Vancomycin Resistant Enterococcus: A Case Report and Review of Literature

Qadri, S. M. Hussain; Qunibi, Wajeh Y.; Al-Ballaa, Saleh R.; Kadhi, Yusuf Al; Burdette, Jill

doi:10.5144/0256-4947.1993.289

Cited by 10 publications

(11 citation statements)

References 37 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…1 Since then, these organisms have been reported to have caused human infections in the USA, UK, Germany, The Netherlands, Spain and Saudi Arabia. [2][3][4][5] The number of cases infected with VRE, as reported by the US Centers for Disease Control and Prevention, had jumped from 99 in 1992 to 278 in 1994, with a rapid increase in colonization, and a fecal carriage rate of 86%. 6 Since colonized patients as well as domestic animals and environment can serve as significant reservoirs for human acquisition of VRE, we determined the presence of these organisms in sewage and fecal samples of poultry, camels, goats and sheep in Riyadh and its vicinity.…”

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confidence: 99%

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

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Qari³

et al. 1997

Ann Saudi Med

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confidence: 99%

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confidence: 99%

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

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Qari³

et al. 1997

Ann Saudi Med

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“…6,7 In our own laboratory, nearly 3000 isolates of enterococci have been screened and no resistance was seen until early 1992. 8 The epidemiological factors responsible for the emergence of these resistance strains include extension of hospital stay, prolonged duration of antimicrobial administration, including oral vancomycin therapy and association with hemodialysis units (possibly related to the prophylactic use of vancomycin for the insertion of lines and shunts). 12 Efforts at reducing these pressure factors may reduce the incidence of resistance in enterococci.…”

Section: Discussionmentioning

confidence: 99%

“…These include modification of penicillin-binding protein, 3 β-lactamase production, 4 the development of aminoglycoside-modifying enzymes, 3 and vancomycin resistance. [6][7][8] Vancomycin was introduced in 1956 and for nearly 30 years enjoyed an enviable status, exemplified by absence of development of resistance to the drug. Isolated cases, however, of resistance in animal species were reported, and in the late 1980s, cases of vancomycin-resistant enterococci emerged from Europe and the USA.…”

Section: Discussionmentioning

confidence: 99%

High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases

et al. 1996

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SMH Qadri, ME Ellis, F Al-Rabiah, P Ernst, S Ingemansson, High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases. 1996; 16(6): 682-685 We describe two patients who died from enterococcal systemic disease. The organisms were identified as Enterococcus faecium. One isolate was resistant to all available antimicrobials and the other was sensitive only to chloramphenicol. The recent emergence of multiple-resistant enterococcal species reflects the critically fragile status of antimicrobial therapeutics. The clinical implications and possible means of their control are discussed.Although the term "enterocoque" was first used almost 100 years ago to emphasize the intestinal origin of these bacteria, 1 until recently they were classified in the genus Streptococcus, mainly because of their morphological resemblance and common biochemical tests. However, in 1984 it was shown by nucleic acid hybridization studies that S. faecalis and S. faecium were so distantly related to streptococci that they should be transferred to a new genus called Enterococcus.2 These bacteria also differ significantly in their antimicrobial susceptibility patterns from other streptococci. Recently these organisms have drawn much attention, not only because of their increasing role in hospital-acquired infections but because of their increasing resistance to antimicrobial agents. Their intrinsic resistance or relative resistance to β-lactams, clindamycin and aminoglycosides, and ability to acquire resistance to ciprofloxacin, erythromycin and tetracycline is well known.3-6 The most recent and most disturbing trait to emerge is resistance to vancomycin.7 Three years ago we had reported the first case of wound infection caused by vancomycin-resistant Enterococcus.7 In this paper we report two cases in which multiresistant enterococci were associated with systemic disease. Case 1A 15-year-old male patient with acute myelogenous leukemia and neutropenia developed fever and was treated with ceftazidime 40 mg/kg q8h intravenously, amikacin 15 mg/kg daily, vancomycin 15 mg/kg q12h and amphotericin B 0.5 mg/kg daily for four weeks. He eventually defervesced, but no organisms were isolated. He then received a regimen which included busulphan and total body irradiation for refractory relapsed acute leukemia prior to bone marrow transplantation. Although he was afebrile at the time of transplantation, he was profoundly neutropenic with a white count of <0.1 x 10 9 /L, and was therefore continued on the same broad spectrum antimicrobials. On the sixth day after the bone marrow transplant, he again became febrile; blood cultures taken 14 days post-transplantation grew Enterococcus, which was identified as E. faecium. Clinical management included catheter and line change, with the administration of imipenem 20 mg/kg q6h intravenously. The patient continued to be unwell, developing peritonitis and right lower lobe pneumonia in the presence of persistent neutropenia. Bone marrow examination showed a hypocellular marrow....

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“…[7][8][9][10][11][12][13][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.…”

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

1996

Ann Saudi Med

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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/...

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Vancomycin Resistant Enterococcus: A Case Report and Review of Literature

Cited by 10 publications

References 37 publications

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

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

High-Level, Multiresistant Enterococci Associated with Systemic Disease: A Report of Two Cases

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

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