Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study

Conceição, Natália; Oliveira, Cristina da Cunha Hueb Barata de; Silva, Paulo Roberto da; Ávila, Bárbara Godoi Melo; Oliveira, Adriana Gonçalves de

doi:10.1590/s0037-86822011005000009

Cited by 28 publications

(22 citation statements)

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“…After that, this pathogen has been periodically isolated from clinical samples, including outbreaks, in different states of Brazil [27,[35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

Resende

Caierão

Prates

et al. 2014

J Infect Dev Ctries

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Introduction: In Porto Alegre (South Brazil), since the first VRE isolation in 2000 until the middle of the last decade, the epidemiology of enterococcal infections presented the peculiarity that, as opposed to other regions of the country, almost all VRE were E. faecalis. The aim of this study was to investigate the microbiological and epidemiological characteristics of a VRE outbreak that occurred between August 2010 and September 2011 in Porto Alegre, South Brazil. Methodology: Twenty-nine isolates from inpatients of Mãe de Deus Hospital that were identified and characterized for their susceptibility profile, vancomycin genotype, presence of esp gene, biofilm production, and clonal relationship were collected. Patients' records were reviewed for clinical information. Results: All isolates were identified as vancomycin/ampicillin resistant E. faecium carrying the vanA gene. Almost all were susceptible to gentamicin and streptomycin. Most patients died and were associated with a hemodialysis unit stay. All but the first isolate were clustered in a main clone. Conclusions: An important change in vancomycin-resistant enterococci was observed. Studies like this are necessary to monitor the dissemination of VRE, especially of some individual clones.

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“…After that, this pathogen has been periodically isolated from clinical samples, including outbreaks, in different states of Brazil [27,[35][36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

Resende

Caierão

Prates

et al. 2014

J Infect Dev Ctries

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“…Recently, enterococcal infections have increased and E. faecalis accounts for the majority of enterococcal infections [19] . Our data suggested that the susceptibility rate to LVFX in E. faecalis in complicated UTI significantly decreased in the most recent 3 years compared to the previous 3 years and the susceptibility rate of catheterized UTI to LVFX in E. faecalis was significantly lower than non-catheterized UTI (p = 0.0153).…”

Section: Discussionmentioning

confidence: 99%

Relationship between Urinary Tract Infection Categorization and Pathogens’ Antimicrobial Susceptibilities

Yamamichi

Shigemura²,

Matsumoto³

et al. 2012

Urol Int

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Background: Urinary tract infections (UTIs) can be hard to treat and treatment plans need to include accurate categorization such as uncomplicated or complicated UTI, or catheterized or uncatheterized UTI. We investigated the antibiotic susceptibilities of representative uropathogens in UTI categories. Methods: We isolated uropathogens and analyzed their antimicrobial susceptibilities according to UTI categorization such as: (1) urology outpatients, urology inpatients, or other department inpatients; (2) uncomplicated or complicated UTIs; (3) upper or lower UTIs, and (4) non-catheterized or catheterized UTIs. Results:Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa were representative uropathogens. Susceptibilities to levofloxacin (LVFX) in E. coli in urology outpatients (p = 0.0179), those to ceftadizime in E. coli in other department inpatients (p = 0.0327), and those to LVFX in E. faecalis in complicated UTI (p = 0.0137) significantly decreased in these 3 years compared with the previous 3 years. Susceptibilities of upper UTI to LVFX in E. coli were significantly lower in the recent 4 years compared to lower UTI (p = 0.0452) and those of catheterized UTI to LVFX in E. faecalis were significantly lower than in non-catheterized UTI (p = 0.0153). Conclusions: Data demonstrated different tendencies of uropathogens’ antibiotic susceptibilities according to UTI categorizations and they could be useful for planning UTI treatments.

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“…Enterococcus faecalis is one of the most common pathogens in urinary tract infections (UTIs) (7). Recently, enterococcal infections have increased, and E. faecalis accounts for the majority of enterococcal infections (7).…”

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confidence: 99%

“…Recently, enterococcal infections have increased, and E. faecalis accounts for the majority of enterococcal infections (7). Fluoroquinolones have been frequently used to treat E. faecalis UTIs, and the emergence of fluoroquinolone-resistant E. faecalis (QREF) strains has recently been reported in several countries (12).…”

mentioning

confidence: 99%

Mechanisms of and Risk Factors for Fluoroquinolone Resistance in Clinical Enterococcus faecalis Isolates from Patients with Urinary Tract Infections

et al. 2011

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We examined Enterococcus faecalis strains clinically isolated from 100 patients with urinary tract infections (UTIs) for their susceptibility to levofloxacin (LVX) by measuring the MIC and investigated amino acid mutations by direct DNA sequencing, which were then correlated with LVX resistance. Next, we studied risk factors for LVX resistance, such as age, gender, and previous fluoroquinolone use, and investigated the statistical correlation of these risk factors with each amino acid mutation and LVX resistance. Of the 100 isolates tested, 14 isolates showed LVX resistance and all of these isolates had amino acid mutations. We demonstrated that 2 out of 4 mutations (Ser83-to-Ile in gyrA and Ser80-to-Ile in parC) had a significant correlation with LVX resistance. There was a significant relationship between isolates with 2 or 3 amino acid mutations and LVX resistance. In addition, we found a significant correlation between the previous use of fluoroquinolones and LVX resistance or the presence of mutations and also demonstrated that previous use of other types of antibiotics was significantly related to the presence of mutations by multivariate analysis. In conclusion, we found significant correlation between amino acid mutations in E. faecalis, LVX resistance, and risk factors such as previous use of fluoroquinolones.Enterococcus faecalis is one of the most common pathogens in urinary tract infections (UTIs) (7). Recently, enterococcal infections have increased, and E. faecalis accounts for the majority of enterococcal infections (7). Fluoroquinolones have been frequently used to treat E. faecalis UTIs, and the emergence of fluoroquinolone-resistant E. faecalis (QREF) strains has recently been reported in several countries (12). In our institution, the proportion of QREF isolates gradually increased from 12/83 (14.4%) in 2004 to 10/49 (20.4%) in 2007, but this was not a statistically significant difference (P ϭ 0.3755). Rudy et al. demonstrated in analyses of 130 E. faecalis strains isolated from urine that all strains were sensitive to glycopeptides (vancomycin [VAN] and teicoplanin), 96% were sensitive to penicillin, 43% to ciprofloxacin, and 28% to tetracycline (22). Muratani et al. reported a 38% frequency of levofloxacin (LVX)-resistant E. faecalis isolates from UTIs (17).Mutations in the quinolone resistance-determining regions (QRDR) of gyrA coding for DNA gyrase and parC coding for DNA topoisomerase IV, the efflux system, antimicrobial-modifying resistance enzymes, and plasmid-mediated mechanisms are considered to contribute to resistance to fluoroquinolones (3,10,11,18,23,25,27). To our knowledge, no previous report has correlated risk factors with fluoroquinolone resistance and amino acid mutation in the QRDR in E. faecalis strains clinically isolated from the urine of UTI patients.Rattanaumpawan et al. investigated the risk factors for fluoroquinolone resistance in enterococcal UTIs and demonstrated that recent exposure to antibiotics such as fluoroquinolones, extended-spectrum cephalosporins, and c...

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Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study

Cited by 28 publications

References 32 publications

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil

Relationship between Urinary Tract Infection Categorization and Pathogens’ Antimicrobial Susceptibilities

Mechanisms of and Risk Factors for Fluoroquinolone Resistance in Clinical Enterococcus faecalis Isolates from Patients with Urinary Tract Infections

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