Gastrointestinal Colonization with Vancomycin-Resistant Enterococci In Hospitalized and Outpatients
Journal
Open Access Macedonian Journal of Medical Sciences
Date Issued
2015-03
Author(s)
Aneta Kuzmanovska
DOI
10.3889/oamjms.2015.002
Abstract
BACKGROUND: The incidence of infection and intestinal colonization with vancomycin resistant
enterococci (VRE) is increasing in many countries in the last decade. Concerning the difficult
antimicrobial treatment of infections caused by VRE, decreasing the incidence and prevalence of
these infections is an important factor in VRE-induced morbidity and mortality control.
AIM: To determine the prevalence of gastrointestinal colonization with vancomycin resistant
enterococci in hospitalized and outpatients, and to determine the genetic base of the vancomycin
resistance in VRE isolates.
MATERIAL AND METHODS: Seven hundred and eighty stool specimens were investigated for the
gastrointestinal carriage of vancomycin-resistant enterococci (VRE). Susceptibility to vancomycin
was tested in all isolates by disk-diffusion test and E-test (AB Biodisk, Sweden). Determined
vancomycin resistant enterococci were than tested for detection of vanA, vanB and vanC genes by
PCR.
RESULTS: Vancomycin resistant strains of enterococci were isolated from 46 (16.1 %) of the 285
hospitalized patients and 5 (7.7 %) of the 65 patients living in the community (p < 0.05). The most of
the highly resistant enterococci strains to vancomycin (95.2 %), were identified as E. faecium.
Minimal inhibitory concentrations (MICs) to vancomycin in all 39 vanA genotypes of E. faecium and
two vanA genotypes of E. fecalis were > 256 g/ml. Three vanB genotypes of E. faecium and one
vanB genotype of E. faecalis had MICs of 32 g/ml. All six vanC genotypes of E. gallinarum had
MICs of 8 g/ml. All vanA genotypes of VRE were highly resistant to vancomycin, with MICs above
256 g/ml. Three vanB genotypes of VR E. faecium and one VR E. fecalis were resistant, with
MICs 32 g/ml. vanC genotypes of VR E. gallinarum were intermediate resistant to vancomycin
with MICs of 8 g/ml.
CONCLUSIONS: The prevalence of vancomycin resistant enterococci in Republic of Macedonia
was 2-fold higher in hospitalized than in outpatients. VanA genotype was dominant in isolates of E.
faecium and it was highly associated with the MIC values above the 256 g/ml. Since most of the
enterococcal infections are endogenous, there is a need for screening the colonization of patient’s
intestinal flora with VRE at the hospital entry. Identification and genotyping of faecal enterococci,
together with their susceptibility testing to vancomycin, could be useful marker for the infection
control.
enterococci (VRE) is increasing in many countries in the last decade. Concerning the difficult
antimicrobial treatment of infections caused by VRE, decreasing the incidence and prevalence of
these infections is an important factor in VRE-induced morbidity and mortality control.
AIM: To determine the prevalence of gastrointestinal colonization with vancomycin resistant
enterococci in hospitalized and outpatients, and to determine the genetic base of the vancomycin
resistance in VRE isolates.
MATERIAL AND METHODS: Seven hundred and eighty stool specimens were investigated for the
gastrointestinal carriage of vancomycin-resistant enterococci (VRE). Susceptibility to vancomycin
was tested in all isolates by disk-diffusion test and E-test (AB Biodisk, Sweden). Determined
vancomycin resistant enterococci were than tested for detection of vanA, vanB and vanC genes by
PCR.
RESULTS: Vancomycin resistant strains of enterococci were isolated from 46 (16.1 %) of the 285
hospitalized patients and 5 (7.7 %) of the 65 patients living in the community (p < 0.05). The most of
the highly resistant enterococci strains to vancomycin (95.2 %), were identified as E. faecium.
Minimal inhibitory concentrations (MICs) to vancomycin in all 39 vanA genotypes of E. faecium and
two vanA genotypes of E. fecalis were > 256 g/ml. Three vanB genotypes of E. faecium and one
vanB genotype of E. faecalis had MICs of 32 g/ml. All six vanC genotypes of E. gallinarum had
MICs of 8 g/ml. All vanA genotypes of VRE were highly resistant to vancomycin, with MICs above
256 g/ml. Three vanB genotypes of VR E. faecium and one VR E. fecalis were resistant, with
MICs 32 g/ml. vanC genotypes of VR E. gallinarum were intermediate resistant to vancomycin
with MICs of 8 g/ml.
CONCLUSIONS: The prevalence of vancomycin resistant enterococci in Republic of Macedonia
was 2-fold higher in hospitalized than in outpatients. VanA genotype was dominant in isolates of E.
faecium and it was highly associated with the MIC values above the 256 g/ml. Since most of the
enterococcal infections are endogenous, there is a need for screening the colonization of patient’s
intestinal flora with VRE at the hospital entry. Identification and genotyping of faecal enterococci,
together with their susceptibility testing to vancomycin, could be useful marker for the infection
control.
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