Vancomycin-resistant Enterococcus faecium in Algeria: phenotypic and genotypic characterization of clinical isolates

Abstract

Introduction: vancomycin-resistant Enterococcus faecium (VREfm) is a major public health problem worldwide. The aim of our study was to determine the microbiological, epidemiological and molecular characteristics of VREfm isolated in north-central, eastern and western Algeria.
 Methodology: a collection of 48 VREfm isolated from September 2010 to April 2017 in several Algerian hospitals were studied. Minimum inhibitory concentrations (MICs) were determined by E-test method according to CLSI guidelines. the detection of van genotype of all strains was performed by PCR. Clonal relationship of five VREfm targeted by region were characterized using multilocus sequence typing (MLST).
 Results: All isolates have multidrug-resistance (MDR) and were resistant to at least five classes of antibiotics; however, all were susceptible to tigecycline and daptomycin with MIC50 at 0.094 µg/mL and 2 µg/mL respectively. All strains belonged to vanA genotype and have high level of resistance to vancomycin and teicoplanin. MLST revealed two sequence types (STs): ST80 (from the four regions of Algeria) and ST789, both belonging to the former hospital-adapted clonal complex CC17.
 Conclusions: the alarming dissemination of MDR E. faecium vanA and the ST80 in several regions of Algeria suggest a clonal spread of VREfm strains, which urgently require implementation of adequate infection control measures.

Antibiotic Susceptibility Patterns and Virulence-Associated Factors of Vancomycin-Resistant Enterococcal Isolates from Tertiary Care Hospitals

“…The majority of the isolates (more than 85%) in this study harbored the vanA gene and showed high-level resistance to vancomycin (MIC > 32 µg/mL) and teicoplanin (MIC > 32 µg/mL), which is the critical feature of the VanA phenotype. This result is correlated with Ghoshal et al [ 40 ] in India, Talebi et al [ 41 ] in Iran, and Benamrouche et al [ 34 ] in Algeria, who reported the presence of vanA gene and the complete absence of vanB among the VRE isolates. Recent studies by George et al [ 42 ] in Southi Arabia and Moosavian et al [ 43 ] in Iran reported that the majority of vancomycin resistance (more than 60%) among enterococcal isolates is due to vanA gene; nearly less than 5% of the isolates harbored vanC gene, and the remaining isolates showed themselves to be positive to vanB gene.…”

“…The prevalence rate of MDR in the current study at least to five antibiotics is about 11% ( n = 91) and is most frequent among E. faecium strains ( n = 54) compared to E. faecalis ( n = 37), indicating the dissemination of MDR pathogens in healthcare communities. The majority of the vancomycin-resistant enterococcal isolates obtained from the inpatients of Algerian hospitals were found to be resistant to at least five antibiotics in addition to glycopeptides [ 34 ].…”

First detection of vanA positive Enterococcus faecium clonal complex 17 in hospital wastewater in Algeria: an epidemiological report

“…Interestingly, the three responsible strains were assigned to the sequence type ST80 [ 14 ], the same as identified in our study. The third study reported the detection of vanA gene in a collection of clinical E. faecium isolates from different Algerian regions, also belonging to the CC17 [ 15 ]. The last one described a high prevalence of vanA positive E. faecium isolates in hospitalized patients at the Tlemcen University Hospital [ 16 ].…”

Investigation of some changes and clonal relationship in enterococci isolates due to relocation of a hospital

“…15 An isolate resistant to at least one antimicrobial agent in three or more antimicrobial categories was defined as multidrug-resistant (MDR). 16 For PFGE, isolation and deproteinisation of the genomic deoxyribonucleic acid (DNA) were obtained, according to the protocol of Asgin and Otlu. 17 Electrophoresis was applied for 20 hours with initial pulse time 3.5 seconds, end pulse time 23.5 seconds, pulse angle 120 o , current 6 V/cm 2 , and temperature 14 o C in the CHEF-DR II PFGE system (Bio-Rad Laboratories, Nazareth, Belgium) using the Sma I enzyme (New England Biolabs).…”