<p>Emergence of multidrug resistance and extensive drug resistance among enterococcal clinical isolates in Egypt</p>

Abstract

Introduction Enterococci commonly inhabit the gastrointestinal tract of both human and animals; however, they have emerged as a leading cause of several infections with substantial morbidity and mortality. Their ability to acquire resistance combined with intrinsic resistance to various antimicrobials makes treatment of enterococcal infections challenging. Materials and methods The aim of the study was to evaluate the antimicrobial resistance pattern, and assess the prevalence of multidrug resistance (MDR) and extensive drug resistance (XDR) among enterococcal isolates, collected from different clinical sources, in Mansoura University Hospitals, Egypt. Results Antibiotic sensitivity testing revealed elevated levels of resistance among enterococcal clinical isolates (N=103). All E. faecium (N=32) and 74.6% of E. faecalis isolates (N=71) were MDR, while two E. faecalis and four E. faecium isolates were XDR. High level gentamicin resistance was detected in 79.6%, most of them carried the aac(6’)-Ie-aph(2’’)-Ia gene. High level streptomycin resistance was seen in 36.9%, of which 52.6% carried the ant(6’)-Ia gene. Resistance to macrolides and lincosamides were mediated by ermB (92.2%) and msrA/B (42.7%). tetK , tetL , and tetM genes were detected among tetracyclines resistant isolates. Resistance to vancomycin was detected in 15.5%, where vanB and vanC 1 gene clusters were detected in VRE isolates. Ten isolates (9.7%) were resistant to linezolid, eight of which harbored the optrA gene. Vancomycin and linezolid resistant enterococci were more likely to exhibit strong/moderate biofilm formation than vancomycin and linezolid sensitive ones. Conclusion Elevated levels of resistance to different classes of antimicrobial agents and emergence of MDR and XDR strains pose a major threat with limited therapeutic options for infections caused by this emerging pathogen.

Prevalence and antimicrobial susceptibility profile of multidrug-resistant bacteria among intensive care units patients at Ain Shams University Hospitals in Egypt—a retrospective study

“…As regards Enterococci , the overall resistance pattern was comparable to that reported by Said and Abdelmegeed [ 29 ] with the exception of the higher linezolid resistance reported (9.7%) in their study. Likewise, the resistance pattern of ciprofloxacin, erythromycin, gentamicin, and linezolid agrees with that reported by Zalipour and coworkers [ 30 ].…”

Molecular epidemiology of vancomycin-resistant Enterococcus faecium clinical isolates in a tertiary care hospital in southern Thailand: a retrospective study

“…The prevalence of VRE isolates in our study was relatively low compared with that found in India (7.0%) ( Bhatt et al., 2015 ) and in Egypt (6.3%) ( Said & Abdelmegeed, 2019 ), indicating that risks of VRE infections may be associated with geographic variability. Blanco et al (2017) reported in 2017 that relative humidity and geographical location were factors affecting VRE colonization rates in adult patients admitted to ICUs in the United States.…”

“…A similarity matrix was estimated using Dice’s coefficient, and a dendrogram was created based on the unweighted-pair group method with arithmetic averages. Enterococci isolates with a similarity coefficient ≥85% were considered as the same genotype ( Said & Abdelmegeed, 2019 ).…”

Peer Review #2 of "Molecular epidemiology of vancomycin-resistant Enterococcus faecium clinical isolates in a tertiary care hospital in southern Thailand: a retrospective study (v0.1)"

“…Enterococci isolates with a similarity coefficient ≥85% were considered as the same genotype (Said & Abdelmegeed 2019).…”