Evaluation of the prevalence of Vancomycin- resistant Enterococci strains isolated from patients in the ICU in Kashan
Subject Areas : Medical MicrobiologySeyede Marzie Jabbari Shiade 1 , Rezvan Moniri 2 , Ahmad Khorshidi 3 , Mohammad ali Saba 4 , Seyed Gholam Abbas Mousavi 5 , Mahdi Salehi 6
1 - Student Research Committe, Kashan University of Medical Science, Kashan, Iran.
2 - Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
3 - Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
4 - Department of Internal Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran.
5 - Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran.
6 - Student Research Committe, Kashan University of Medical Science, Kashan, Iran.
Keywords: Antibiotic Resistance, Enterococcus, Vancomycin,
Abstract :
Background and Objectives: Enterococcus is part of human and animal intestinal flora. The withdrawal of these bacteria from their original location causes infections such as bacteremia, endocarditis, and Urinary Tract Infection (UTI) in hospitalized patients. The aim of this study is to determine the prevalence of vancomycin-resistant Enterococci (VRE) strains and the phenotypes of the Van genes in Enterococcus isolated from rectal swabs of patients hospitalized in the Intensive Care Unit (ICU). Methods and Materials: In this cross-sectional study, 156 rectal-swab samples were collected from patients in three wards of ICUs in the Shahid Beheshti Hospital. Enterococcus was detected in samples with the Gram stain and biochemical tests. An antibiotic resistance test was done using CLSI criteria. Different types of vancomycin resistance genes were identified by the multiplex PCR technique. Results: Enterococcus was detected in 135 rectal-swab samples (86.5%). The prevalence of VRE strains was 42.9% (58 cases). The frequency of Van A and Van C genes were 69% and 6.9%, respectively. In this study neither of van B, D, E and G genes were observed. 59.2% of patients who consumed 3 to 4 types of antibiotics, and 35.4% of those who consumed 1 to 2 types of antibiotics, had VRE. Conclusion: Our findings highlight that antibiotic consumption can lead to increasing the resistance phenotypes. The prevalence of VRE was indicated 3.6 times more in patients who had consumed antibiotics. Also, with increasing number of antibiotic consumption of 1-2 to 3-4 types, risk of antibiotic-resistant Enterococci increases 2.65 times.
1. Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol. 1993; 6:428-442.
2. Chiang PC, Wu TL, Su JY, Huang YC, Chiu YP. Unusual increase of vancomycin-resistant Enterococcus faecium but not Enterococcus faecalis at a university hospital in Taiwan. Chang Gung Med J. 2007; 30(6): 493-503.
3. Jones RN, Marshall SA, Pfaller MA, Wilke WW, Hollis RJ, Erwin ME, et al. Nosocomial enterococcal blood stream infections in the SCOPE program: antimicrobial resistance, species occurrence, molecular testing results, and laboratory testing accuracy. Diagn Microbiol Infect Dis. 1997; 29: 95-102.
4. Palladino S, Kay ID, Flexman JP, Boehm I, Costa AMG, et al. Rapid detection of van A & van B genes directly from clinical speicimens & enrichment broths by real-time multiplex PCR assay. J Clin Microbiol. 2003; 41(6): 2483-2486.
5. Liassine N, Frei R, Jan I, Auckenthaler R. Characterization of glycopeptid-resistant enterococci from a Swiss hospital. J Clin Microbiol. 1993; 36: 1853-1858.
6. Murray BE. Vancomycin-resistant enterococcal infections. N Engl J Med. 2000; 342: 710-721.
7. Schentag JJ. Antimicrobial management strategies for gram-positive bacterial resistance in the intensive care unit. Crit Care Med. 2001; 29: 100-107.
8. Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin-resistant enterococci. Lancet. 1988; 1(8575-6): 57-58.
9. Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant enterococci. Clin Microbiol. 2000; 13(4): 686-707.
10. Fisher DA, Lin R, Chai L, Kumarasinghe G, Singh K. Vancomycin-resistant enterococci in a Singapore teaching hospital prior to 2005. Singapore Med J. 2005; 46(6): 311-312.
11. Raja NS, Karunakaran R, Ngeow YF, Awang R. Community acquired vancomycin-resistant Enterococcus faecium: a case report from Malaysia. J Med Microbiol. 2005; 54(9): 901-903.
