Phenotypic speciation of enterococci with special reference to prevalence, virulence and antimicrobial resistance

Jayavarthinni Manavalan; Kavitha Kannaiyan; Abarna Velayutham; Sindhanai Vadivel; Sethumadhavan Kuthalaramalingam

doi:10.18203/2320-6012.ijrms20150802

Authors

Jayavarthinni Manavalan Department of Microbiology, Indira Gandhi Medical College and Research Institute, Pondicherry
Kavitha Kannaiyan Department of Microbiology, Aarupadaiveedu Medical College and Hospital, Pondicherry
Abarna Velayutham Department of Microbiology, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry
Sindhanai Vadivel Department of Microbiology, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamilnadu
Sethumadhavan Kuthalaramalingam Department of Microbiology, Aarupadaiveedu Medical College and Hospital, Pondicherry

DOI:

https://doi.org/10.18203/2320-6012.ijrms20150802

Keywords:

Enterococci, Biofilm formation, Vancomycin resistance, E test

Abstract

Background: Now considered as one of the most important Nosocomial pathogen, enterococci have been found to possess virulence factors like biofilm formation and are increasingly exhibiting antimicrobial resistance in India. This study was undertaken to estimate the prevalence of enterococci from various clinical samples simultaneously correlating their virulence property and antimicrobial resistance, in addition to speciation.

Methods: A total of 126 enterococcal isolates from various clinical samples were included and processed according to standard protocols and speciation was based on Facklam and Collins conventional method. Virulence determinants like hemolysin, gelatinase and biofilm formation were assessed by phenotypic tests. Antibacterial susceptibility pattern was determined by Kirby Bauer disc diffusion method with recommended drugs including high level aminoglycoside resistance. Minimum inhibitory concentration (MIC) for vancomycin was done by E-test.

Results: Out of 1746 clinical samples, enterococci accounted for 7.22%. They consisted of E. faecium 52.38%, E. faecalis 32.54%, and E. avium 15.08% isolated from urine 8.26%, pus 8.44%, blood 0.56% and body fluids 1.28%. Study on virulence factors revealed that 19.84% strains produced gelatinase, 18.25% produced hemolysin and 73.81% produced biofilm. High level resistance to gentamycin and streptomycin were 4.76% and 5.56% respectively. Vancomycin resistance was 3.17%.

Conclusions: This study indicates the change in epidemiology of enterococcal infections from E. faecalis to E. faecium and low prevalence of vancomycin resistant enterococcus (VRE) in our region. To maintain the low level of resistance, improvement of antibiotic policies and hospital infection control is essential.

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References

Murray BE. The life and times of the Enterococcus. Clin Microbiol Rev 1990;3:46-65.

Karmarkar, M.G, Gershom, Edwin S, Mehta, P.R, Enterococcal infections with special reference to phenotypic characterization & drug resistance. Indian Journal of Medical Research, May 2004.

RagandoleVA, Agarwal G, Jalgaonkar SV. Study of Antimicrobial Resistance in Enterococci. Indian J Med Microbiol Dec 2007,pp 286-287.

Desai PJ, Pandit D, Mathur M, GogateA, Prevalence, identification and distribution of various species of enterococci isolated from clinical specimens with special reference to urinary tract infection in catheterized patients. Indian J Med Microbiol 2001;19:132-7.

Anbumani Narayanaswamy, Rajalakshmi K, Mallika Varadharajan, Speciation and antimicrobial susceptibility pattern of Enterococci from a tertiary health care center of south India. Journal of Pharmacy Research 2011,4(4),989-990.

Facklam RR and Collins MD: Identification of enterococcus species isolated from human infections by a conventional test scheme, Journal of clinical microbiology, apr.1989,pp 731-734.

Andrea Marra, Fadia Dib-Hajj, Lucinda Lamb, Frank Kaczmarek, Wenchi Shang1, Gretchen Beckius, Anthony J. Milici, Ivette Medina, Thomas D. Gootz Enterococcal virulence determinants may be involved in resistance to clinical therapy. Diagnostic Microbiology and Infectious Disease. 2007;58:59–65.

Masoud Alebouyeh, Nour Amirmozafari and Homa Forohesh. Evaluation of Virulence Factors and Plasmid-Related Transmissibility among Different Isolates of Enterococci. Iranian Biomedical Journal 2005;9(2):51-5.

