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

Phanvasri Saengsuwan, Kamonnut Singkhamanan, Natnicha Ingviya

Abstract


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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References


Arias, C. A., G. A. Contreras and B. E. Murray (2010). "Management of multidrug-resistant enterococcal infections." Clin Microbiol Infect 16(6): 555-562.

Arshadi, M., M. Mahmoudi, M. S. Motaharand (2018). "Virulence Determinants and Antimicrobial Resistance Patterns of Vancomycin-resistant Enterococcus faecium Isolated from Different Sources in Southwest Iran." Iranian Journal of Public Health 47(2): 264-272.

Bhatt, P., A. Sahni, A. Praharajand (2015). "Detection of glycopeptide resistance genes in enterococci by multiplex PCR." medical journal armed forces india 71(1): 43-47.

Billington, E. O., S. H. Phang, D. B. Gregsonand (2014). "Incidence, risk factors, and outcomes for Enterococcus spp. blood stream infections: a population-based study." Int J Infect Dis 26: 76-82.

Bourgogne, A., K. V. Singh, K. A. Foxand (2007). "EbpR Is Important for Biofilm Formation by Activating Expression of the Endocarditis and Biofilm-Associated Pilus Operon (ebpABC) of Enterococcus faecalis OG1RF." Journal of Bacteriology 189(17): 6490-6493.

Clinical and Laboratory Standards Institute (CLSI) (2015). Clinical and Laboratory Standards Institute, W., PA. (2015). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically; approved standard, 10th ed. CLSI document M07-A10, Wayne, PA.

Courvalin, P. (2006). "Vancomycin Resistance in Gram-Positive Cocci." Clinical Infectious Diseases 42(Supplement_1): S25-S34.

El-Ghazawy, I. F., Okasha, H. A. S., & Mazloum, S. M. (2016). "A study of high level aminoglycoside resistant enterococci." African Journal of Microbiology Research 10(16): 572-277.

Elsner, H.-A., I. Sobottka, D. Mackand (2000). "Virulence factors of Enterococcus faecalis and Enterococcus faecium blood culture isolates." European Journal of Clinical Microbiology & Infectious Diseases 19(1): 39-42.

Fang, H., A. K. Ohlsson, M. Ullbergand (2012). "Evaluation of species-specific PCR, Bruker MS, VITEK MS and the VITEK 2 system for the identification of clinical Enterococcus isolates." Eur J Clin Microbiol Infect Dis 31(11): 3073-3077.

Fossi Djembi, L., E. Hodille, S. Chomat-Jaboulayand (2017). "Factors associated with Vancomycinresistant Enterococcus acquisition during a large outbreak." Journal of Infection and Public Health 10(2): 185-190.

Freitas, A. R., C. Novais, B. Duarteand (2018). "High rates of colonisation by ampicillin-resistant enterococci in residents of long-term care facilities in Porto, Portugal." Int J Antimicrob Agents 51(3): 503-507.

Furtado, G. H., S. T. Martins, A. P. Coutinhoand (2005). "Prevalence and factors associated with rectal vancomycin-resistant enterococci colonization in two intensive care units in Sao Paulo, Brazil." Braz J Infect Dis 9(1): 64-69.

Gozalan, A., F. F. Coskun-Ari, B. Ozdemand (2015). "Molecular characterization of vancomycinresistant Enterococcus faecium strains isolated from carriage and clinical samples in a tertiary hospital, Turkey." J Med Microbiol 64(7): 759-766.

Howden, B. P., K. E. Holt, M. M. C. Lamand (2013). "Genomic Insights to Control the Emergence of Vancomycin-Resistant Enterococci." mBio 4(4): e00412-00413.

Jackson, C. R., P. J. Fedorka-Cray and J. B. Barrett (2004). "Use of a Genus- and Species-Specific Multiplex PCR for Identification of Enterococci." Journal of Clinical Microbiology 42(8):3558-3565.

O’Driscoll, T. and C. W. Crank (2015). "Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management." Infection and Drug Resistance 8: 217-230.

Protonotariou, E., E. Dimitroulia, S. Pournarasand (2010). "Trends in antimicrobial resistance of clinical isolates of Enterococcus faecalis and Enterococcus faecium in Greece between 2002 and 2007." J Hosp Infect 75(3): 225-227.

Puchter, L., I. F. Chaberny, F. Schwaband (2018). "Economic burden of nosocomial infections caused by vancomycin-resistant enterococci." Antimicrobial Resistance and Infection Control 7: 1.

Rahimi, F., M. Talebi, M. Saifiand (2007). "Distribution of enterococcal species and detection of vancomycin resistance genes by multiplex PCR in Tehran sewage." Iran Biomed J 11(3): 161-167.

Reyes, K., A. C. Bardossy and M. Zervos (2016). "Vancomycin-Resistant Enterococci: Epidemiology, Infection Prevention, and Control." Infectious Disease Clinics of North America 30(4): 953-965.

Sharifi, Y., A. Hasani, R. Ghotaslouand (2012). "Survey of Virulence Determinants among Vancomycin Resistant Enterococcus faecalis and Enterococcus faecium Isolated from Clinical Specimens of Hospitalized Patients of North west of Iran." Open Microbiol J 6: 34-39.

Soares, R. O., A. C. Fedi, K. C. Reiterand (2014). "Correlation between biofilm formation and gelE, esp, and agg genes in Enterococcus spp. clinical isolates." Virulence 5(5): 634-637.

Tripathi, A., S. K. Shukla, A. Singhand (2016). "Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India." Indian J Med Microbiol 34(1): 38-45.

Vankerckhoven, V., T. Van Autgaerden, C. Vaeland (2004). "Development of a multiplex PCR for the detection of asa1, gelE, cylA, esp, and hyl genes in enterococci and survey for virulence determinants among European hospital isolates of Enterococcus faecium." Journal of clinical microbiology 42(10): 4473-4479.

Yadav, G., B. Thakuria, M. Madanand (2017). "Linezolid and Vancomycin Resistant Enterococci: A Therapeutic Problem." J Clin Diagn Res 11(8): Gc07-gc11.

Yang, J. X., T. Li, Y. Z. Ningand (2015). "Molecular characterization of resistance, virulence and clonality in vancomycin-resistant Enterococcus faecium and Enterococcus faecalis: A hospitalbased study in Beijing, China." Infect Genet Evol 33: 253-260.


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