12. Riley PA, Parasakthi N, Teh A. Enterococcus faecium with high level vancomycin resistance isolated from the blood culture of a bone marrow transplant patient in Malaysia. Med J Malaysia. 1996; 51: 383-385.
13. Zubaidah AW, Ariza A, Azmi S. Hospital-acquired vancomycin resistant enterococci: now appearing in Kuala Lumpur Hospital. Med J Malaysia. 2006; 61(4): 487-489.
14. Dutka-Malen S, Evers S, Courvalin P. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR. J Clin Microbiol 1995; 33: 24-27.
15. Huyke MM, Sahm DF, Gilmore MM. Multiple-drug resistant enterococci: the nature of the problem and the agenda for the future. Emerg Infect Dis. 1998; 4: 239-249.
16. Liassine N, Frei R, Jan I, Auckenthaler R. Characterization of glycopeptide-resistant enterococci from a Swiss hospital. J Clin Microbiol. 1998; 36: 1853-1858.
17. Moellering JR. The enterococcus: a classic example of the impact of antimicrobial resistance on therapeutic options. J Antimicrob Chemother. 1991; 28: 1-12.
18. Kuriyama T, Williams DW, Patel M, Lewis MA, Jenkins LE, Hill DW, Hosein IK. Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from a teaching hospital in Wales. J Med Microbiol. 2003; 52(Pt 9): 821-827.
19. Chou YY, Lin TY, Wang NC, Peng MY, Chang FY. Vancomycin-resistant enterococcal bacteremia comparison of clinical features & outcome between Enterococcus faecium & Enterococc faecalis. J Microbiol Immunol Infect. 2008; 41(2): 124-129.
20. Woodford N. Glycopeptide-resistant enterococci: a decade of experience. J Med Microbiol. 1998; 47: 849-862.
21. Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistance enterococci. 2000; 13(4): 686-707.
22. Noble WC, Virani Z, Cree RGA. Co-transfer of vancomycin and other resistance genes from Enterococcus faecium NCTC 12201 to Staphylococcus aureus. FEMS Newsl. 1992; 93: 195-198.
23. Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med. 1988; 319: 157-161.
24. Quintiliani R, Evers S, Courvalin P. The van B gene confers various levels of self-transferable resistance to vancomycin in enterococci. J Infect Dis. 1993; 167: 1220-1223.
25. Uttley AH, George RC, Naidoo J, Woodford N, Johnson AP, Collins CH, et al. High-level vancomycin-resistant enterococci causing hospital infections. Epidemiol Infect. 1989; 103: 173-181.
26. Murray BE. Problems and dilemmas of antimicrobial resistance. Pharmacotherapy. 1992; 12: 86-93.
27. Ghaffarpasand I, Moniri R, Kheradi E, MD MT. Antibiotic resistance in fecal enterococci in hospitalized patients. Indian J Pathol Microbiol. 2010; 53: 898-899.
28. Zirakzadeh A, Patel R. Vancomycin-resistant enterococci: colonization, infection, detection and treatment. Mayo Clin Proc. 2006; 81(4): 529-536.
29. Chavers LS, Moser SA, Benjamin WH. Vancomycin-resistant enterococci: 15 years and counting. J Hosp Infect. 2003; 53: 159-171.
30. Emaneini M, Aligholi M, Aminshahi M. Characterization of glycopeptides, aminoglycosides and macrolide resistance among Enterococcus faecalis and Enterococcus faecium isolated from hospitals in Tehran. Polish J Microbiol. 2008; 57(2): 173-178.
31. Yoon Y, Kim H, Lee W, Lee S, Yang K, Park D, et al. Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting. J Antimicrob Chemother. 2012; 67(12): 2963-2969.
32. Japoni A, Farshad S, Ziyaeyan M, Ziaian S. Detection of Van-Positive & Negative vancomycin resistant enterococci & their antibacterial suseptibility patterns to the newly introduced antibiotics. Pakistan J Biol Sci. 2009; 12(11): 844-851.
33. Azevedo PA, Santiago KAdS, Furtado GHC. Rapid detection of vancomycin-resistant enterococci (VRE) in rectal samples from patients admitted to intensive care units. Braz J Infect Dis. 2009; 13(4): 289-293.
34. Woodford N. Glycopeptide-resistant enterococci: a decade of experience. J Med Microbiol. 1998; 47: 849-862.