Vancomycin-Resistant Enterococci (VRE) as Normal Flora of the Intestine in Patients at a Tertiary Care Hospital

Abstract

There has been a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) in American and European hospitals in the last six to seven years, with fecal carriage reported to be as high as 86% on some services. In order to determine the frequency of VRE as normal flora of the intestine in Saudi patients, microbiological analysis of stool specimens from 4276 patients from a tertiary care referral hospital was performed. VRE, identified as Enterococcus faecium, was found in six patients. None of the patients had any clinical disease associated with VRE. Five were hospitalized patients, four with severe underlying diseases; five had a history of prior antimicrobial therapy with broad-spectrum antibodies and two of them were treated with vancomycin. Ann Saudi Med 1996;16(6) Hospital. 1996; 16(6): 625-628 Enterococci constitute normal flora of the human intestine. Although considered as bacteria of low virulence, they have been associated with urinary tract infections, intraabdominal infections, bacteremia and endocarditis, especially in compromised patients. They account for 12% of all nosocomial infection reported in the USA, second only to Escherichia coli in incidence.1,2 During the last 15 years, these bacteria have become more resistant to ampicillin and have acquired a high level of resistance to aminoglycosides. [3][4][5] The most disturbing trend to emerge is vancomycin resistance. Since the initial report of vancomycin-resistant enterococci (VRE) from France in 1988, 6 their occurrence has been reported from the USA, the UK, Germany, the Netherlands, Spain and Saudi Arabia.7-14 A rapid increase in the incidence of infection and colonization with VRE has been seen in US hospitals in the last five years, with a fecal carriage rate of as high as 86% in Pittsburgh. 15 Since no one has reported the colonization of Saudi patients with VRE, we did a prospective study to determine the prevalence of its fecal carriage in patients at a tertiary care center. Our findings are presented in this paper. Material and MethodsStool specimens from 4276 patients at King Faisal Specialist Hospital and Research Centre were collected during the period from March 1, 1995, to February 29, 1996. The specimens were received in the laboratory in widemouthed, water-tight plastic containers with tightfitting lids. All stool specimens received during the study period of one year for bacterial cultures from both outpatients as well as inpatients from all services (e.g., ICU, oncology, surgery, ob/gyn, medicine, etc.) were analyzed for the presence of VRE. The hospital is a 500-bed tertiary care facility which also serves as a referral center for Saudi Arabia and the Middle East. Specimens were inoculated on 5% sheep blood agar (BAP), McConkey agar and Campy BAP (containing 10 mg vancomycin/L). All plates were incubated at 35°C for 24-48 hours, BAP and McConkey under aerobic and Campy BAP under microaerophilic conditions. Suspected colonies of enterococci were selected from either BAP and/...

Characterization and risk factors of vancomycin-resistantEnterococci(VRE) among animal-affiliated workers in Malaysia

“…), Czech Republic (Kolar et al . ) and Saudi Arabia (Qadri and Postle ). The highest documented VRE colonization rates occur in Palestine (Hijazi et al .…”

Changes in the pattern of hospital intravenous antimicrobial use in Saudi Arabia, 2006–2008

“…In a study of 4276 patients from a tertiary care referral hospital, VRE was identified in only six (0.14%) patients. 18 …”

Vancomycin-Resistant Enterococci (VRE) as Intestinal Flora from Poultry in Riyadh

“…To our knowledge, only six cases of VRE infections and some colonization have been seen or reported. 4,5,7,10 As the prudent use of antimicrobials by clinicians is effective in lowering the emergence of resistant isolates in humans, animal husbandries and poultry farms should be discouraged to use avoparcin and other antimicrobial agents as feed supplement, in order to minimize acquisition of resistant flora.…”