Fri, Nov 29, 2024
Volume 18, Issue 3 (May-Jun 2024)
mljgoums 2024, 18(3): 4-7 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Devhare D, Pol S. Clinical and microbiological study of vancomycin-resistant enterococci isolated from colonized and infected patients with special reference to risk factors. mljgoums 2024; 18 (3) :4-7
URL: http://mlj.goums.ac.ir/article-1-1680-en.html
URL: http://mlj.goums.ac.ir/article-1-1680-en.html
1- BVDUMC, Pune, India , deepadevhare@gmail.com
2- BJ. Government Medical College, Pune, India
2- BJ. Government Medical College, Pune, India
Abstract: (541 Views)
Background: Vancomycin-resistant enterococci (VRE) has become a growing concern in healthcare settings as a major cause of many nosocomial infections worldwide. Risk factors associated with VRE are important to study. High-risk patients need to be screened and isolated to prevent the spread of infection and colonization. The present study aims to investigate the clinical spectrum, risk factors, and source of transmission of VRE in infected and colonized patients.
Methods: A prospective observational study was carried out for 1 year. A total of 200 Enterococcus species isolated from clinical samples such as urine, pus, blood, sterile body fluids, and stool from 200 patients without infection were included in the study. Stool samples were screened to measure the prevalence of VRE colonization. All samples were screened for vancomycin resistance using the Kirby-Bauer disc diffusion method. Vancomycin MIC was detected using the macrobroth dilution method. Demographic and clinical history of the patients were recorded.
Results: Vancomycin resistance was detected in 7 (3.5%) of 200 enterococci isolates from clinical samples. Urinary tract infection (n = 5, 71.4%) was the most common clinical illness caused by VRE. Gut colonization was found in 12 (6%) out of 200 patients screened for VRE. A history of previous antibiotic exposure was a significant risk factor in the current study and was associated with VRE infection and colonization. Endogenous bloodstream infection caused by VRE was found in one patient with VRE colonization.
Conclusion: The findings of this study highlight the significant burden of VRE on patients, both those infected and colonized. The emergence of multidrug-resistant bacteria in healthcare settings, a consequence of inappropriate antibiotic use, is a serious concern that warrants further research and our continued attention.
Methods: A prospective observational study was carried out for 1 year. A total of 200 Enterococcus species isolated from clinical samples such as urine, pus, blood, sterile body fluids, and stool from 200 patients without infection were included in the study. Stool samples were screened to measure the prevalence of VRE colonization. All samples were screened for vancomycin resistance using the Kirby-Bauer disc diffusion method. Vancomycin MIC was detected using the macrobroth dilution method. Demographic and clinical history of the patients were recorded.
Results: Vancomycin resistance was detected in 7 (3.5%) of 200 enterococci isolates from clinical samples. Urinary tract infection (n = 5, 71.4%) was the most common clinical illness caused by VRE. Gut colonization was found in 12 (6%) out of 200 patients screened for VRE. A history of previous antibiotic exposure was a significant risk factor in the current study and was associated with VRE infection and colonization. Endogenous bloodstream infection caused by VRE was found in one patient with VRE colonization.
Conclusion: The findings of this study highlight the significant burden of VRE on patients, both those infected and colonized. The emergence of multidrug-resistant bacteria in healthcare settings, a consequence of inappropriate antibiotic use, is a serious concern that warrants further research and our continued attention.
Research Article: Research Article |
Subject:
Microbiology
Received: 2023/06/15 | Accepted: 2024/05/20 | Published: 2024/11/12 | ePublished: 2024/11/12
Received: 2023/06/15 | Accepted: 2024/05/20 | Published: 2024/11/12 | ePublished: 2024/11/12
References
1. Ahmed MO, Baptiste KE. Vancomycin-Resistant Enterococci: A Review of Antimicrobial Resistance Mechanisms and Perspectives of Human and Animal Health. Microb Drug Resist. 2018; 24(5): 590-606. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Karna A, Baral R, Khanal B. Characterization of Clinical Isolates of Enterococci with Special Reference to Glycopeptide Susceptibility at a Tertiary Care Center of Eastern Nepal. Int J Microbiol. 2019; 2019: 7936156. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Janjusevic A, Cirkovic I, Minic R, Stevanovic G, Soldatovic,I, Mihaljevic B, et al. Predictors of Vancomycin-Resistant Enterococcus spp. Intestinal Carriage among High-Risk Patients in University Hospitals in Serbia. Antibiotics. 2022; 11: 1228. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Hendrix CW, Hammond JM, Swoboda SM, Merz WG, Harrington SM, Perl TM, et al. Surveillance strategies and impact of vancomyc inresistant enterococcal colonization and infection in critically ill patients. Ann Surg .2001; 233 : 259-265. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Mainous MR, Lipsett PA, O'Brien M. Enterococcal bacteremia in the surgical intensive care unit. Does vancomycin resistance affect mortality? The Johns Hopkins SICU Study Group. Arch Surg. 1997; 132 : 76-81. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Kajihara T, Nakamura S, Iwanaga N, Oshima K , Takazono T , Miyazaki T, et al. Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study. BMC Infectious Diseases .2015; 15:426. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Montecalvo MA, Shay DK, Gedris C, Petrullo C, Uman J, Rodney K et al. A semiquantitative analysis of the fecal flora of patients with vancomycin-resistant Enterococci : colonized patients pose an infection control risk. Clin Infect Dis.1997; 25 : 929-930. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Correa-Martinez CL, Stollenwerk VB, Kossow A, Schaumburg F, Mellmann A, Kampmeier S. Risk Factors for Long-Term Vancomycin-Resistant Enterococci Persistence-A Prospective Longitudinal Study. Microorganisms. 2019; 7(10): 400. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Se YB, Chun HJ, Yi HJ, Dong-Won Kim DW, Yong Ko Y, Oh SJ. Incidence and Risk Factors of Infection Caused by Vancomycin-Resistant Enterococcus Colonization in Neurosurgical Intensive Care Unit Patients. J Korean Neurosurg Soc. 2009; 46: 123-129. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Bhatt P, Patel A, Sahni A, Grover N, Chaudhari C , Nikunja Kumar Das, et al. Emergence of multidrug resistant Enterococci at a tertiary care centre. Med J Armed Forces India. 2015; 71(2): 139-144. [View at Publisher] [DOI] [PMID] [Google Scholar]
