Characterization of Vancomycin Resistant Enterococci in Hospitalized Patients and Role of Gut Colonization
Introduction: Enterococci are part of the normal intestinal flora and have been recognized as important human pathogens. Vancomycin Resistant Enterococci (VRE) are global threat as this resistance is transmissible and also poses a challenge for infection control. Aim: This study was undertaken...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2017-09-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/10548/25988_110917_25988_CE(RA1)_F(T)PF1_(NE_VT_PY)_PFA(MJ_AP).pdf |
| Summary: | Introduction: Enterococci are part of the normal intestinal flora
and have been recognized as important human pathogens.
Vancomycin Resistant Enterococci (VRE) are global threat as
this resistance is transmissible and also poses a challenge for
infection control.
Aim: This study was undertaken to study phenotypic and
genotypic characteristics of VRE from clinically significant
infections among hospitalized patients and their association
with gut colonization.
Materials and Methods: Clinically significant isolates of
enterococci (n=250) were studied. Species confirmation was
done by Polymerase Chain Reaction (PCR). Minimum Inhibitory
Concentration (MIC) for vancomycin was determined by E-test.
PCR for VanA, VanB and VanC1 gene was done for genotypic
characterization. MIC for teicoplanin, linezolid, tigecycline,
daptomycin and quinupristin-dalfopristin was determined
by E test. Patients with VRE infection were screened for gut
colonization using vancomycin screen agar (6 µg/mL). Continuous
data was analysed using the Student’s t-test. Categorical data
was assessed using Pearson’s Chi-square test. A value of p ≤
0.05 was considered statistically significant.
Results: There was good correlation between the phenotypic
and genotypic methods used for species identification and
detection of vancomycin resistance. E. faecium (162, 64.8%)
was most common followed by E. faecalis (82, 32.84%) and E.
gallinarum (6, 2.4%). Overall higher resistance was observed
among E. faecium. Vancomycin MIC ≥ 2 µg/mL was noted in 63
(25.2%) isolates. Fifty seven isolates showed presence of vanA
and vanC1 was detected in six isolates of E. gallinarum. Isolates
with VanB genotype was not detected in the present study.
MIC50 (µg/mL) for teicoplanin, linezolid, tigecycline, daptomycin
and quinupristin-dalfopristrin was 24, 0.75, 0.064, 2 and 0.064
respectively. Resistance to linezolid (1, 1.6%) and tigecycline (2,
3.2%) was rare. Majority (33/47, 70.2%) patients with clinically
significant VRE infection showed gut colonization.
Conclusion: Vancomycin resistance among enterococci is emerging. Emergence of tigecycline and linezolid resistance is also
posing a challenge for clinicians. Thus, further investigations are
warranted to control vancomycin resistance among pathogens. |
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| ISSN: | 2249-782X 0973-709X |