<p>High Level Aminoglycoside Resistance And Distribution Of The Resistance Genes In <em>Enterococcus faecalis</em> And <em>Enterococcus faecium</em> From Teaching Hospital In Malaysia</p>

Abstract

BackgroundEnterococcus faecium and Enterococcus faecalis are among the predominant species causing hospital-acquired infections. Currently, enterococcal infections are treated using combination therapy of an aminoglycoside with cell-wall active agents, which led to high level aminoglycoside resistance (HLAR) and vancomycin resistance (VRE) among enterococci. The aim of this study was to determine the prevalence of HLAR and the distribution of the resistance genes among clinical E. faecalis and E. faecium isolates in Malaysia.Materials and methodsSeventy-five enterococci isolates recovered from different clinical sources were re-identified by subculturing on selective medium, Gram staining, biochemical profiling (API 20 Strep), and 16s rRNA sequencing. Antimicrobial susceptibility testing (AST) was performed using Kirby-Bauer disc diffusion, E-test, and broth microdilution methods. PCR amplification was used to detect the presence of aminoglycoside modifying enzyme (AME) genes [aac(6’)-Ie-aph(2”)-Ia, aph(2”)-Ib, aph(2”)-Ic, aph(2”)-Id, aph(3’)-IIIa]. Descriptive data analysis was used to analyze the antibiotic susceptibility profiles and the distribution of HLAR genes.ResultsThe majority of the isolates recovered from the clinical samples are E. faecalis (66.7%), with the highest recovery from the pus. The prevalence of HLGR (51%) is higher when compared to HLSR (45–49%). Analysis of the resistance genes showed that bifunctional genes aac(6’)-Ie-aph(2”)-Ia and aph(3’)-IIIa contributed to the HLAR E. faecalis and E. faecium. The other AME genes [aph(2”)-Ib, aph(2”)-Ic, aph(2”)-Id] were not detected in this study.ConclusionThis study provides the first prevalence data on HLAR and the distribution of the AME genes among E. faecalis and E. faecium isolates from Malaysia. These highlight the need for continued antibiotic surveillance to minimize its emergence and further dissemination.

Resistance towards Critically Important Antimicrobials among Enterococcus faecalis and E. faecium in Poultry Farm Environments in Selangor, Malaysia

“…In our study, E. faecalis was more predominant compared to E. faecium . A similar phenomenon was observed among clinical samples obtained in a hospital in Malaysia [ 13 ] and in raw poultry meat samples from Canada, Colombia and Sweden [ 14 ]. In contrast, studies conducted in Indonesia, Thailand, and Vietnam reported E. faecium to be the predominat species in samples of chicken feces [ 15 ].…”

Genetic mechanisms and correlated risk factors of antimicrobial-resistant ESKAPEE pathogens isolated in a tertiary hospital in Malaysia

“…We observed an increased prevalence of VRE when compared to recent studies within the same geographical region. Moussa and colleagues reported a 4% occurrence of VRE among the 75 enterococci strains obtained in Hospital Kuala Lumpur (HKL), all of which were E. faecalis [ 17 ]. An earlier study by Daniel et al .…”

“…The enterococci strains in our sample pool showed a slightly lower prevalence of HLAR (39%) compared to a similar study within the same region. A recent study in HKL documented 45–49% HLAR, concerning streptomycin resistance, among the enterococci strains [ 17 ]. In the HKL study, the aac(6′)-Ie-aph(2″)-Ia AME gene was most common among the HLAR enterococci, accounting for their high level of resistance to gentamicin.…”

“…However, our enterococci strains showed a greater prevalence of ant(4′)-Ia (22%), followed by aph(2″)-Ic (15%), and a total absence of aph(3′)-IIIa . The HKL study did not screen for ant(4′)-Ia , and none of the strains carried aph(2″)-Ic gene [ 17 ]. Given that AME genes are responsible for acquired aminoglycoside resistance through horizontal gene transfer, we infer that there might be different lineages of aminoglycoside resistant enterococci currently circulating in this region, each lineage developing resistance through a separate evolutionary pathway.…”

Prevalence of Vancomycin and Gentamycin Resistance among Enterococci spp. in Iran during 2007-2019: A Systematic Review

“…Moreover, in a study conducted by Chakraborty et al (2015) in India, all isolates were sensitive to vancomycin, and minimal inhibitory concentration of vancomycin against all enterococcal isolates was ≤1 μg/mL [26] . High levels of aminoglycoside resistance have become a very serious problem in healthcare settings worldwide [34] . Therapeutic options for invasive enterococcal infections typically include an aminoglycoside (e.g., gentamicin, streptomycin, and tobramycin) in combination with a cell wall active agent (e.g., vancomycin).…”