Antimicrobial Susceptibility Pattern of Enterococcus Species Isolated from Various Clinical Specimens in a Tertiary Care Hospital, Kathmandu, Nepal

Abstract

Resistance to vancomycin and high level aminoglycosides are common among Enterococcus spp. and are being increasingly reported from different parts of the world. These resistance phenomena in enterococci have limited the therapeutic options to treat the infections caused by them. The objective of our study was to determine the antimicrobial resistance patterns of Enterococcus spp. (n=60) isolated over a year from clinical specimens received from patients visiting Nepal Medical College Teaching Hospital, Kathmandu, Nepal. All enterococci were subjected to antimicrobial susceptibility testing, high level gentamicin resistance testing by disc diffusion method and minimum inhibitory concentration of vancomycin by agar dilution method. Prevalence of high level gentamicin resistance among enterococci was 55%. None of the isolates were resistant to vancomycin by both disc diffusion and agar dilution method. However 8.3% of them were intermediate to vancomycin. All of these vancomycin intermediate isolates were from samples from hospital admitted patients and resistant to ampicillin, ciprofloxacin, erythromycin and high level gentamicin. Present findings were suggestive of possible emergence of vancomycin resistant enterococci in the hospital if immediate and adequate control measures are not implemented.

Current Trend of Antibiogram of Enterococcus Species Isolated From Urine Samples of Patients Attending Tertiary Care Center, Pokhara

“…14,23 In contrast to this study, higher prevalence of HLGR was reported in different studies from different places. 12,13,24,25 This variation may be due to varied antibiotic prescribing manner and infection control practices in different places.…”

“…Resistance to high level gentamicin is of utmost interest as combination therapy with beta-lactam drugs are used to treat complicated Enterococcus associated infections, which restrict the therapeutic options. 12 Vancomycin resistant Enterococci (VRE) are being reported from different places at different times. Our finding shows higher incidence of VRE as compared to studies done in India (2011) 26 , Pakistan (2013) 1 , and central Nepal (2019).…”

“…11 Studies from Nepal, depicting Enterococcus species resistance to high level gentamicin (HLG) and vancomycin has raised concern. [12][13][14] Better understanding of antibiotic susceptibility pattern of Enterococcus spp. is necessary in order to develop strategies for optimizing empirical therapy in every region.…”

Identificación de especies y resistencia a vancomicina y linezolid en Enterococcus spp aislados en un hospital de Ecuador

“…Además, estos autores señalan a las muestras secreciones y sangre como la segunda y tercera fuente de este microorganismo. Resultados discrepantes han sido reportados por Adhikari y col (30) , en Nepal y Castellano y col (18) , en Venezuela, quienes reportaron un mayor número de aislamientos a partir de secreciones de piel y tejidos blandos, seguidos de orina y sangre.…”

“…En concordancia con los resultados de esta investigación, Pinholt y col (33) , en Dinamarca, comunicaron 1,9% de resistencia a vancomicina. Adhikari (30) , en un hospital de Nepal, no detecto enterococos resistentes, sólo 8,3% de las cepas fueron intermedias. Por otra parte, Boccella y col (34) , analizaron la susceptibilidad antimicrobiana de aislamientos de Enterococcus spp obtenidos de muestras clínicas, desde 2015-2019, en un hospital universitario de Italia e informaron 0,8% y 3,2% de resistencia a este antimicrobiano en cepas de E. faecalis y E. faecium, respectivamente.…”