11. Dadfarma N, Imani FA, Oskoui M, Hosseini H. "High level of gentamicin resistance (HLGR) among Enterococcus strains isolated from clinical specimens. J Infect Public Health. 2013; 6(3): 202-208. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Jia W, Li G, Wang W. Prevalence and antimicrobial resistance of Enterococcus species: a hospital-based study in China. Int J Environ Res Public Health. 2014; 11(3): 3424-3442. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Biswas P, Dey S, Adhikari L, Sen A. Detection of vancomycin resistance in Enterococcus species isolated from clinical samples and feces of colonized patients by phenotypic and genotypic methods. Indian J Pathol Microbiol. 2016; 59(2): 188-93. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Mikulska M, Del BV, Prinapori R, Boni L, Raiola AM, Gualandi F, et al. Risk factors for Enterococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients. Transpl Infect Dis. 2010; 12(6): 505-12. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Weinstock DM, Conlon M, Iovino C, Aubrey T, Gudiol C, Riedel E, et al. Colonization, bloodstream infection, and mortality caused by vancomycin resistant Enterococcus early after allogeneic hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2007; 13(5): 615-21. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Vydra J, Shanley RM, George I, Ustun C, Smith AR, Weisdorf DJ, et al. Enterococcal bacteremia is associated with increased risk of mortality in recipients of allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2012; 55(6): 764-70. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Buetti N, Wassilew N, Rion V, Senn L, Gardiol C, Widmer A, et al. Emergence of vancomycin-resistant Enterococci in Switzerland: a nation-wide survey. Antimicrobial Resistance and Infection Control. 2019; 8:16. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Uddhav SB, Sivagurunathan MS. Antibiotic Susceptibility Testing: A Review On Current Practices. Int J Pharm 2016; 6(3): 11-17. [View at Publisher]
19. CLSI. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-third Informational Supplement, M100-S23. Vol. 33. Wayne, USA;, CLSI; 2008. 90-3. [View at Publisher] [Google Scholar]
20. Cetinkaya Y, Falk P, Mayhall CG. Vancomycin-resistant Enterococci. Clin Microbiol Rev 2000; 13(4): 686-707. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Betty AF, Daniel LS, Weissfeld AS, editors. Overview of bacterial identifications methods and strategies. In: Bailey & Scott's Diagnostic Microbiology. 12th ed. Missouri: Mosby Elsevier; 2007: 216-41. [View at Publisher] [Google Scholar]
22. Jenkins SG, Raskoshina L, Schuetz AN. Comparison of Performance of the Novel Chromogenic Spectra VRE Agar to That of Bile Esculin Azide and Campylobacter Agars for Detection of Vancomycin-Resistant Enterococci in Fecal Samples. J Clin Microbiol. 2011; 49(11): 3947-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC, editors. Gram-positive cocci Part 2: Streptococci, Enterococci and the Streptococcus like bacteria. In: Colour Atlas and Text Book of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott; 2006. p. 725-33.
24. Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, editors. Special Phenotypic Methods for Detecting Antibacterial Resistance. In: Manual of Clinical Microbiology. 9th ed. Washington, DC: ASM Press; 2007. p. 1152-72. [View at Publisher] [Google Scholar]
25. Center for disease control and prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Wkly Rep 1995; 44(RR- 12):1-13. 1995;44(RR-12):1-13. [View at Publisher] [Google Scholar]
26. Center for disease control and prevention. Vancomycin resistant Enterococci in health care settings. HAI. 2024. [View at Publisher]
27. Pan S, Wang J, Chen Y, Chang Y, Chen M, Chang C. Incidence of and Risk Factors for Infection or Colonization of Vancomycin-Resistant Enterococci in Patients in the Intensive Care Unit Acute renal failure. PLoS One. 2012;7(10):e47297. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Heintz BH, Halilovic J, Christensen CL. Vancomycin resistant Enterococcal Urinary Tract Infections. Pharmacotherapy. 2010; 30(11): 1136-49. [View at Publisher] [DOI] [PMID] [Google Scholar]
29. Deshpande VR, Karmarkar MG, Mehta PR. Letter to the Editor Prevalence of multidrug-resistant Enterococci in a tertiary care hospital in. J Infect Dev Ctries. 2013; 7(2): 155-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Rahangdale V, Agrawal G. Study of antimicrobial resistance in Enterococci. Indian J Med Microbiol. 2008; 26(3): 285-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Baragundi M, Sonth S, Solabannavar S, Patil C. Species Prevalence And Antimicrobial Resistance Pattern Of Enterococcal Isolates In A Tertiary Health Care Centre. J Clin Diagnostic Res. 2010; 4: 3405-9. [View at Publisher] [DOI]
32. Tacconelli E, Cataldo MA. Vancomycin-resistant Enterococci (VRE) : transmission and control. Int J Antimicrob Agents. 2008; 31(2): 99-106. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Taneja N, Rani P, Emmanuel R, Sharma M. Significance of vancomycin resistant Enterococci from urinary specimens at a tertiary care centre in Northern India. Indian J Med Res. 2004; 119: 72-4. [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Enamad
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.