Vancomycin-resistant Enterococci In Songklanagarind Hospital: Molecular Epidemiology And Infection Control

Phanvasri Saengsuwan, Kamonnut Singkhamanan, Natnicha Ingviya


Vancomycin-resistant enterococci are important causes of healthcare-associated infections that have recently become the major nosocomial pathogen exhibiting resistance to many antimicrobials especially to vancomycin with increasing frequency. However, the epidemiology data of VRE in Thailand is limited. This study aimed at determining the prevalence, antibiotic resistance patterns, and molecularly characterize of VRE among patients admitted in a tertiary care hospital, in southern part of Thailand. We collected VRE isolates from various clinical samples of a 7-year period (March 2011 to April 2018) in Songklanagarind Hospital. VRE isolates were identified by Kirby Bauer disc diffusion method with Clinical and Laboratory Standards Institute guidelines. Vancomycin-resistance genes and virulence genes were detected by multiplex PCR and the sequence verified by the blast. The highest rate of VRE infection was in 2014 (39.4%). Most VRE isolates originated from the patient's digestive tract or urogenital tract that was positive for 17 (24.3%), followed by body fluid 14 (20.0%). The highest incidence of VRE infection was in Medical wards 29 (40.8%) and followed by surgical ward 16 (22.5%), operation theatres 7 (9.9%), Intensive Care Units (ICUs) 5 (7.0%), and emergency room 6 (8.5%). All the VRE isolates exhibited multidrug resistance, with the rates of resistance to ampicillin, imipenem, gentamicin and ceftazidime reaching high levels. It also found that 5.6% of E. faecium isolates were resistant to colistin. Most of these VRE isolates carried the vanA gene possed the esp genes (enterococcal surface protein), where rates were 100% and 74.6%, respectively. The study showed a high prevalence of diverse VRE strains with threatening resistance phenotypes in clinical sections among different medical wards in Songklanagarind hospitals. These findings indicated that the molecular detection of various glycopeptide resistance genes among VRE isolates are important information that useful to prevent and control of VRE infections.

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