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Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey

Authors Asgin N, Otlu B

Received 20 October 2019

Accepted for publication 7 January 2020

Published 21 January 2020 Volume 2020:13 Pages 191—198

DOI https://doi.org/10.2147/IDR.S191881

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Joachim Wink


Nergis Asgin, 1 Baris Otlu 2

1Department of Medical Microbiology, Faculty of Medicine, Karabuk University, Karabuk, Turkey; 2Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey

Correspondence: Nergis Asgin
Karabuk University, Faculty of Medicine, Department of Medical Microbiology, Baliklarkayasi Mevkii Demir Celik Kampusu, Karabuk 78050, Turkey
Tel +90 370 4189446
Fax +90 370 4189299
Email drnasgin@gmail.com

Purpose: Vancomycin-resistant enterococci (VRE) have become a global health threat in the last two decades. In this study, we aimed to determine antibiotic resistance using phenotypic and genotypic methods in VRE strains obtained from inpatients and to investigate clonal relatedness among strains.
Methods: Identification and antibiotic susceptibility of 47 VRE strains obtained from inpatients at Karabuk University Hospital from 2014 to 2015 were determined using the BD Phoenix™ automated microbiology system. Vancomycin resistance genes (Van A and B) were detected by polymerase chain reaction. Clonal relatedness among the strains was evaluated by pulsed-field gel electrophoresis (PFGE).
Results: All 47 VRE strains obtained from rectal (n=35), blood (n=7), and urine (n=5) samples were confirmed as Enterococcus faecium; they were resistant to ampicillin, gentamicin, vancomycin, and teicoplanin. One E. faecium isolate was intermediately resistant to linezolid. No strain was resistant to quinupristin–dalfopristin or daptomycin. Only vanA was detected among strains. According to the PFGE results, 31 of 47 strains were clonally related with a clustering rate of 66%. No common clone was detected.
Conclusion: VRE infections are associated with high mortality, morbidity, and healthcare expenditures. Increasing resistance to last-line drugs, such as linezolid and daptomycin, among VRE strains is a great concern. Therefore, comprehensive measures should be performed to reduce VRE colonization. Although there was no common clone VRE outbreak, polyclonal spread was observed in our hospital. The high clustering rate indicated cross-contamination. Thus, a more effective infection control program should be implemented.

Keywords: antimicrobial resistance, Enterococcus faecium, gastrointestinal tract, linezolid resistance, pulsed-field gel electrophoresis

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