity tests were performed using the modified Kirby-Bauer disk diffusion method. Data was entered into SPSS software version 25 and descriptive statistics; bivariate and multivariate logistic regression analyses were performed. In all cases, a P value ≤ 0.05 with corresponding 95% confidence interval were considered as statistically significant.

RESULT

The overall prevalence of enterococci was 2.7% (11/403). Of which, the highest number of enterococci infection was recovered from urine sample (54.5%) followed by blood (27.3%), wound swab (9.1%), and other body fluids (9%). The overall multidrug resistance rate was 54.5%. Higher drug resistance pattern was observed against tetracycline, chloramphenicol, and amoxicillin/clavulanate. Having history of invasive procedure (P < 0.001), chronic illness (P < 0.001) and previous admission history of the children (P < 0.001) were statistically significant associated risk factors for pediatrics enterococci infection.

CONCLUSION

The prevalence of enterococci from pediatric patients in this study was relatively low compared to other studies. Significant rates of MDR and VRE were identified, and the risk of infection became high when children had a history of different chronic illnesses and history of admission and underwent invasive treatment procedures. Therefore, efforts should be made to prevent enterococci infections and spread of multidrug-resistant enterococci.

Prevalence of vancomycin-resistant enterococcus in Africa in one health approach: a systematic review and meta-analysis

Vancomycin-resistant enterococci are a global challenge currently as reported by the World Health Organization. It is also important to recognize that combating antimicrobial resistance needs to recognize the interconnections between people, animals, plants and their shared environment in creating public health, the so-called One Health approach. Although the presence of VRE has been described in many regions of the world, there is a lack of comprehensive data indicating their prevalence of in Africa. Therefore, this study aimed to aggregate the result of studies describing VRE reported across multiple regions in Africa. A literature search was conducted on PubMed, Google scholar, and Hinari with the term “Vancomycin resistance enterococcus in Africa” on August 1–3, 2019. All available articles were downloaded to “Endnote version 7.1” then to Microsoft Word 2013. Articles determined to meet our criteria for the review was extracted to Microsoft Excel 2013. Those articles that reported the prevalence of vancomycin resistance Enterococcus obtained from all sample types and published from 2010 to 2019 in the English language were included for the review. A meta-analysis was conducted with OpenMetaAnalyst version R.3.1.0 software. The effect size was determined using a binary random effect model and statically significant considered when p < 0.05. Heterogeneity determined with the inconsistency index. A leave one out analysis used to perform the sensitivity analysis. There were 151 articles identified from the database searches; of this, 36 articles included after extensive review with two independent authors. Out of 4073 samples collected, 1488 isolates identified with an overall pooled prevalence of VRE 26.8% (95% CI; 10.7–43.0%) in Africa with a one-health perspective. The analysis showed that considerable heterogeneity among the studies (I² = 99.97%; p < 0.001). Subgroup analysis in-country, African region, laboratory method, year of publication, and sample source showed that a high prevalence was identified from South Africa (74.8%), South African regions (74.8%), PCR (959.2%), 2010–2015 years (30.3%) and environmental (52.2%), respectively. This meta-analysis indicates that there was a high-pooled prevalence of vancomycin-resistant enterococci in African. A lot should be done to prevent and control the transmission of vancomycin resistance enterococci to a human being from the environment in the continent.

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

Background

The 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.

Methods

Literature 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.

Results

Twenty 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%).

Conclusion

The 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.

Prevalence of Multidrug-Resistant Enterococcus faecalis in Hospital-Acquired Surgical Wound Infections and Bacteremia: Concomitant Analysis of Antimicrobial Resistance Genes

Background:

The study aimed to assess the prevalence of Enterococcus faecalis infections among patients with hospital-acquired surgical wound sepsis and bacteremia in surgical wards and identify the antimicrobial susceptibility in these pathogens. Genetic role of erythromycin, vancomycin, and cephalosporin resistance in these pathogens was also examined.

Methods:

Two hundred samples were collected from surgical wound infections and 100 blood cultures from patients with suggested bacteremia to identify E faecalis by phenotypic and genotypic methods. Antimicrobial susceptibility to 12 antimicrobial agents was tested. The presence of resistance genes was examined by polymerase chain reaction (PCR) assay.

