Vancomycin Resistant Enterococci and Trend of Antimicrobial Susceptibility in Urine Cultures
-
Jitu Mani Kalita
,
Kavita Yedale
,
Vibhor Tak
,
Vijaya Lakshmi Nag
,
Alisha Aggarwal
,
Gautam Ram Choudhary
Abstract
Background: Enterococci are emerging nosocomial pathogen showing resistance to broad spectrum antibiotics. As reported by the center for disease control and prevention, enterococci (13.9%) are the second leading cause of urinary tract infection, after Escherichia coli. After the first report of vancomycin-resistant enterococci in England (1988), India reported its first vancomycin resistant enterococci isolate from New Delhi (1999). The prevalence of vancomycin resistant enterococci ranges from 1-9%, in India. To evaluate the prevalence of vancomycin resistant enterococci among urinary isolates and to check their antimicrobial resistance pattern.
Methods: A retrospective observational study conducted at a tertiary care hospital. Data were analysed from November, 2017 to October, 2018. A total of 12,129 urine samples were received and subjected to culture on HiCrome UTI agar (Hi-Media laboratories, Mumbai) and incubated at 37 °C for a period of 18-24 hours. Antimicrobial susceptibility was performed using Kirby–Bauer disc diffusion method. Identification was done on the basis of colony colour and species identification was done by using biochemical test as per standard laboratory protocol. In one case automated siemens microscan walkaway identification system was used for confirmation.
Results: Enterococci were isolated in 4.06% from urine cultures out of which 7.52% were vancomycin resistant. Most of the vancomycin resistant enterococci isolate (86.49%) were multi drug resistant.
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7. Codelia-Anjum A, Lerner LB, Elterman D, et al. Enterococcal Urinary Tract Infections: A Review of the Pathogenicity, Epidemiology, and Treatment. Antibiotics 2023; 12(4):778.
8. Moellering JRC. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis 1992; 14(4):1173-6.
9. Shah L, Mulla S, Patel GP, et al. Prevalence of enterococci with higher resistance level in a tertiary care hospital: a matter of concern. Natl J Med Res 2012; 2(01):25-7.
10. Clevel DB. Movable genetic elements and antibiotic resistance in enterococci. Eur J Clin Microbiol Infect Dis 1990; 9(2):90-102.
11. Choice of antibacterial drugs. Treat Guidel Med Lett 2007; 5(57):33-50.
12. Uttley AHC, Collins CH, Naidoo J, et al. Vancomycin-resistant enterococci. Lancet 1988; 1(8575-6):57-8.
13. Leclercq R, Derlot E, Duval J, et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988; 319(3):157-61.
14. Swaminathan S, Alangaden GJ. Treatment of resistant enterococcal urinary tract infections. Curr Infect Dis Rep 2010; 12(6):455-64.
15. Purohit G, Gaind R, Dawar R, et al. Characterization of vancomycin resistant enterococci in hospitalized patients and role of gut colonization. J Clin Diagn Res 2017; 11(9):DC01-DC05.
16. Mamtora D, Saseedharan S, Bhalekar P, et al. Microbiological profile and antibiotic susceptibility pattern of Gram-positive isolates at a tertiary care hospital. J Lab Physicians 2019; 11(2):144-8.
17. 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.
18. Bhatt P, Patel A, Sahni AK, et al. Emergence of multidrug resistant enterococci at a tertiary care centre. Med J Armed Forces India 2015; 71(2):139-44.
19. Arias CA, Murray BE. Increase rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012; 10(4):266-78.
20. Rosa RG, Schwarzbold AV, Dos Santos RP, et al. Vancomycin-resistant Enterococcus faecium bacteremia in a tertiary care hospital: epidemiology, antimicrobial susceptibility, and outcome. Biomed Res Int 2014; 2014:958469.
21. Wavare SM, Ghorpade MV, Gajul SV, et al. A study of vancomycin resistant enterococci isolated from urinary tract infections. Int J Pharm Pharm Sci 2015; 7(5):337-9.
22. Toner L, Papa N, Aliyu SH, et al. Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom. Investig Clin Urol 2016; 57(2):129-34.
23. Meena M, Kishoria N, Meena DS, et al. Bacteriological profile and antibiotic resistance in patients with urinary tract infection in tertiary care teaching hospital in Western Rajasthan India. Infect Disord Drug Targets 2021; 21(2):257-61.
