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Smout E, Palanisamy N, Valappil SP. Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2023; 12:79. [PMID: 37605268 PMCID: PMC10441759 DOI: 10.1186/s13756-023-01287-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Vancomycin-resistant Enterococci (VRE) infections are recurrently reported in different parts of India in the last two decades. However, an up-to-date, countrywide information concerning the prevalence and the rate of VRE in India is limited and hence this study aimed to estimate the pooled prevalence of VRE in India. METHODS A literature search was performed using various databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Cross-sectional studies reporting the prevalence of VRE in India from human samples whereby at least two Enterococci were isolated between 1 January 2000 and 31 December 2022 were sought for inclusion. Data were extracted and analysed using Microsoft Excel and Comprehensive Meta-analysis version 4, respectively. RESULTS Nineteen studies were included in the analyses. A collective total of 3683 Enterococci isolates were examined, of which 368 were VRE strains. The pooled prevalence of VRE in India was calculated at 12.4% (95% CI: 8.6-17.5; Q = 189.69; I2 = 90.51%; p = < 0.001). E. faecalis was the most frequently isolated species (1450 [39.37%]) followed by E. faecium (724 [19.66%]). Amongst the VRE strains, E. faecium was the most prevalent (214 [58.15%]) followed by E. faecalis (134 [36.41%]). An upsurge in the rate of VRE infections was observed in India over time: VRE prevalence was estimated at 4.8% between 2000 and 2010 and 14.1% between 2011 and 2020. CONCLUSION This study presents the most up-to-date information on the rate of VRE infections in India. Though lower than the findings for some less developed countries, VRE prevalence in India is notable and on the rise.
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Affiliation(s)
- Emily Smout
- Chester Medical School, University of Chester, Bache Hall, Countess View, Chester, CH2 1BR, UK
| | - Navaneethan Palanisamy
- Chester Medical School, University of Chester, Bache Hall, Countess View, Chester, CH2 1BR, UK.
| | - Sabeel P Valappil
- Chester Medical School, University of Chester, Bache Hall, Countess View, Chester, CH2 1BR, UK.
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Gastrointestinal colonization of Extended-Spectrum Beta lactamase producing bacteria among children below five years of age hospitalized with fever in Dar es Salaam, Tanzania. J Glob Antimicrob Resist 2022; 30:107-114. [PMID: 35667646 DOI: 10.1016/j.jgar.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gastrointestinal colonization of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is of concern because prior colonization increases risk for subsequent infections. To date, the link between ESBL-PE fecal carriage and the risk of subsequent ESBL-PE infection has not been well established, and information on carriage of such pathogens among children with invasive infections such as blood stream infections (BSI) remains to be explored worldwide. METHODS This cross-sectional study was conducted among childrenunder the age of 5 years admitted for febrile illness in Dar es Salaam, Tanzania, between March 2017 and July 2018. We used rectal swabs to screen for ESBL-PE using selective media, ChromID® ESBL. Bacterial isolates were identified by MALDI-TOF.Blood cultures were drawn from all children. Antimicrobial susceptibility testingwas done using disk diffusion method. ESBL alleles were identified by Real-Time PCR and sequencing. RESULTS The overall prevalence of ESBL-PE carriage was 56% (112/200) and washighestamong children 4-6 months old (17/21, 81%) (p =0.05). Children with BSI had high ESBL-PE carriage (78.4%) compared to those without BSI (53.1%)(p=0.02; AOR 3.4, 95% CI1.20-9.58).The most common isolate was E.coli (64/112, 45%). Sixteen pairs of ESBL-PEisolates(from the gut and from blood)had similar antimicrobial susceptibility profile. We detectedblaCTX-M gene in 97% of all phenotypically detected ESBL-PE; among those,blaCTX-M-15 was dominant (99%). CONCLUSIONS We report a high prevalence of ESBL-PEfecal carriage among children with BSI in Tanzania. Colonization of ESBL-PEwasa risk factor for ESBL-BSI.
