Epidemiology and molecular characterization of vancomycin resistant Enterococci isolates in India

Abstract

Little attention has been paid to the problem of the spread of vancomycin resistant enterococci (VRE) in India. Between August 2002 to March 2003, faecal and urine samples of patients from various wards of the Postgraduate Institute of Medical Education and Research, Chandigarh, India, were screened for vancomycin resistance. 36 VRE were isolated (18 Enterococcus gallinarum, 9 E. casseliflavus, 7 E. faecium and 2 E. faecalis). These isolates were characterized as low-, moderate- and high-level resistant strains by phenotypic as well as genotypic methods such as minimum inhibitory concentration determination, polymerase chain reaction assays, sequencing of PCR products and multiple sequence alignment of van genes. Correlations established between these results and the vancomycin resistance markers were designated as vanA (783 bp), vanB (635 bp), vanC1 (822 bp) and vanC2 (484 bp) according to the findings of earlier workers as well as comparison with existing databases. Prolonged hospital stay and vancomycin were important risk factors for both VRE UTI and colonization. Renal dialysis, renal failure, prior aminoglycoside and third generation cephalosporin were the other significant factors for VRE UTI. The study also highlights the importance of screening for VRE in clinical samples and recommends the institution of control measures to prevent the further spread of VRE.

Prevalence of vancomycin resistance and multiple drug resistance in enterococci in equids in North India

“…The presence of vancomycin resistance in 80.2% and MDR in more than 99% of enterococci isolates of equine origin indicated that VRE and MDRE in [3,4,7], there is little information about their prevalence in Indian equids.…”

“…Epidemiology of VRE infections has been studied in several hospitals in different parts of India [3,4,7]; however, there is dearth of information on VRE from animals, including equids. The present study was undertaken to assess the extent of vancomycin resistance and MDR in enterococci isolates of equine origin.…”

“…Recently vancomycin resistant enterococci (VRE) and multi-drug-resistant (MDR) enterococci (MDRE) have emerged as cause of nosocomial super infections in surgical and in tertiary care units, particularly after organ transplants [3]. Besides nosocomial infections of surgical wounds, VRE and MDRE are emerging causes of meningitis in neonates, as well as infections of the central nervous system, osteomyelitis, lung infections, and urinary tract and pelvic infections in adults [2,[4][5][6][7]8].…”

Enterococcus: review of its physiology, pathogenesis, diseases and the challenges it poses for clinical microbiology

“…In addition, the enterococci are becoming one of the most common sources of infections acquired in hospitals (nosocomial infections) and infections due to physician error (iatrogenic infections) (reviewed in Emori and Gaynes, 1993;Teixeira et al, 2011). These infections are especially a problem in developing world countries (Budavari et al, 1997;Cohen, 1997;Khudaier et al, 2007;Singh 2009;Panesso et al, 2010), but are also prevalent in wealthier nations (reviewed in Emori and Gaynes, 1993). According to the National Nosocomial Infections Surveillance (NNIS) system conducted by the Centers for Disease Control and Prevention (CDC), the enterococci are the fourth leading cause of hospital-acquired infections and the third leading cause of bacteremia (reviewed in Emori and Gaynes, 1993).…”

“…As it is, molecular testing for HIV/AIDS and tuberculosis has overwhelmed many resources within developing world hospitals, and most of the published literature addresses cost-benefit analysis for molecular tests related to these two infectious agents, while little is published in the clinical bacteriology area for other pathogens such as the enterococci. When one observes the situation for bacterial induced diseases, one finds many alarming trends: (1) antimicrobial resistant bacteria, such as the enterococci, are on the rise in both hospitals and communities within the developing world, (2) developing world hospitals have less than basic clinical microbiology facilities, (3) developing world hospitals lack the trained staff to perform molecular testing and even basic classical culture and analysis (such as the Gram stain procedure), and (4) developing world hospitals lack adequate infection control programs and surveillance (Budavari et al, 1997;Cohen, 1997;Morrison et al, 1997;Cetinkaya et al, 2000;Archibald and Reller, 2001;Elzinga et al, 2004;Rice, 2006;Khudaier et al, 2007;Chan and Iseman, 2008;Singh 2009;Panesso et al, 2010). In light of the present trend, it is important for clinical microbiology laboratories in more underprivileged nations to invest in classical culture techniques that are rapid, cost effective, feasible within the confinements of developing world hospitals, and that can lead to effective identification of enterococci to the genus and species level.…”