Results:

E faecalis was isolated with a frequency of 24/200 (12%) from surgical wound samples and 2/100 (2%) from blood cultures. All isolates were completely resistant to cefepime, ampicillin, and tetracycline, 96% of isolates were resistant to erythromycin, 53.8% to vancomycin, and 23.1% to linezolid. Multidrug resistance (MDR) was found in 100% of isolates. ere(B) and erm(B) genes were present in 20/25 (80%) and 17/25 (68%) of erythromycin-resistant isolates, respectively, 15 (60%) isolates carry both ere(B) and erm(B) genes. Van A gene was detected in 71.4% of vancomycin-resistant isolates. All isolates were negative for mef(A/E), blaSHV, and blaTEM genes.

Conclusion:

MDR in all isolates (100%) and high-level resistance to gentamicin, erythromycin, and vancomycin were reported in E Faecalis isolates. In the studied isolates, erythromycin resistance mainly related to the presence of ere(B) and erm(B) genes and vancomycin resistance was mainly related to the presence of vanA gene.

Characterization of Clinical Isolates of Enterococci with Special Reference to Glycopeptide Susceptibility at a Tertiary Care Center of Eastern Nepal

Background

Enterococci, once considered as a harmless commensal of intestine, have now emerged as medically important pathogens and are associated with both community-acquired and nosocomial infections. They bear the potential to exhibit resistance against all commonly used antibiotics either by inherent or acquired mechanism, posing a therapeutic challenge.

Objectives

This study aimed to characterize enterococci up to the species level and study their antibiogram with special regard to vancomycin.

Methods

A descriptive cross-sectional study was conducted in the Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, from February to May 2017. A total of 91 enterococcal isolates recovered from clinical specimens were investigated in this study. Their identification and speciation were done according to standard microbiological guidelines. Kirby–Bauer disc diffusion technique was used to study antimicrobial susceptibility pattern, whereas minimum inhibitory concentration of vancomycin was determined by the agar dilution method, with reference to Clinical and Laboratory Standards Institute guidelines.

Results

Seven different species of enterococci were isolated, E. faecalis and E. faecium accounting about 45% each. The other species encountered were E. avium, E. cecorum, E. dispar, E. durans, and E.

Conclusions

Enterococcus faecalis and E. faecium were the predominant species in causing enterococcal infections. The alarming rise in prevalence of vancomycin and multidrug resistance strains warrants immediate, adequate, and efficient surveillance program to prevent and control its spread.

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.

Vancomycin-Resistant Enterococci and Its Associated Risk Factors among HIV-Positive and -Negative Clients Attending Dessie Referral Hospital, Northeast Ethiopia

Background

Enterococci are becoming the most important public health concern and emerging as multidrug-resistant organisms around the world including Africa particularly in Ethiopia where there is a lack of availability of effective antimicrobial drugs. However, there is a paucity of data on the prevalence and associated risk factors of vancomycin-resistant enterococci in Ethiopia.

Objective

This study was aimed to assess the prevalence of vancomycin-resistant enterococci and its associated risk factors among HIV-positive and -negative clients.

Methods

A comparative cross-sectional study was conducted from February to May, 2017, on 300 participants at Dessie Referral Hospital. Data were gathered using a pretested structured questionnaire, stool samples were collected and inoculated on to bile esculin agar, and presumptive colonies were inoculated in brain-heart infusion broth containing 6.5% NaCl for selective identification of enterococci. Antibiotic susceptibility tests were done using the Kirby-Bauer disk diffusion method. Data were analyzed using SPSS version 22 software package.

Results

A total of 300 study participants were enrolled in this study, of which 57.7% were females with a mean age of 34.4, a range of 19-73 years. The overall prevalence of enterococci was 37.3%. The prevalence of VRE was 6.3%. From all isolates, the prevalence of VRE among HIV-positive and -negative clients was 5.9% and 7.4%, respectively. Resistance gentamicin, ampicillin, penicillin, and erythromycin was 37.5%, 34.8%, 34.8%, and 22.3%, respectively. Prevalence of multidrug resistance was (29.5%). Being low in hemoglobin content was significantly associated with VRE.

Conclusion

The high prevalence of VRE and multidrug-resistant enterococci in this study signals the emergence of VRE. Detection of VRE in this study indicates decreased antibiotic treatment options of multidrug-resistant enterococci. Therefore, there should be a need to perform continuous surveillance, rational use of antibiotics, and more detailed study using phenotypic and genotypic methods.

Prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, south west Ethiopia

OBJECTIVE

This study was done to determine the prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, Southwest Ethiopia.

RESULTS

The overall prevalence of Enterococci species was 5.5% (22/403). Five (22.7%) of Enterococci species were vancomycin resistant. Haemolysin, gelatinase and biofilm production was seen among 45.5, 68.2 and 77.3% of isolates respectively. The overall rate of antibiotic resistance was 95.5% (21/22). High resistance was observed against norfloxacin (87.5%), and tetracycline (77.3%). Whereas, low resistance (36.5%) was observed against ciprofloxacin and eighteen (80.8%) of the isolates were multi-drug resistant.

Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

This article reviews antibiotic resistance and treatment of bacterial infections in the growing number of patients who are immunocompromised: solid organ transplant recipients, the neutropenic host, and persons with human immunodeficiency virus and AIDS. Specific mechanisms of resistance in both gram-negative and gram-positive bacteria, as well as newer treatment options are addressed elsewhere, and are only briefly discussed in the context of the immunocompromised host.

CARRIAGE OF MULTIDRUG RESISTANT ENTEROCOCCUS FAECIUM AND ENTEROCOCCUS FAECALIS AMONG APPARENTLY HEALTHY HUMANS

Background:

Enterococci are indigenous flora of the gastro-intestinal tracts of animals and humans. Recently, interest in two major species, E. faecium and E. faecalis, has heightened because of their ability to cause serious infections and their intrinsic resistance to antimicrobials. This study was aimed at determining the prevalence of E. faecium and E. faecalis in human faecal samples and evaluating the susceptibility of the isolates to antibiotics.

Materials and Methods:

One hundred faecal samples were collected from apparently healthy individuals and analysed using conventionalbacteriological methods. The susceptibility profile of the isolates to nine antibiotics were determined using disk diffusion method.

Results:

Seventy-three (73) Enterococcus were phenotypically identified and 65 of the isolates were differentiated into 36 (55.4%) E. faecium and 29 (44.6%) E. faecalis. Eight (8) isolates could not be identified by the conventional biochemical methods employed. No dual colonization by the E. faecalis and E. faecium was observed and isolation rate was not dependent on sex of the participants. All the isolates were resistant to ceftriaxone, cefuroxime and ceftizoxime. Enterococcus faecium exhibited resistance toerythromycin (88.9%), gentamicin (77.8%), amoxicillin-clavulanate (63.9%), ofloxacin (44.4%), teicoplanin (19.4%) and vancomycin (16.7%). Enterococcus faecalis showed the least resistance to vancomycin (13.8%) and teicoplanin (27.7%). Remarkable multiple antibiotic resistances to the classes of antibiotic tested were observed among the two species.

Conclusion:

The high carriage rate of antibiotic resistant E. faecium and E. faecalis in this study provides information on the local antibiotic patterns of our enterococci isolates thereby suggesting that they could present as important reservoir and vehicle for dissemination of resistant genes in our community.

Isolation of enterococci, their antimicrobial susceptibility patterns and associated factors among patients attending at the University of Gondar Teaching Hospital

Background

Enterococci become clinically important especially in immune compromised patients and important causes of nosocomial infections. Data on the prevalence, antimicrobial susceptibility patterns and associated factors of enterococci are scarce in Ethiopia.

Methods

A hospital based cross-sectional study was conducted at the University of Gondar Teaching Hospital from February 28, 2014 to May 1, 2014. Pretested structured questionnaire was used to collect socio-demographic data and possible associated factors of enterococci infections. Clinical samples including urine, blood, wound swabs and other body fluids from patients requested by physician for culture and antimicrobial susceptibility test during the study period were included. A total of 385 patients were included in the study. Data were entered and analyzed using SPSS Version 20. P values <0.05 were considered as statistically significant.

Result

The overall prevalence of enterococci infection was 6.2% (24/385). The commonest sites of infections were urinary tract followed by wound and blood. Among the 24 isolates, 33.3% (8/24) were resistant to all tested antimicrobial agents. Forty one point 7 % (10/24) of the enterococci isolates were vancomycin resistant enterococci (VRE). Moreover, two third of the isolates were multidrug resistant (MDR) enterococci. In multivariate analysis, duration of hospital stay for two days and more than two days with infection rate 17/32 (53.1%), previous history of any antibiotics (AOR = 9.13; [95% CI; 2.01–41.51] P = 0.00) and history of urinary catheterization (AOR = 8.80; [95% CI; 1.70–45.64] P = 0.01) were associated with presence of higher enterococci infections than their respective groups.

Conclusion

The prevalence of enterococci infections among patients with UTIs, wound infections and sepsis were higher than the other infections. Multi drug resistant enterococci including VRE were isolated from clinical samples in the study area. Being hospitalized for ≥48 h, having history of any antibiotic administration and catheterization were associated factors for enterococci infections. Presence of VRE indicates decreased antibiotic treatment options of multidrug resistant enterococci. Therefore, efforts should be made to prevent enterococci infections and emergency of multidrug resistant enterococci. Moreover, species identification and antibiotic resistant in advanced and at large scale is demanding.