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Dudeja M, Das A, Kohli S, Ray P. Genotypic characterization of vancomycin-resistant Enterococcus causing urinary tract infection in northern India. Indian J Med Res 2022; 155:423-431. [DOI: 10.4103/ijmr.ijmr_2554_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Phenotypic and Molecular Characterization of Plasmid-Mediated Virulence and Antimicrobial Resistance Traits among Multidrug Resistant Enterococcus spp. in Egypt. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Enterococcus spp. are remarkable multidrug resistant (MDR) bacteria that are causing serious healthcare-associated infections. The current study investigated the frequency of Enterococcus spp., antimicrobial susceptibility, biofilm formation and the presence of some plasmid-mediated virulence characters and antimicrobial resistance determinants in enterococcal isolates from Egyptian hospitals in Cairo. Enterococcus bacterial isolates were recovered from different clinical specimens and identified using biochemical testing and KB005A HiStrep™ identification kit. Kirby-Bauer disc diffusion method and/or broth microdilution method were used to determine the antimicrobial susceptibility patterns. Phenotypic assays were performed to study biofilm formation and cytolysin and gelatinase production. PCR assays targeting the plasmid-carried genes aac(6’)-aph(2’), aph(3)-IIIa, vanA, agg and cylA were performed. In this study, 50 isolates of diverse Enterococcus spp. were identified with E. faecium was the most frequently isolated one. High resistance profiles were determined against tested antimicrobials and all isolates were MDR. Moderate biofilm formation was detected in 20% of isolates, 18% showed complete blood hemolysis and 12% produced gelatinase. All isolates carried the tested aminoglycosides resistance genes, while vanA was found only in 4 isolates (8%). The virulence genes agg and cylA were detected in 4% and 32% of isolates, respectively. In conclusion, E. faecium was the most prevalent species. The entire isolates set were MDR and the plasmid-carried aminoglycoside resistance genes were extensively disseminated among MDR isolates. Thus, regular surveillance studies, from the area of study or other geographical regions in Egypt, and strict infection control measures are required to monitor the emerging MDR enterococci.
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Kateete DP, Edolu M, Kigozi E, Kisukye J, Baluku H, Mwiine FN, Najjuka CF. Species, antibiotic susceptibility profiles and van gene frequencies among enterococci isolated from patients at Mulago National Referral Hospital in Kampala, Uganda. BMC Infect Dis 2019; 19:486. [PMID: 31151413 PMCID: PMC6545014 DOI: 10.1186/s12879-019-4136-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background The increase in drug resistance to affordable antibiotics used to treat Gram positive bacterial infections has complicated the management of enterococcal infections. Resistance to vancomycin, one of the most powerful antibiotics, is of utmost concern as both intrinsic and acquired forms of resistance do occur in enterococci. This cross-sectional study aimed to determine the species, antibiotic susceptibility profiles and vanA/vanB gene frequencies among enterococci isolated from patients at Mulago Hospital in Kampala, Uganda. Methods Between November 2011 and October 2012, stool, urine, sputum and blood samples, as well as vaginal, endocervical, pus, ear and urethra swabs from 3229 patients were processed for isolation of bacteria, yielding 162 enterococci of which 115 were available for analysis (one isolate per specimen/patient). Species-level confirmation and susceptibility testing were determined with the Phoenix™ AST/ID Automated System, while vanA/vanB gene carriage was determined by PCR. Results Species-level identification revealed 72 isolates of E. faecalis, 20 E. gallinarum/casseliflavus, 5 E. faecium, 4 E. raffinosus and 2 isolates each for E. hirae and E. durans. Ten isolates could not be identified to species level. Antibiotic resistance was generally low especially to ampicillin, quinolones, nitrofurantoin, glycopeptides and linezolid, but high for erythromycin and tetracycline. Equally, vanA and vanB gene frequencies were low (i.e. 15.8 and 7.9%, respectively) and detected only in E. casseliflavus/gallinarum species that are intrinsically resistant to vancomycin. Vancomycin resistant isolates of E. faecalis and E. faecium were not detected. Conclusions Enterococcus species are frequent in clinical specimens at Mulago Hospital but they are highly susceptible to common antibiotics especially ampicillin. While vancomycin resistant enterococcal (VRE) isolates of E. faecium and E. faecalis are rare in the hospital and frequency of multidrug resistance is low, non-faecium and non-faecalis VRE isolates (i.e. E. gallinarum/casseliflavus) are frequent, some with VanA/VanB (high-level) vancomycin resistance. Therefore, species-level identification of enterococci is necessary in resource limited settings to guide infection control and treatment of enterococcal infections. Electronic supplementary material The online version of this article (10.1186/s12879-019-4136-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David P Kateete
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Moses Edolu
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Biomolecular Resources & Biolab Sciences, School of Biosecurity, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edgar Kigozi
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jeffrey Kisukye
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hannington Baluku
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Frank Nobert Mwiine
- Department of Biomolecular Resources & Biolab Sciences, School of Biosecurity, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Christine F Najjuka
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.
