Favorable Outcomes in Patients with Pre-Transplant Gut Colonization with Intrinsically Vancomycin-Resistant Enterococci

Abstract PURPOSE: Vancomycin-resistant enterococci (VRE) emerged as one of the major nosocomial pathogens across the globe. Gut colonization rate with VRE is higher in patients admitted to intensive care units (ICUs) due to the higher antibiotic pressure. VRE colonization increases the risk of developing infection up to 5–10 folds. The aim of this study was to determine the rates of VRE colonization among the patients admitted to pediatric ICU (PICU) and risk factors associated with it. MATERIALS AND METHODS: Rectal swabs were collected after 48 h of admission to PICU from 198 patients. The samples were inoculated onto bile esculin sodium azide agar with 6 mg/ml of vancomycin. Growth on this medium was identified by the standard biochemical test, and minimum inhibitory concentration of vancomycin and teicoplanin was detected by agar dilution method. Resistance genes for vancomycin were detected by polymerase chain reaction. Risk factors were assessed by logistic regression analysis. RESULTS: The rates of VRE colonization in patients admitted to PICU was 18.6%. The majority of the isolates were Enterococcus faecium (75.6%) followed by Enterococcus faecalis (24.4%). One patient acquired a VRE bloodstream infection (2.6%) among colonized patients, and none of the noncolonized patients acquired the infection. Consumption of vancomycin was found to be the only risk factor significantly associated with VRE colonization. CONCLUSION: Routine surveillance and isolation of patients found to be VRE colonized may not be possible in tertiary care hospitals; however, educating health-care workers, promoting handwashing with antiseptic soaps or solutions, and antibiotic Stewardship policy may help in the reduction of vancomycin resistance and VRE colonization.

Download Full-text

Utility of bile esculin azide agar for screening of stool samples for vancomycin resistant enterococci from patients with gut colonization

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214713 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3633

Author(s):

Deepa Pramod Devhare ◽

Sae Satish Pol ◽

Varsha Pendse

Keyword(s):

Drug Resistance ◽

Tertiary Care ◽

Hospitalized Patients ◽

Care Hospital ◽

Test Protocol ◽

Gut Colonization ◽

Vancomycin Resistant Enterococci ◽

Agar Dilution ◽

Stool Samples ◽

Vancomycin Resistant

Background: Due to increased prevalence of vancomycin resistant enterococci (VRE) in hospital settings as an important nosocomial pathogen, microbiology laboratories should be prepared with test protocol for prompt detection and reporting of these resistant organisms. This helps in appropriate treatment of patients without delay and implementation of infection control measures in order to prevent spread of such infections. With this background present study was conducted to demonstrate utility of bile esculin azide agar with vancomycin (BEAV) for screening of enterococci for vancomycin drug resistance.Methods: Over a period of one year 200 stool samples were collected from hospitalized patients in a tertiary care hospital. Samples were inoculated on bile esculin azide agar with vancomycin (6ug/ml) to screen for vancomycin drug resistance in enterococci isolated from stool samples. Vancomycin drug resistance was confirmed by agar dilution method.Results: Out of 200 stool samples collected from hospitalized patients, 13 (6.5%) samples showed growth on bile esculin azide agar with vancomycin (6 µg/ml). Of these 13 isolates, 12 (92.3%) isolates were confirmed as VRE by agar dilution method and demonstrated minimum inhibitory concentration (MIC) of ≥32 µg/ml and all 12 isolates were identified as E. faecium. One (7.7%) isolate grown on BEAV was identified as E. gallinarum and showed MIC value of 8 µg/ml.Conclusions: Present study recommends use of bile esculin azide agar with vancomycin (6 µg/ml) as a screening medium for isolation of VRE from stool samples which usually carries mixed commensal flora of gastrointestinal tract.

Download Full-text

Vancomycin resistant enterococci gut Colonization and its associated factors among HIV infected patients on anti-Retro viral therapy in Ethiopia

10.21203/rs.3.rs-96175/v1 ◽

2020 ◽

Author(s):

Belayneh Regasa ◽

Zerihun Solomon ◽

Mheret Tesfaye

Keyword(s):

Associated Factors ◽

Cross Sectional Study ◽

Diffusion Method ◽

Resistance Pattern ◽

P Value ◽

Cross Sectional ◽

Gut Colonization ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Study Participants

Abstract BackgroundThe emergence of vancomycin resistant Enterococci (VRE) has alarmed the global infectious diseases community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the prevalence of vancomycin resistant Enterococci gut colonization and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART).MethodsInstitution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. P-value <0.05 was considered as significant.ResultsAmong a total of 200 study participants, colonization of Enterococci spp was isolated on 123 (61.50%) respondents. Among these isolates, the prevalence of vancomycin resistant Enterococci colonization was 11.4% [95% CI: (6.0-17.0)]. Enterococci isolates tested against commonly prescribed antibiotics showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibiotic exposure for more than two weeks [AOR=7.35; 95% CI: (1.2144.64)] and hospitalization in the last six months [AOR=5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci gut colonization.ConclusionHigh prevalence of vancomycin resistant Enterococci gut colonization was found. Previous exposure to antibiotics for more than two weeks and previous hospitalization for more than six months were significant factors for vancomycin resistant Enterococci colonization. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.

Download Full-text