Frequency of vanA & vanB genes in vancomycin-resistant enterococci isolated from clinical specimens at Shahid Mohammadi hospitals Bandar Abbass

Subject Areas : Bacteriology

Zeinab Ghalandarzade Daryaii ¹ (کارشناسی ارشد، دانشگاه آزاد اسلامی، واحد جهرم، گروه میکروبیولوژی)
Sedighe Javadpour ² (دانشیار، مرکز تحقیقات پزشکی مولکولی، دانشگاه علوم پزشکی هرمزگان)
Mohammad Kargar ³ (دانشیار، دانشگاه آزاد اسلامی، واحد جهرم، گروه میکروبیولوژی)

Received: 2012-08-20 Accepted : 2013-02-18 Published : 2013-04-01

Keywords: E-test, Vancomycin resistant enterococci, vanA gene, vanB gene,

Abstract :

Background and Objectives: Enterococci are normal flora of  alimentary tract of humans and many other mammals. Recently vancomycin resistant enterococci (VRE) have emerged as an increasingly important cause of nosocomial infections all around the world. The aims of this study were to determine frequency and antibiogram  patterns of enterococci to vancomycin and also to detect the corresponding genes (vanA and vanB) in clinical isolates. Materials and Methods: This cross–sectional study was carried out on 54 enterococci strains isolated from clinical specimens (urine, wound, blood, …) obtained from the patients hospitalized in Shahid Mohammadi hospital, Bandar Abbass. RapID STR System Kit was used to identify species of isolated enterococci. Antibiogram pattern was examined by Kirby-Bauer disk diffusion method and CLSI criteria. MIC of vancomycin was determined by E-Test. Multiplex PCR and specific primers was used to detect vanA and vanB genes. Results: 38 out of 54 isolates (70.4%) of enterococci belonged to E. faecalis while E, feacium and  and  E. hirea consist only and 10 (18.5%)  and 3 (5.55%) of the isolates, respectively. Furthermore, one  (1.85%) of each E.mundtii, E.durans and E.avium were isolated from these samples. These strains were mostly resistant to gentamicin and cephalexin while showed lowest antibiotic resistance to linezolid. 13 (24.10%) of the isolates were resistant to vancomycin. Van A and Van B genes were found in 69.23% and 15.38%  of VRE strains,  respectively. Two strains (16.38%) harbored both genes. Conclusion: According to the extensive frequency of vancomycin resistant enterococci, application of precautionary and management procedures are highly required. Furthermore, it is recommended to carry out the antibiogram assay for each patient, before the treatment process, in order to prescribe an appropriate antibiotic.

References:

1. BjØrkeng E. 2010. On mobile genetic elements in Enterococci; adding more facets to the complexity. A thesis submitted according to the requirements for the degree of Philosophiae Doctor. University of Tromse.

2. Gordon S, Swenson J, Hill B, Pigott N, Facklam R, Cooksey RC, Thornsberry C, Jarvis WR, Tenover FC. Antimicrobial susceptibility patterns of common and unusual species of enterococci causing infections in the United States. J Clin Microbiol. 1992; 30: 2373-2378.

3. Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiol. 2009; 155: 1749-1757.

4. Morrison D, Woodford N, Cookson B. Enterococci as emerging pathogens of humans. J Appl Microbiol Symp, Suppl. 1997; 83: 89-99.

5. Ghaffarpasand I, Moniri R, Kheradi I. The prevalence of fecal carriage of antibiotic resistant enterococci among hospitalized patients in Shahid Beheshti hospital, Kashan, Iran at 2007. Feyz. 2010; 14: 70-75 [In Persian].

6. Huycke MM, Sahm DF, Gilmore MS. Multi-drug-resistant Enterococci: the nature of the problem and an agenda for the future. Emerg Infect Dis. 1998; 4: 239-249.

7. Cetinkaya Y, Fallk P, Mayhall C. Vancomycin-resistant Enterococci. Clin Microbiol Rev. 2000; 13: 686-707.

8. Afkhamzadeh A, Askarian M, Barari M, Hadinia M, Jokar M. Comparison of the rate of enteric colonization with vancomycin-resistant enterococci in medical wards with surgical wards of Namazi Hospital in Shiraz. J Kurdistan Uni Med Sci. 2008; 13:7-14 [In Persian].

9. Portillo A, Ruiz-Larrea F, Zarazaga M, Alonso A, Martinez JL, Torres C. Macrolide resistance genes in Enterococcus Spp. AAC. 2000; 44: 967-971.

10. Courvalin P. Vancomycin resistance in gram-positive cocci. CID. 2006; 42: 25-34.

11. Depardieu F, Podglajen I, Leclercq R, Collatz E, Courvalin P. Modes and modulations of antibiotic resistance gene expression. CM R. 2007; 20: 79-114.

12.  French GL.  Enterococci and vancomycin resistance. CID. 1998; 27: S75-83.

13. Teymourrnejad O, Mohabati MA, Hosseini Doust R. Epidemiologic evaluation of vancomycin resistant genes in Enterococcus spp. isolated from clinical samples. JFUMS. 2011; 2: 1-6 [In Persian].

14. Talebi M, Eshraghi SS, Pourshafie MR, Pourmand MR, Eshraghian MR. Characterization of vancomycin resistant Enterococcus faecium. Iranian J Publ Health. 2007; 36: 20-25.