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BATHINI JAGRUTI, ARORA AK, RAI TS. Isolation and molecular characterization of enterococci from different animal species. THE INDIAN JOURNAL OF ANIMAL SCIENCES 2018. [DOI: 10.56093/ijans.v88i11.85024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The study was undertaken to determine the occurrence of Enterococcus spp. with special reference to vancomycin resistant enterococci (VRE) in bovines, equines and poultry; detection of vancomycin resistance gene markers by polymerase chain reaction (PCR) and to compare VRE isolates by means of pulse field gel electrophoresis (PFGE). In this study, 60 VRE were isolated from 150 faecal samples. Besides vancomycin sensitivity, isolates were also tested for 6 more antimicrobial drugs by MIC. Significant number of isolates exhibited intermediate level of resistance to vancomycin (70%), norfloxacin (50%) and cephalothin (43.3%). Multidrug resistance (MDR) was observed in 37 (61.6%) isolates. Multiplex PCR revealed vanC1 (14), vanC2/3 (9), van C1 + vanC2/3 (11) but no vanA or vanB genes. Further genotyping of the VRE isolates carrying vanC genes using pulse field gel electrophoresis revealed ~73% homology.
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Prevalence and antimicrobial susceptibility pattern of Enterococcus species isolated from different clinical samples at Black Lion Specialized Teaching Hospital, Addis Ababa, Ethiopia. BMC Res Notes 2018; 11:793. [PMID: 30400980 PMCID: PMC6218977 DOI: 10.1186/s13104-018-3898-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Enterococci which are parts of the normal intestinal flora are opportunistic human pathogens. Their increasing importance is largely due to their resistance to antimicrobials. So the aim this study was to determine the prevalence and antimicrobial pattern of Enterococcus spp. RESULT From the total of 422 samples processed, 15 Enterococcus species were isolated. In this study, linezolid were the drug of choice for Enterococcus species, which showed 100% sensitive followed by vancomycin 93.3% sensitive. In contrast, highly resistance (80%) was observed for ampicillin followed by doxycycline (73.3%). All of isolated Enterococci were sensitive to linezolid, however, resistance was observed to common antibiotics. The presence of multidrug resistant Enterococci in our study should be considered as an alarm for Enterococcal infections.
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Toru M, Beyene G, Kassa T, Gizachew Z, Howe R, Yeshitela B, Yeshitila B. Prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, south west Ethiopia. BMC Res Notes 2018; 11:281. [PMID: 29739441 PMCID: PMC5941600 DOI: 10.1186/s13104-018-3382-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/30/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study was done to determine the prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, Southwest Ethiopia. RESULTS The overall prevalence of Enterococci species was 5.5% (22/403). Five (22.7%) of Enterococci species were vancomycin resistant. Haemolysin, gelatinase and biofilm production was seen among 45.5, 68.2 and 77.3% of isolates respectively. The overall rate of antibiotic resistance was 95.5% (21/22). High resistance was observed against norfloxacin (87.5%), and tetracycline (77.3%). Whereas, low resistance (36.5%) was observed against ciprofloxacin and eighteen (80.8%) of the isolates were multi-drug resistant.
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Affiliation(s)
| | - Getnet Beyene
- School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, POBox 378, Jimma, Ethiopia.
