Characterization of Clinical Isolates ofEnterococciwith Special Reference to Glycopeptide Susceptibility at a Tertiary Care Center of Eastern Nepal

Abstract

Background. Enterococci, once considered as a harmless commensal of intestine, have now emerged as medically important pathogens and are associated with both community-acquired and nosocomial infections. They bear the potential to exhibit resistance against all commonly used antibiotics either by inherent or acquired mechanism, posing a therapeutic challenge. Objectives. This study aimed to characterize enterococci up to the species level and study their antibiogram with special regard to vancomycin. Methods. A descriptive cross-sectional study was conducted in the Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, from February to May 2017. A total of 91 enterococcal isolates recovered from clinical specimens were investigated in this study. Their identification and speciation were done according to standard microbiological guidelines. Kirby–Bauer disc diffusion technique was used to study antimicrobial susceptibility pattern, whereas minimum inhibitory concentration of vancomycin was determined by the agar dilution method, with reference to Clinical and Laboratory Standards Institute guidelines. Results. Seven different species of enterococci were isolated, E. faecalis and E. faecium accounting about 45% each. The other species encountered were E. avium, E. cecorum, E. dispar, E. durans, and E. raffinosus. Highest proportion of antimicrobial susceptibility was recorded for linezolid (97.8%), followed by teicoplanin (95.6%) and high-level gentamicin (81.3%). Sensitivity to vancomycin was seen in 79.1% isolates. Likewise, 82.1% of urinary strains were susceptible to nitrofurantoin. A total of 4 disparities were observed between the disc diffusion technique and agar dilution method in determining vancomycin resistance. Multidrug resistance was observed in 31.9% isolates. The overall prevalence of vancomycin-resistant enterococci based on the standard minimum inhibitory concentration method was 25.3%. Conclusions. Enterococcus faecalis and E. faecium were the predominant species in causing enterococcal infections. The alarming rise in prevalence of vancomycin and multidrug resistance strains warrants immediate, adequate, and efficient surveillance program to prevent and control its spread.

Evaluation of the antibacterial and anticancer activities of marine Bacillus subtilis ESRAA3010 against different multidrug resistant Enterococci (MDRE) and cancer cell lines

“…On the other hand, Table 2 showed the different department from which specimens were collected, 17 (28.81%); 16 (27.12%); 8 (13.56%); 7 (11.86%); 5 (8.48%); 4 (6.78%); 1 (1.70%) and 1 (1.70%) isolates were obtained from I.C.U (intensive care unit), surgery, diabetic, skin and venereal disease, hematology, emergency, E.N.T (ear, nose and throat) and neurology departments, respectively which indicating that hospitalization in the intensive care unit is an important risk factor for MDRE colonization and occurrence. Similar distribution observation were reported previously in resistant Enterococci collated from different humanoid In agreement with our results, Karna, et al [4] analyzed ninety one isolates of Enterococcus obtained from numerous clinical samples, among them the highest Enterococci isolates incidence reported from urine then pus and blood (61.5%, 19.8% and 5.5%, respectively).…”

“…The presence of resistant Enterococci isolates in human societies acts as a source for hospital infections [1]. In line with our results, Karna, et al [4] revealed that the predominance of Enterococci isolates were achieved from age group 0-10 (20.9%), after that age group 20-30 (19.8%) along with detection of the high incidence of infection in male participants. Enterococci are recognized as unique reasons of hospital infections in patients with weakened immune systems.…”

“…In the current work, the susceptibility patterns in the infections [19], clinical samples in Kashmir; North India [43], health care setting [3], tertiary care center of Eastern Nepal [4] and Turkey [1].…”

“…They developed multidrug resistance to different antibiotics in common use (MDR) with markedly increasing prevalence by contacting with contaminating surfaces and apparatus or infected persons [3]. They gain increasing concern due to their facility for withstanding the in luence of various antibacterial agents, accordingly limit the drug of choices and leads to higher mortality and morbidity [4]. Therefore, inding of alternate powerful, inexpensive and harmless natural agents against multidrug resistant bacteria can be potent way for solving this serious global problem [5][6][7].…”

Antibiotic susceptibility pattern of Enterococcus isolates in a five year period at a tertiary care hospital

“…Enterococci are associated with both communityacquired and nosocomial infections and their antibiotic resistance potential and multidrug resistant isolates poses an important therapeutic challenge [8]. Sattari et al [9] reported that more than 92% of E. faecium isolates were resistant to ampicillin (92.5%), ciprofloxacin (96%), erythromycin (100%) and clindamycin (96%) while a high frequency of resistance to clindamycin (100%), erythromycin (98.5%) and ciprofloxacin (80.5%) was reported in E. faecalis isolates, with a less frequent resistance to ampicillin (7%) in a children's hospital.…”