Species, antibiotic susceptibility profiles and van gene frequencies among enterococci isolated from patients at Mulago National Referral Hospital in Kampala, Uganda

Abstract

Background The increase in drug resistance to affordable antibiotics used to treat Gram positive bacterial infections has complicated the management of enterococcal infections. Resistance to vancomycin, one of the most powerful antibiotics, is of utmost concern as both intrinsic and acquired forms of resistance do occur in enterococci. This cross-sectional study aimed to determine the species, antibiotic susceptibility profiles and vanA / vanB gene frequencies among enterococci isolated from patients at Mulago Hospital in Kampala, Uganda. Methods Between November 2011 and October 2012, stool, urine, sputum and blood samples, as well as vaginal, endocervical, pus, ear and urethra swabs from 3229 patients were processed for isolation of bacteria, yielding 162 enterococci of which 115 were available for analysis (one isolate per specimen/patient). Species-level confirmation and susceptibility testing were determined with the Phoenix™ AST/ID Automated System, while vanA / vanB gene carriage was determined by PCR. Results Species-level identification revealed 72 isolates of E. faecalis , 20 E. gallinarum/casseliflavus, 5 E. faecium, 4 E. raffinosus and 2 isolates each for E. hirae and E. durans . Ten isolates could not be identified to species level. Antibiotic resistance was generally low especially to ampicillin, quinolones, nitrofurantoin, glycopeptides and linezolid, but high for erythromycin and tetracycline. Equally, vanA and vanB gene frequencies were low (i.e. 15.8 and 7.9%, respectively) and detected only in E. casseliflavus/gallinarum species that are intrinsically resistant to vancomycin . Vancomycin resistant isolates of E. faecalis and E. faecium were not detected. Conclusions Enterococcus species are frequent in clinical specimens at Mulago Hospital but they are highly susceptible to common antibiotics especially ampicillin. While vancomycin resistant enterococcal (VRE) isolates of E. faecium and E. faecalis are rare in the hospital and frequency of multidrug resistance is low, non- faecium and non- faecalis VRE isolates (i.e. E. gallinarum / casseliflavus ) are frequent, some with VanA/VanB (high-level) vancomycin resistance. Therefore, species-level identification of enterococci is necessary in resource limited settings to guide infection control and treatment of enterococcal infections. Electronic sup...

Vancomycin resistant enterococci gut Colonization and its associated factors among HIV infected patients on anti-Retro viral therapy in Ethiopia

“…On the other hand, the antibiotic resistance pro le in our study is higher as compared to studies conducted in Iran 41.2% (42), Brazil 0% (1), Uganda 1.4% (15) and Ethiopia 36% (41) for ampicillin; Brazil 32.6% (1) and Ethiopia 37.7% (2) for tetracycline; and Brazil 10.9% (1) for chloramphenicol. This discrepancy might be due to the fact that we are in the time of gradual increase in antibiotic resistance pattern which in turn might be due to overuse or misuse of antibiotics, inappropriate antibiotics prescription, extensive antibiotics use for agricultural purpose, mutation, gene transfer among bacteria, etc.…”

“…Vancomycin resistant Enterococci was rst encountered in clinical isolates in England and France in 1986 as E. faecium, followed the next year by isolation of Vancomycin Resistant Enterococcus faecalis in the United States (15). They have become an important cause of serious invasive healthcare-associated infections globally (6, 7).…”

Species and drug susceptibility profiles of staphylococci isolated from healthy children in Eastern Uganda

“…vanA type of resistance is widely spread in enterococci and it is transferrable between enterococci and staphylococci [29,38,39]. While phenotypic resistance to vancomycin among enterococci and staphylococci is rare in Uganda [24,40], vanA/vanB PCR-positive vancomycin-susceptible isolates of enterococci and staphylococci have been reported in Uganda [28,40]. While it is puzzling, vanA-positive-vancomycin-susceptible enterococci do occur, and they have also been reported from the developed countries [39,41,42].…”

Vancomycin Resistance Enterococcus in Africa in Onehealth approach: A systematic review and meta-analysis

“…This part of the study strained the one health approach, which is an important way of combating antibiotics resistance which worsens the world know a day's [57]. Tables Table 1 articles [42] 2018 Egypt Clinical specimen PCR Houssem et al [43] 2018 Tunisia Wild birds feces Culture& Toru et al [44] 2018 Ethiopia Clinical specimen Culture Molechan et al [45] 2019 South Africa Poultry Culture& Daniel et al [46] 2019 South Africa Water Culture&…”

“…Whatever the sample type and laboratory method employed captured for the review and meta-analysis. The author name, year of publication, country of origin, source of sample (human vs non-human), laboratory method used Tanzania [40][41][42] and Uganda, [43][44][45]), two (2) articles from Nigeria, [46,47] and one (1) article from Algeria [48] were included for the review as presented in Table 1.…”