Antibiotic Resistant Superbugs: Assessment of the Interrelationship of Occurrence in Clinical Settings and Environmental Niches

The increasing threat to global health posed by antibiotic resistance remains of serious concern. Human health remains at higher risk due to several reported therapeutic failures to many life threatening drug resistant microbial infections. The resultant effects have been prolonged hospital stay, higher cost of alternative therapy, increased mortality, etc. This opinionated review considers the two main concerns in integrated human health risk assessment (i.e., residual antibiotics and antibiotic resistant genes) in various compartments of human environment, as well as clinical dynamics associated with the development and transfer of antibiotic resistance (AR). Contributions of quorum sensing, biofilms, enzyme production, and small colony variants in bacteria, among other factors in soil, water, animal farm and clinical settings were also considered. Every potential factor in environmental and clinical settings that brings about AR needs to be identified for the summative effects in overall resistance. There is a need to embrace coordinated multi-locational approaches and interrelationships to track the emergence of resistance in different niches in soil and water versus the hospital environment. The further integration with advocacy, legislation, enforcement, technological innovations and further research input and recourse to WHO guidelines on antibiotic policy would be advantageous towards addressing the emergence of antibiotic resistant superbugs.

An agmatine-inducible system for the expression of recombinant proteins in Enterococcus faecalis

Background

Scientific interest in Enterococcus faecalis has increased greatly over recent decades. Some strains are involved in food fermentation and offer health benefits, whereas others are vancomycin-resistant and cause infections that are difficult to treat. The limited availability of vectors able to express cloned genes efficiently in E. faecalis has hindered biotechnological studies on the bacterium’s regulatory and pathogenicity-related genes. The agmatine deiminase (AGDI) pathway of E. faecalis, involved in the conversion of agmatine into putrescine, is driven by a response inducer gene aguR.

Results

This study describes that the exposure to the induction factor (agmatine) results in the transcription of genes under the control of the aguB promoter, including the aguBDAC operon. A novel E. faecalis expression vector, named pAGEnt, combining the aguR inducer gene and the aguB promoter followed by a cloning site and a stop codon was constructed. pAGEnt was designed for the overexpression and purification of a protein fused to a 10-amino-acid His-tag at the C-terminus. The use of GFP as a reporter of gene expression in E. faecalis revealed that under induction with 60 mM agmatine, fluorescence reached 40 arbitrary units compared to 0 in uninduced cells.

Conclusion

pAGEnt vector can be used for the overexpression of recombinant proteins under the induction of agmatine in E. faecalis, with a close correlation between agmatine concentration and fluorescence when GFP was used as reporter.

Vancomycin-resistant enteroccus faecium and enterococcus faecalis isolated from education hospital of iran

INTRODUCTION

Enterococci are opportunistic pathogens which represent one of the leading agents of nosocomial infections, especially urinary tract infections (UTI) in hospitalized patients. The aim of the present study was to determine the resistance pattern and the type of resistance genes in vancomycin-resistant Enterococcus isolated from an educational hospital in Iran.

MATERIALS AND METHODS

From February 2012 till February 2013, one hundred and eighty six clinical isolates from different department of educational hospitals were collected and identified as Enterococci and specified by biochemical tests. Identification was confirmed by specific PCR. Antibiotic resistance properties of strains were examined by Kerby-bauer method. PCR was performed for ddlE, ddlF, vanA and vanB genes.

RESULTS

One hundred and six (57%) isolates were identified as E. faecalis and 80 (43%) of the isolates were identified as E. faecium. 24 isolates had vanA gene and 19 isolates had vanB genes. In E. faecalis isolates, 15 isolates had vanB and 4 isolates had vanA gene. In E. faecium isolates, 20 isolates had vanA and 4 isolates had vanB gene. Prevalence of van genes between E. faecalis and E. faecium were significantly different for both vanA and vanB (p<0.01, p<0.041, respectively). VRE isolates were sensitive to Linezolid, Nitrofurantoin and Tigecyclin.

DISCUSSION

The overall prevalence of VRE was 23.65%, which shows an increase in VRE isolation in our region. Also, prevalence of E. faecium dramatically increased from 9% to 43% in the present study. Also increase in Gentamicin resistant isolates observed, but VRE isolates were sensitive to Linezolid, Tigecyclin and Nitrofurantoin. Stewardships for antibiotic usage in hospitals, especially for last option antibiotics, can prevent the spread of resistant isolates and losing all treatment options in the future.