| | - Tesfaye Kassa
- School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, POBox 378, Jimma, Ethiopia
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Jahansepas A, Aghazadeh M, Rezaee MA, Hasani A, Sharifi Y, Aghazadeh T, Mardaneh J. Occurrence of Enterococcus faecalis and Enterococcus faecium in Various Clinical Infections: Detection of Their Drug Resistance and Virulence Determinants. Microb Drug Resist 2017; 24:76-82. [PMID: 28525287 DOI: 10.1089/mdr.2017.0049] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to characterize virulence determinants and antibiotic resistance profiles in enterococci obtained from various clinical sources in the northwest of Iran. A total of 160 enterococcal clinical isolates from various wards of University Teaching Hospitals were collected and specified by biochemical test, from September 2014 to July 2015. Identification of enterococci was confirmed by multiplex PCR in the genus and species level. Antibiotic resistance properties and virulence determinants were examined by phenotypic and molecular methods. Of 160 enterococcal isolates, 125 (78.12%) and 35 (21.88%) isolates were identified as Enterococcus faecalis and Enterococcus faecium, respectively. The most common antibiotic nonsusceptible pattern observed was resistance toward rifampicin [n = 122 (76.25%)] followed by erythromycin [n = 117 (73.12%)]. Among all isolates, gelE [n = 140 (87.5%)], cpd [n = 137 (85.6%)], and asa1 [n = 118 (73.8%)] were the most prevalent virulence genes studied. Thirty isolates (11 E. faecalis, 19 E. faecium) were found to be resistant to vancomycin, with minimum inhibitory concentration of ≥256 μg/ml. Twenty-seven isolates carried the vanA gene, whereas none of the isolates carried vanB. E. faecalis had a considerable ability to show virulence genes and drug resistance. Emergence of antibiotic-resistant enterococci and the high prevalence of virulence traits in our study could be regarded as an alarming situation.
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Affiliation(s)
- Ali Jahansepas
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Mohammad Aghazadeh
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Mohammad Ahangarzadeh Rezaee
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Alka Hasani
- 1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences , Tabriz, Iran .,2 Department of Clinical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Yaeghob Sharifi
- 3 Department of Clinical Microbiology, Faculty of Medicine, Urmia University of Medical Sciences , Urmia, Iran
| | - Toofan Aghazadeh
- 4 Department of Medical Genetics, Motahari Teaching Hospital, Urmia University of Medical Sciences , Urmia, Iran
| | - Jalal Mardaneh
- 5 Department of Microbiology, School of Medicine, Gonabad University of Medical Sciences , Gonabad, Iran
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Shogan BD, Belogortseva N, Luong PM, Zaborin A, Lax S, Bethel C, Ward M, Muldoon JP, Singer M, An G, Umanskiy K, Konda V, Shakhsheer B, Luo J, Klabbers R, Hancock LE, Gilbert J, Zaborina O, Alverdy JC. Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med 2016; 7:286ra68. [PMID: 25947163 DOI: 10.1126/scitranslmed.3010658] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Even under the most expert care, a properly constructed intestinal anastomosis can fail to heal, resulting in leakage of its contents, peritonitis, and sepsis. The cause of anastomotic leak remains unknown, and its incidence has not changed in decades. We demonstrate that the commensal bacterium Enterococcus faecalis contributes to the pathogenesis of anastomotic leak through its capacity to degrade collagen and to activate tissue matrix metalloproteinase 9 (MMP9) in host intestinal tissues. We demonstrate in rats that leaking anastomotic tissues were colonized by E. faecalis strains that showed an increased collagen-degrading activity and also an increased ability to activate host MMP9, both of which contributed to anastomotic leakage. We demonstrate that the E. faecalis genes gelE and sprE were required for E. faecalis-mediated MMP9 activation. Either elimination of E. faecalis strains through direct topical antibiotics applied to rat intestinal tissues or pharmacological suppression of intestinal MMP9 activation prevented anastomotic leak in rats. In contrast, the standard recommended intravenous antibiotics used in patients undergoing colorectal surgery did not eliminate E. faecalis at anastomotic tissues nor did they prevent leak in our rat model. Finally, we show in humans undergoing colon surgery and treated with the standard recommended intravenous antibiotics that their anastomotic tissues still contained E. faecalis and other bacterial strains with collagen-degrading/MMP9-activating activity. We suggest that intestinal microbes with the capacity to produce collagenases and to activate host metalloproteinase MMP9 may break down collagen in the intestinal tissue contributing to anastomotic leak.
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Affiliation(s)
- Benjamin D Shogan
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | | | - Preston M Luong
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Alexander Zaborin
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Simon Lax
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Cindy Bethel
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Marc Ward
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | | | - Mark Singer
- NorthShore University HealthSystem, Evanston, IL 60201, USA
| | - Gary An
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | | | - Vani Konda
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Baddr Shakhsheer
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - James Luo
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Robin Klabbers
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | - Jack Gilbert
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. Argonne National Laboratory, Argonne, IL 60439, USA
| | - Olga Zaborina
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - John C Alverdy
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
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