Change in prevalence and antibiotic resistance of Enterococcus species isolated from blood cultures over an 8-year period

Iwen, Peter C.; Kelly, D M; Linder, James; Hinrichs, Steven H.; Domínguez, Elena; Rupp, Mark E.; Patil, K D

doi:10.1128/aac.41.2.494

Cited by 82 publications

(43 citation statements)

References 10 publications

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“…Several studies showed that an increased proportion of nosocomial enterococcal infections caused by E. faecium [14–17]. The isolates obtained in this study were E. faecium (35.1%) followed by E. faecalis (29.5%) while E. gallinarium , E. casseliflavus , and E. durans accounted for 17.5, 8.8 and 8.8% of the isolates, respectively.…”

Section: Discussionmentioning

confidence: 47%

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Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

2015

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BackgroundMulti-drug-resistant Enterococci colonizing the intestinal tract of hospitalized patients are the major source of infection as well as nosocomial spread. Despite worldwide increasing rate of multidrug resistant Enterococci colonization and infection among hospitalized patients, there is scarcity of data from resource limited setting. The present study aimed at determining the antimicrobial resistance profile of Enterococcus species from intestinal tracts of hospitalized patients in Jimma, Ethiopia.MethodsThe study was conducted among hospitalized patients at Jimma University Specialized Hospital, from January to July 2013. Fecal samples were collected and processed for bacterial isolation and susceptibility testing to antimicrobial agents. Stool samples were inoculated onto enterococcus selective media (Bile Esculin azide agar plate) with and without 6 µg/ml of vancomycin. The isolates were identified to genus and species level by cultural characteristics, Gram’s stain, catalase test, growth in 6.5% NaCl broth, growth at 45°C, motility test and by using API 20 Streptococcus system. Sensitivity testing was done using Kirby–Bauer disk diffusion method. Minimum inhibitory concentrations for vancomycin were determined using E-test strips.ResultOverall, Enterococci were isolated from 114 (76%) of the study subjects. The isolates were Enterococcus faecium (35.1%) followed by Enterococcusfaecalis (29.8%), Enterococcus gallinarum (17.5%), Enterococcuscasseliflavus (8.8%) and Enterococcusdurans (8.8%). Among 114 tested Enterococci isolates, 41 (36%) were resistant to ampicillin, 62 (54.4%) to streptomycin and 39 (34.2%) to gentamycin. Other alternative antibiotics to treat mixed nosocomial infection caused by Enterococci also showed high rate of resistance in vitro: ciprofloxacin (50% of resistance), norfloxacin (49.1%), erythromycin (63.2%), tetracycline (64.9%), chloramphenicol (34.2%), and nitrofrantoin (32.4%). Multiple drug resistance was observed among 89.5% of E. faecium and E. faecalis. Vancomycin resistant Enterococci were observed in 5% of E. faecium isolates.ConclusionThis study reveals high rate of fecal colonization by multidrug-resistant Enterococci and prevalence of vancomycin resistance strains. Thus periodic surveillance of antibacterial susceptibilities is recommended to detect emerging resistance and to prevent the spread of antibacterial-resistant strains.

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Section: Discussionmentioning

confidence: 47%

“…Another study from India has also reported 66% of blood isolates as E. faecium [17]. Iwen et al [14] has also reported an increase in E. fecium isolates from 12.9 to 36.3 over a period of 8 years during 1987–1995 from blood cultures.…”

Section: Discussionmentioning

confidence: 97%

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

2015

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“…These healthcare-associated infections are frequently associated with intravascular medical devices such as catheters and stents in the immunocompromised patient. While E. faecalis caused the majority of enterococcal infections (80-90%) over 30 years ago, the proportion of E. faecium infections has increased from 10 to 40% in recent times [3,9,[12][13][14][15][16][17][18][19]. This may be due to the virtually complete penetration of ampicillin resistance (>80%) in hospital-associated E. faecium isolates, in contrast to approximately 5% of the E. faecalis strains [10,17,20].…”

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confidence: 95%

The Cell Wall Architecture of Enterococcus Faecium : From Resistance to Pathogenesis

2013

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The cell wall of Gram-positive bacteria functions as a surface organelle that continuously interacts with its environment through a plethora of cell wall-associated molecules. Enterococcus faecium is a normal inhabitant of the GI tract of mammals, but has recently become an important etiological agent of hospital-acquired infections in debilitated patients. Insights into the assembly and function of enterococcal cell wall components and their interactions with the host during colonization and infection are essential to explain the worldwide emergence of E. faecium as an important multiantibiotic-resistant nosocomial pathogen. Understanding the biochemistry of cell wall biogenesis and principles of antibiotic resistance at the molecular level may open up new frontiers in research on enterococci, particularly for the development of novel antimicrobial strategies. In this article, we outline the current knowledge on the most important antimicrobial resistance mechanisms that involve peptidoglycan synthesis and the role of cell wall constituents, including lipoteichoic acid, wall teichoic acid, capsular polysaccharides, LPxTG cell wall-anchored surface proteins, WxL-type surface proteins and pili, in the pathogenesis of E. faecium.

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“…In recent years, the emergence of enterococci has been associated with a gradual replacement of E. faecalis (responsible for approximately 40% of enterococcal infections) with E. faecium (more than 60% of these infections) probably because of the rapid accumulation of antibiotic-resistance determinants in this latter species (Iwen et al, 1997; Treitman et al, 2005; Top et al, 2007; Hidron et al, 2008). …”

Section: The Genus Enterococcusmentioning

confidence: 99%

Genomic Diversification of Enterococci in Hosts: The Role of the Mobilome

Santagati¹,

Campanile²,

Stefani³

2012

Front. Microbio.

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Enterococci are ubiquitous lactic acid bacteria, possessing a flexible nature that allows them to colonize various environments and hosts but also to be opportunistic pathogens. Many papers have contributed to a better understanding of: (i) the taxonomy of this complex group of microorganisms; (ii) intra-species variability; (iii) the role of different pathogenicity traits; and (iv) some markers related to the character of host-specificity, but the reasons of such incredible success of adaptability is still far from being fully explained. Recently, genomic-based studies have improved our understanding of the genome diversity of the most studied species, i.e., E. faecalis and E. faecium. From these studies, what is becoming evident is the role of the mobilome in adding new abilities to colonize new hosts and environments, and eventually in driving their evolution: specific clones associated with human infections or specific hosts can exist, but probably the consideration of these populations as strictly clonal groups is only partially correct. The variable presence of mobile genetic elements may, indeed, be one of the factors involved in the evolution of one specific group in a specific host and/or environment. Certainly more extensive studies using new high throughput technologies are mandatory to fully understand the evolution of predominant clones and species in different hosts and environments.

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Change in prevalence and antibiotic resistance of Enterococcus species isolated from blood cultures over an 8-year period

Cited by 82 publications

References 10 publications

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia

The Cell Wall Architecture of Enterococcus Faecium : From Resistance to Pathogenesis

Genomic Diversification of Enterococci in Hosts: The Role of the Mobilome

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