24. Sood S, Gupta R. Antibiotic resistance pattern of community acquired uropathogens at a tertiary care hospital in jaipur, Rajasthan. Indian J Community Med 2012: 37(1);39-44.
25. Das R, Chandrasekhar TS, Joshi HS, et al. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore Med J 2006; 47(4):281-5.
26. Parameswarappa J, Basavaraj VP, Basavaraj CM. Isolation, identification, and antibiogram of enterococci isolated from patients with urinary tract infection. Ann Afr Med 2013; 12(3):176-81.
27. Goel V, Kumar D, Kumar R, et al. Community acquired enterococcal urinary tract infections and antibiotic resistance profile in North India. J Lab Physicians 2016; 8(1):50-4.
28. Meena S, Mohapatra S, Sood S, et al. Revisiting nitrofurantoin for vancomycin resistant enterococci. J Clin Diagn Res 2017; 11(6):DC19-DC22.
29. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18(3):268-81.
30. Zhanel GG, Laing NM, Nichol KA, et al. Antibiotic activity against urinary tract infection (UTI) isolates of vancomycin-resistant enterococci (VRE): results from the 2002 North American Vancomycin Resistant Enterococci Susceptibility Study (NAVRESS). J Antimicrob Chemother 2003; 52(3):382-8.
31. Schouten MA, Voss A, Hoogkamp-Korstanje JA. Antimicrobial susceptibility patterns of enterococci causing infections in Europe. The European VRE Study Group. Antimicrob Agents Chemother 1999; 43(10):2542-6.
32. Heintz BH, Halilovic J, Christensen CL. Vancomycin-resistant enterococcal urinary tract infections. Pharmacotherapy 2010; 30(11):1136-49.
33. Rivera AM, Boucher HW. Current concepts in antimicrobial therapy against select gram-positive organisms: methicillin resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci. Mayo Clin Proc 2011; 86(12):1230-43.
34. Wang JL, Hsueh PR. Therapeutic options for infections due to vancomycin-resistant enterococci. Expert Opin Pharmacother 2009; 10(5):785-96.
35. Heintz BH, Cho S, Fujioka A, et al. Evaluation of the treatment of vancomycin-resistant enterococcal urinary tract infections in a large academic medical center. Ann Pharmacother 2013; 47(2):159-69.
2. Cetinkaya Y, Falk P, Mayhall GC. Vancomycin-Resistant Enterococci. Clin Microbiol Rev 2000; 13(4):686-707.
3. Flores-Mireles AL, Walker JN, Caparon M, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015; 13(5):269-84.
4. Toledo-Arana A, Valle J, Solano C, et al. The enterococcal surface protein, esp, is involved in Enterococcus faecalis biofilm formation. Appl Environ Microbiol 2001; 67(10):4538-45.
5. William Costerton J. Cystic fibrosis pathogenesis and the role of biofilms in persistent infection. Trends Microbiol 2001; 9(2):50-2.
6. Moniri R, Ghasemi A, Moosavi SGA, et al. Virulence gene’s relationship with biofilm formation and Detection of aac (6’)/aph (2”) in Enterococcus faecalis isolated from Patients with Urinary Tract Infection. Jundishapur J Microbiol 2013; 6(5):e94137.
7. Codelia-Anjum A, Lerner LB, Elterman D, et al. Enterococcal Urinary Tract Infections: A Review of the Pathogenicity, Epidemiology, and Treatment. Antibiotics 2023; 12(4):778.
8. Moellering JRC. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis 1992; 14(4):1173-6.
9. Shah L, Mulla S, Patel GP, et al. Prevalence of enterococci with higher resistance level in a tertiary care hospital: a matter of concern. Natl J Med Res 2012; 2(01):25-7.
10. Clevel DB. Movable genetic elements and antibiotic resistance in enterococci. Eur J Clin Microbiol Infect Dis 1990; 9(2):90-102.
11. Choice of antibacterial drugs. Treat Guidel Med Lett 2007; 5(57):33-50.
12. Uttley AHC, Collins CH, Naidoo J, et al. Vancomycin-resistant enterococci. Lancet 1988; 1(8575-6):57-8.
13. Leclercq R, Derlot E, Duval J, et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988; 319(3):157-61.
14. Swaminathan S, Alangaden GJ. Treatment of resistant enterococcal urinary tract infections. Curr Infect Dis Rep 2010; 12(6):455-64.
