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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 898-899
Antibiotic resistance in fecal enterococci in hospitalized patients


1 Student of medicine, Student Research Committe, Kashan University of Medical Science, Kashan, Iran
2 Professor of Microbiology, Department of Microbiology, Kashan University of Medical Science, Kashan, Iran

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Ghaffarpasand I, Moniri R, Kheradi E, Tehrani MD. Antibiotic resistance in fecal enterococci in hospitalized patients. Indian J Pathol Microbiol 2010;53:898-9

How to cite this URL:
Ghaffarpasand I, Moniri R, Kheradi E, Tehrani MD. Antibiotic resistance in fecal enterococci in hospitalized patients. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 24];53:898-9. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/898/72054


Sir,

Surveillance for Vancomycin-resistant enterococci (VRE), which have emerged as an important pathogen during the past years in the world, is becoming an important aspect of infection control management within hospitals. [1] An important component of VRE control within healthcare facilities is the identification of colonized patients. These colonized patients serve as reservoirs and facilitate VRE spread within hospitals. The major risk factor for colonization with VRE appears to be the use of vancomycin or third-generation cephalosporins, length of stay in the intensive care unit (ICU), previous ICU admission and solid organ transplantation. [2] This survey was carried out among patients who stayed at a 500-bed teaching hospital for at least 2 days. A total of 198 patients hospitalized for at least 2 days were enrolled in this investigation. A stool sample or rectal swab collected from each patient was inoculated into appropriate media within 1 h. Enterococcus species were identified by lack of catalase production, pyrrolidonyl arylamidase activity and growth in 6.5% salt broth. Resistance to vancomycin was detected by the E-test method (AB Biodisk, Solna, Sweden). For vancomycin, the categories of susceptible, intermediate and resistant were minimum inhibition concentrations (MICs) of ≤4, 8-16 and 32 mg/L. The Kirby-Bauer disk diffusion method was used to determine susceptibility to a range of antimicrobials (streptomycin, erythromycin, ciprofloxacin, nitrofurantoin, ampicillin, levofloxacin, gentamycin, tetracycline, penicillin-G, linezolid, vancomycin). Enterococcus faecalis ATCC 29212 (vancomycin susceptible) was used for quality control. Statistical analysis was performed using the SPSS#16 software. Categorical variables were compared using either Fisher's exact test or the Chi-square test.

Enterococci were isolated from 100 (50.5%) of the specimens collected from 198 patients [Table 1]. Twenty-seven of these were colonized with VRE (the MIC >32 μg/ml). Seventy-three of these strains were found to be sensitive to vancomycin (MIC ≤4 μg/ml). By the disk diffusion tests, 96 of 100 strains were found to be resistant to streptomycin, 82% to erythromycin and gentamicin, 70% to ciprofloxacin, 60% to nitrofurantoin, 56% to ampicillin, 52% to levofloxacin, 38% to tetracycline, 36% to penicillin-G, 34% to vancomycin and 33% to linezolid. Isolation of VRE was not significantly associated with age, sex, use of total parenteral nutrition (TPN), use of central venous catheter, long hospitalization period and antimicrobial usage.

In the recent years, enterococcal infections have become a major therapeutic challenge because of their increased incidence and the spread of strains that have acquired resistance to several antimicrobial classes. [2],[3] Their resistance to several antimicrobial agents, whether intrinsic to penicillin, cephalosporins and aminoglycocides or acquired (glycopeptides, high concentrations of aminoglycosides), is of great concern. [3],[4] More than 50% of the enterococcus isolates in this study exhibit resistance to aminoglycosides, ampicillin and quinolones, which are three of the traditionally most useful anti-enterococcal antibiotics, and resistance to vancomycin and newer antibiotics such as linezolid was more than 30%. Rare occurrences of linezolid resistance were reported in North America (0.8-1.8%). [4] Ciprofloxacin resistance in North America was >99% and in Europe was varying from 85.7% to 87.5%. [4] Other studies confirmed that previous antibiotic use and prolonged hospital stay are significantly related to VRE colonization. [5] In contrast, we reported that VRE carriage is not associated with prolonged hospital stay and antibiotic usage. Our study demonstrates that VRE prevalence is high in our hospital. VRE colonization must be monitored and risk factors should be determined because they are useful for screening hospitalized patients for VRE colonization in order to establish prevention and control measures.
Table 1: Characteristics of Patients with and without Vancomycin-Resistant Enterococcus (VRE) Strain Colonization by E-Test

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   References Top

1.Arias CA, Murray BE. Emergence and management of drug-resistant enterococcal infections. Expert Rev Anti Infect Ther 2008;6:637-55.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Boost M, Lai L, O'Donoghue M. Drug resistance in fecal enterococci in Hong Kong. J Infect Chemother 2004;10:326-30.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Werner G, Coque TM, Hammerum AM, Hope R III, Hryniewicz W, Johnson A, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill 2008;20:13.  Back to cited text no. 3
    
4.Deshpande LM, Fritsche TR, Moet GJ, Biedenbach DJ, Jones RN. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: A report from the SENTRY antimicrobial surveillance program. Diagn Microbiol Infect Dis 2007;58:163-70.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Benenson S, Cohen MJ, Block C, Stern S, Weiss Y, Moses AE. Vancomycin-resistant enterococci in long-term care facilities. Infect Control Hosp Epidemiol 2009;30:786-9.  Back to cited text no. 5
    

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Correspondence Address:
Iman Ghaffarpasand
Student Research Committee, Kashan University of Medical Science, Kashan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72054

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