Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : September | Volume : 11 | Issue : 9 | Page : DC01 - DC05

Characterization of Vancomycin Resistant Enterococci in Hospitalized Patients and Role of Gut Colonization

Geetarani Purohit, Rajni Gaind, Reetika Dawar, P.K. Verma, K.C. Aggarwal, Raman Sardana, Monorama Deb

1. Senior Resident, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India. 2. Professor and Head, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India. 3. Senior Consultant, Department of Microbiology, Apollo Hospital, New Delhi, India. 4. Professor, Department of Anaesthesia, VMMC and Safdarjung Hospital, New Delhi, India. 5. Professor and Head, Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi, India. 6. Senior Consultant, Department of Microbiology, Apollo Hospital, New Delhi, India. 7. Director Professor, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India.

Correspondence Address :
Dr. Rajni Gaind,
Professor and Head, Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi-110029, India.
E-mail: rgaind5@hotmail.com

Abstract

Introduction: Enterococci are part of the normal intestinal flora and have been recognized as important human pathogens. Vancomycin Resistant Enterococci (VRE) are global threat as this resistance is transmissible and also poses a challenge for infection control.

Aim: This study was undertaken to study phenotypic and genotypic characteristics of VRE from clinically significant infections among hospitalized patients and their association with gut colonization.

Materials and Methods: Clinically significant isolates of enterococci (n=250) were studied. Species confirmation was done by Polymerase Chain Reaction (PCR). Minimum Inhibitory Concentration (MIC) for vancomycin was determined by E-test. PCR for VanA, VanB and VanC1 gene was done for genotypic characterization. MIC for teicoplanin, linezolid, tigecycline, daptomycin and quinupristin-dalfopristin was determined by E test. Patients with VRE infection were screened for gut colonization using vancomycin screen agar (6 µg/mL). Continuous data was analysed using the Student’s t-test. Categorical data was assessed using Pearson’s Chi-square test. A value of p = 0.05 was considered statistically significant.

Results: There was good correlation between the phenotypic and genotypic methods used for species identification and detection of vancomycin resistance. E. faecium (162, 64.8%) was most common followed by E. faecalis (82, 32.84%) and E. gallinarum (6, 2.4%). Overall higher resistance was observed among E. faecium. Vancomycin MIC = 2 µg/mL was noted in 63 (25.2%) isolates. Fifty seven isolates showed presence of vanA and vanC1 was detected in six isolates of E. gallinarum. Isolates with VanB genotype was not detected in the present study. MIC50 (µg/mL) for teicoplanin, linezolid, tigecycline, daptomycin and quinupristin-dalfopristrin was 24, 0.75, 0.064, 2 and 0.064 respectively. Resistance to linezolid (1, 1.6%) and tigecycline (2, 3.2%) was rare. Majority (33/47, 70.2%) patients with clinically significant VRE infection showed gut colonization.

Conclusion: Vancomycin resistance among enterococci is emerging. Emergence of tigecycline and linezolid resistance is also posing a challenge for clinicians. Thus, further investigations are warranted to control vancomycin resistance among pathogens.

Keywords

Linezolid, Surgery, Urine, vanA, vanB

How to cite this article :

Geetarani Purohit, Rajni Gaind, Reetika Dawar, P.K. Verma, K.C. Aggarwal, Raman Sardana, et al.. CHARACTERIZATION OF VANCOMYCIN RESISTANT ENTEROCOCCI IN HOSPITALIZED PATIENTS AND ROLE OF GUT COLONIZATION . Journal of Clinical and Diagnostic Research [serial online] 2017 September [cited: 2017 Nov 22 ]; 11:DC01-DC05. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=September&volume=11&issue=9&page=DC01-DC05&id=10548

DOI and Others

DOI: 10.7860/JCDR/2017/25988.10548

Date of Submission: Dec 13, 2016
Date of Peer Review: Feb 08, 2017
Date of Acceptance: Jun 06, 2017
Date of Publishing: Sep 01, 2017

Financial OR OTHER COMPETING INTERESTS: None.

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