Fecal carriage and enrichment of multidrug-resistant Enterococci among admitted children in a pediatric intensive care unit

Abstract

Background: The present study aimed to investigate intestinal carrier’s status of Enterococcus spp. in children and revealing role of hospitalization on alteration of their resistance phenotype and clonal diversity during the admission and discharge periods. Methods: Two separate rectal swab samples were collected from hospitalized patients in pediatric intensive care unit at the admission and discharge time. Culture was done and confirmed colonies of Enterococcuswere analyzed for antimicrobial susceptibility and carriage of vanA/B/C/Dgene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for phylogenetic study to check homology of pairs of the isolates. Results: The results showed colonization of Enterococci in 31% of the cases at the admission, 28.7% at the discharge, and 40.1% at both time points. Resistance to vancomycin, ampicillin and rifampicin was higher in E. faecium, but resistance to ciprofloxacin was higher in E. faecalis. The frequency of MDR was higher in E. faecalis than E. faecium isolates. No significant difference in colonization with VRE, MDR-Enterococci and resistance to antibiotics were detected at the time of admission and discharge; however, there was a significant relationship between the longer hospitalization stay and VRE colonization. While homology of the isolates was low among different patients, identical and similar RAPD-PCR pattern was detected in 9% and 21% of pairs of the isolates in each patient, respectively. Conclusions: High rate of intestinal colonization with VRE, HLGR, and MDR-Enterococci before admission and their enrichment during hospitalization in PICU shows the importance of antibiotic stewardship programs to control their transmission and spread.