15. Purohit G, Gaind R, Dawar R, et al. Characterization of vancomycin resistant enterococci in hospitalized patients and role of gut colonization. J Clin Diagn Res 2017; 11(9):DC01-DC05.
16. Mamtora D, Saseedharan S, Bhalekar P, et al. Microbiological profile and antibiotic susceptibility pattern of Gram-positive isolates at a tertiary care hospital. J Lab Physicians 2019; 11(2):144-8.
17. 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.
18. Bhatt P, Patel A, Sahni AK, et al. Emergence of multidrug resistant enterococci at a tertiary care centre. Med J Armed Forces India 2015; 71(2):139-44.
19. Arias CA, Murray BE. Increase rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 2012; 10(4):266-78.
20. Rosa RG, Schwarzbold AV, Dos Santos RP, et al. Vancomycin-resistant Enterococcus faecium bacteremia in a tertiary care hospital: epidemiology, antimicrobial susceptibility, and outcome. Biomed Res Int 2014; 2014:958469.
21. Wavare SM, Ghorpade MV, Gajul SV, et al. A study of vancomycin resistant enterococci isolated from urinary tract infections. Int J Pharm Pharm Sci 2015; 7(5):337-9.
22. Toner L, Papa N, Aliyu SH, et al. Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom. Investig Clin Urol 2016; 57(2):129-34.
23. Meena M, Kishoria N, Meena DS, et al. Bacteriological profile and antibiotic resistance in patients with urinary tract infection in tertiary care teaching hospital in Western Rajasthan India. Infect Disord Drug Targets 2021; 21(2):257-61.
24. Sood S, Gupta R. Antibiotic resistance pattern of community acquired uropathogens at a tertiary care hospital in jaipur, Rajasthan. Indian J Community Med 2012: 37(1);39-44.
25. Das R, Chandrasekhar TS, Joshi HS, et al. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore Med J 2006; 47(4):281-5.
26. Parameswarappa J, Basavaraj VP, Basavaraj CM. Isolation, identification, and antibiogram of enterococci isolated from patients with urinary tract infection. Ann Afr Med 2013; 12(3):176-81.
27. Goel V, Kumar D, Kumar R, et al. Community acquired enterococcal urinary tract infections and antibiotic resistance profile in North India. J Lab Physicians 2016; 8(1):50-4.
28. Meena S, Mohapatra S, Sood S, et al. Revisiting nitrofurantoin for vancomycin resistant enterococci. J Clin Diagn Res 2017; 11(6):DC19-DC22.
29. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18(3):268-81.
30. Zhanel GG, Laing NM, Nichol KA, et al. Antibiotic activity against urinary tract infection (UTI) isolates of vancomycin-resistant enterococci (VRE): results from the 2002 North American Vancomycin Resistant Enterococci Susceptibility Study (NAVRESS). J Antimicrob Chemother 2003; 52(3):382-8.
31. Schouten MA, Voss A, Hoogkamp-Korstanje JA. Antimicrobial susceptibility patterns of enterococci causing infections in Europe. The European VRE Study Group. Antimicrob Agents Chemother 1999; 43(10):2542-6.
32. Heintz BH, Halilovic J, Christensen CL. Vancomycin-resistant enterococcal urinary tract infections. Pharmacotherapy 2010; 30(11):1136-49.
33. Rivera AM, Boucher HW. Current concepts in antimicrobial therapy against select gram-positive organisms: methicillin resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci. Mayo Clin Proc 2011; 86(12):1230-43.
34. Wang JL, Hsueh PR. Therapeutic options for infections due to vancomycin-resistant enterococci. Expert Opin Pharmacother 2009; 10(5):785-96.
35. Heintz BH, Cho S, Fujioka A, et al. Evaluation of the treatment of vancomycin-resistant enterococcal urinary tract infections in a large academic medical center. Ann Pharmacother 2013; 47(2):159-69.
| Files | ||
| Issue | Vol 12 No 3 (2024) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jmb.v12i3.16596 | |
| Keywords | ||
| HiChrome UTI agar Multidrug resistant Urinary tract infection Vancomycin resistant enterococci. | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Kalita J, Yedale K, Tak V, Nag V, Aggarwal A, Choudhary G. Vancomycin Resistant Enterococci and Trend of Antimicrobial Susceptibility in Urine Cultures. J Med Bacteriol. 2024;12(3):1-8.