Mathur T, Singhal S, Khan S, Upadhyay DJ, Fatma T, Rattan A. Detection of biofilm formation among the clinical isolates of staphylococci: an evaluation of three different screening methods. Indian Journal of Medical Microbiology. 2006;24(1):25-9.

Luna Adhikari, High-level aminoglycoside resistance and reduced susceptibility to vancomycin in nosocomial enterococci. Journal of global infectious diseases 2010;2(3):231-5.

Upadhyaya PG, Ravikumar KL, Umapathy BL. Review of virulence factors of Enterococcus: An emerging nosocomial pathogen. Indian J Med Microbiol 2009;27:301-5.

Rupali S Shinde, Geeta V Koppikar, Seema Oommen Characterization and antimicrobial susceptibility pattern of clinical isolates of Enterococci at a tertiary care hospital in Mumbai, India. Annals of tropical medicine and public health, 2012;5(2):85-8.

Marothi YA, Agnihotri H, Dubey D, Enterococcal Resistance – An Overview, Indian Journal of Medical Microbiology. 2005;23(4):214-9.

Fitzroy A. Orrett and Ehlich Connors, Enterococcal Urinary tract infections eight years’ experience at a regional hospital in Trinidad West Indies, Chinese Medical Journal. 2001;114(1):90-2.

De A, Bindlish A, Kumar S, Mathur M, Vancomycin resistant enterococci in a Tertiary Care Hospital in Mumbai. Indian Journal of Medical Microbiology. 2009;27(4):375-6.

Katharine Bar, Hilmar Wisplinghoff, Richard P Wenzel, Gonzalo ML Bearman and Michael B Edmond, Systemic inflammatory response syndrome in adult patients with nosocomial bloodstream infections due to enterococci, BMC Infectious Diseases, 2006,6:14

Coque, T. M., J. E. Patterson, J. M. Steckelberg, and B. E. Murray. 1995. Incidence of hemolysin, gelatinase, and aggregation substance among enterococci isolated from patients with endocarditis and other infections and from feces of hospitalized and community-based persons. J. Infect. Dis. 171:1223–9.

Lewis, K. 2001. Riddle of biofilm resistance. Antimicrob. Agents Chemother.45:999–1007.

Simonsen G S, Småbrekke L, Monnet D L, Sørensen T L, Møller J K, Kristinsson K G, Lagerqvist-Widh A, Torell E, Digranes A, Harthug S and Sundsfjord A, Prevalence of resistance to ampicillin, gentamicin and vancomycin in Enterococcus faecalis and Enterococcus faecium isolates from clinical specimens and use of antimicrobials in five Nordic hospitals. Journal of Antimicrobial Chemotherapy. 2003;51:323–1.

Vandana A. Agarwal, Yogyata I. Jain, AA Pathak, Concomitant High Level Resistance to penicillin And Aminoglycosides in Enterococci at Nagpur, Central India, Indian Journal of Medical Microbiology, (1999) 17 (2):85-87.

Kapoor L, Randhawa VS, Deb M. Antimicrobial resistance of enterococcal blood isolates at a pediatric care hospital in India. Jpn J Infect Dis 2005;58 :101-3.

Mohanty S, Jose S, Singhal R, Sood S, Dhawan B, Das BK, et al. Species prevalence and antimicrobial susceptibility of enterococci isolated in a tertiary care hospital of north India. Southeast Asian J Trop Med Public Health 2005;36:962-5.

Stosor V, Peterson LR, Postelnick M, Noskin GA. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158(5):522-7.

Sanchez ML, Barrett MS, Jones RN. The E-test applied to susceptibility tests of gonococci, multiply resistant enterococci and Enterobacteriaceae producing potent betalactamases. Diagn. Microbiol. Infect. Dis. 1992;15:459-64.

Vittal P. Prakash, Sambasiva R. Rao and Subash C. Parija, Emergence of unusual species of enterococci causing infections, South India, BMC Infections Diseases 2005; 5:14/1417-2334.

Gupta V, Singla N. Speciation and Antimicrobial Resistant pattern of enterococci in a tertiary care centre in north India, Journal of Clinical and Diagnostic Research. 2007;5:385-9.