15. Pourakbari B, Aghdam MK, Mahmoudi Sh, Ashtiani MTH, Sabouni F, Movahedi Z, Alyari AE, Sadeghi RH, Mamishi S. High frequency of vancomycin-resistant Enterococcus faecalis in an Iranian referral children medical hospital. Maedica J Clin Med. 2012; 7: 201-204.

16. Koch S, Hufnagel M, Theilacker C, Huebner J. Enterococcal infections: host response, therapeutic, and prophylactic possibilities. Vaccine. 2004; 22: 822-830.

17. Hayakawa K, Marchaim D, Palla M, Mahesh GU, Pulluru H, Bathina P. Epidemiology of vancomycin-resistant Enterococcus faecalis: a case-case-control study. AAC. 2013; 57: 49-55.

18. Khan SA, Nawaz MS, Khan AA, Hopper SL, Jones RA, Cerniglia CE. Molecular characterization of multidrug-resistant Enterococcus spp. from poultry and dairy farms: detection of virulence and vancomycin resistant gene markers by PCR. Mol Cell Probes. 2005; 19: 27-34.

19. Mundy L, Sahm D, Gilmore M. Relationships between enterococcal virulence and antimicrobial resistance. Clin Microbiol Rev. 2000; 13: 513-522.

20. Feizabadi MM, Asadi S, Khatibi S, Etemadi G, Parvin M, Oskoui M. Assesment of drug resistant pattern species about Enterococcus faecalis and Enterococcus faecium of Labbafinejad hospitals and Shahid Chamran hospitals during the years 2000-2003. Pejouhandeh. 2004; 9: 333-339 [In Persian].

21. Fatholazadeh B, Hashemi BF, Emaneini M, Aligholi M, Nakhjavani AF, Kazemi B. Detection of vancomycin resistant Enterococci (VRE) isolated from urinary tract (UTI) in Tehran, Iran. DARU. 2006; 14: 141-145.

22. Schouten MA, Hoogkamp-Korstanje JAA, Meis JFG, Voss A and the European VRE study group. Prevalence of vancomycin-resistant Enterococci in Europe. Eur J Clin Microbiol Infect Dis. 2000; 19: 816-822.

23. Fernandes SC, Dhanashree B. Drug resistance and virulence determinants in clinical isolates of Enterococcus species. Indian J Med Res. 2013; 137: 981-985.

24. Harris AD, Nemoy L, Johnson JA, Martin-Carnahan A, Smith LD, Standiford H, Perencevich EN. Co-carriage rates of vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase-producing bacteria among a cohort of intensive care unit patients: implications for an active surveillance program. ICHE. 2004; 25: 105-108.

25. Salah R, Dar-odeh N, Abu Hammad O, Shehabi AA. Prevalence of putative virulence factor and antimicrobial susceptibility of Enterococcus faecalis isolates from patients with dental diseases. BMC Oral Health. 2008; 1: 8-17.

26. Guiney M, Urwin G. Frequency and antimicrobial susceptibility of clinical isolates of Enterococci. Eur J Clin Microbiol Infect Dis. 1993; 12: 362-366.

27. Mohammadi F, Tabaraie B,  Sadeghifard N,  Ghafoorian S, Maleki A, Davoodian E, Rahbar M, Mohammadzadeh M. Evaluation of drug resistance frequency among Entrococci faecium and E. faecalis strains and detection of VanA/B genes in vancomycin resistance isolated by PCR method in Ilam and Kermanshah hospitals. Sci J Ilam Uni Med Sci. 2010; 19:1-8 [In Persian].

28. Ghasemi A, Moniri R, Khorshidi A, Gholam Abbas Musavi GH. The survey of virulence factors of Enterococcus faecalis isolated from urine samples, Iran. J Med Microbiol, 2008; 3&4: 53-58 [In Persian].

29. Shafiyabi S, Mariraj J, Sumathi S, Krishna S. Emergence of vancomycin resistant Enterococci in a tertiary care hospital in South India. Int J Pharm Biomed Res 2013; 4: 111-113.

30. Ahmadi A, Soltan Dallal MM, Pourshafie MR. Molecular study of Van genes in vancomycin resistant Enterococci isolated from wastewater in Tehran, Iran. J Ilam Uni Med Sci. 2006; 14: 1-7 [In Persian].

31. Padiglione A, Grabsch E, Wolfe R, Gibson K, Grayson ML. The prevalence of fecal colonization with VRE among residents of long-term-care facilities in Melbourne, Australia. Infect Control Hosp Epidemiol. 2001; 22: 576-578.

32. Thierfelder C, Keller PM, Kocher C, Gaudenz R, Hombach M, Bloemberg GV, Ruef C. A multiple-strain out break of eight weeks duration at a Swiss tertiary care hospital. Eur J Basic Med Sci. 2012; 142: 1-6.

33. Lee W, Kim M, Huh J, Kim Y, Hyun B. The conversion pattern of epidemiology among vancomycin resistant Enterococci: a transitional strain of enterococcus faecium containing both vanA and vanB genes. Abstr Intersci Conf. AAC. 2001; C2-511.

34. Oskoui  M, Farrokh P. Evaluation phenotypic and genotypic characteristics of the strains of vancomycin-resistant Enterococci isolated from clinical specimens. Iran J Med Microbiol. 2008; 1: 15-22 [In Persian].