Emergence of VRE and their antimicrobial sensitivity pattern in a tertiary care teaching hospital

Abstract

Abstract: During the last few years enterococci have emerged as an important cause of nosocomial and community acquired infection. They have acquired resistance to commonly used antibiotics including glycopeptides posing challenge to therapeutic options. The aim of this study was to investigate the prevalence and sensitivity of VRE to newer drugs. A total of 250 strains of E. faecalis were isolated using conventional scheme of Facklam and Collins. High level aminoglycoside resistance (HLAR) was detected by disc diffusion method using 120 μg gentamicin disc and confirmed by agar dilution screen method. Screening for vancomycin resistance was done by disc diffusion and the agar screen method, and was further confirmed by broth dilution method for minimum inhibitory concentration (MIC). The strains which were resistant to vancomycin were further tested for sensitivity to newer and commonly available antibiotics. Maximum number of enterococcal isolates were recovered from urine (32.8%) followed by blood (25.6%) and pus (18.4%). Penicillin (83.6%) and cotrimoxazole (77.9%) were found to be least effective drugs against the E. faecalis whereas; cefuroxime (76.8%) and vancomycin (98%) were most effective drugs in vitro. About two percent isolates of enterococci were resistant to vancomycin. All the VRE isolates were sensitive to quinupristin/dalfopristin. Linezolid and chloramphenicols were the two other in vitro effective drugs with 80% sensitive isolates. MIC of all the VRE isolates was found to be in range of 64-512μg/mL. So, quinupristin/dalfopristin can be used for infections caused by VRE. Continuous surveillance is necessary to detect early outbreak, and spread of VRE.Abstract During the last few years enterococci have emerged as an important cause of nosocomial and community acquired infection. They have acquired resistance to commonly used antibiotics including glycopeptides posing challenge to therapeutic options. The aim of this study was to investigate the prevalence and sensitivity of VRE to newer drugs. A total of 250 strains of E. faecalis were isolated using conventional scheme of Facklam and Collins. High level aminoglycoside resistance (HLAR) was detected by disc diffusion method using 120 μg gentamicin disc and confirmed by agar dilution screen method. Screening for vancomycin resistance was done by disc diffusion and the agar screen method, and was further confirmed by broth dilution method for minimum inhibitory concentration (MIC). The strains which were resistant to vancomycin were further tested for sensitivity to newer and commonly available antibiotics. Maximum number of enterococcal isolates were recovered from urine (32.8%) followed by blood (25.6%) and pus (18.4%). Penicillin (83.6%) and cotrimoxazole (77.9%) were found to be least effective drugs against the E. faecalis whereas; cefuroxime (76.8%) and vancomycin (98%) were most effective drugs in vitro. About two percent isolates of enterococci were resistant to vancomycin. All the VRE isolates were sensitive to quinupristin/dalfopristin. Linezolid and chloramphenicols were the two other in vitro effective drugs with 80% sensitive isolates. MIC of all the VRE isolates was found to be in range of 64-512μg/mL. So, quinupristin/dalfopristin can be used for infections caused by VRE. Continuous surveillance is necessary to detect early outbreak, and spread of VRE.