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Emergence of multidrug resistance and extensive drug resistance among enterococcal clinical isolates in Egypt

Authors Said HS, Abdelmegeed ES

Received 1 October 2018

Accepted for publication 18 January 2019

Published 7 May 2019 Volume 2019:12 Pages 1113—1125

DOI https://doi.org/10.2147/IDR.S189341

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Joachim Wink


Heba Shehta Said, Eman Salama Abdelmegeed

Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt

Introduction: Enterococci commonly inhabit the gastrointestinal tract of both human and animals; however, they have emerged as a leading cause of several infections with substantial morbidity and mortality. Their ability to acquire resistance combined with intrinsic resistance to various antimicrobials makes treatment of enterococcal infections challenging.
Materials and methods: The aim of the study was to evaluate the antimicrobial resistance pattern, and assess the prevalence of multidrug resistance (MDR) and extensive drug resistance (XDR) among enterococcal isolates, collected from different clinical sources, in Mansoura University Hospitals, Egypt.
Results: Antibiotic sensitivity testing revealed elevated levels of resistance among enterococcal clinical isolates (N=103). All E. faecium (N=32) and 74.6% of E. faecalis isolates (N=71) were MDR, while two E. faecalis and four E. faecium isolates were XDR. High level gentamicin resistance was detected in 79.6%, most of them carried the aac(6’)-Ie-aph(2’’)-Ia gene. High level streptomycin resistance was seen in 36.9%, of which 52.6% carried the ant(6’)-Ia gene. Resistance to macrolides and lincosamides were mediated by ermB (92.2%) and msrA/B (42.7%). tetK, tetL, and tetM genes were detected among tetracyclines resistant isolates. Resistance to vancomycin was detected in 15.5%, where vanB and vanC1 gene clusters were detected in VRE isolates. Ten isolates (9.7%) were resistant to linezolid, eight of which harbored the optrA gene. Vancomycin and linezolid resistant enterococci were more likely to exhibit strong/moderate biofilm formation than vancomycin and linezolid sensitive ones.
Conclusion: Elevated levels of resistance to different classes of antimicrobial agents and emergence of MDR and XDR strains pose a major threat with limited therapeutic options for infections caused by this emerging pathogen.

Keywords: enterococci, antibiotic resistance, biofilm formation, RAPD typing, MDR enterococci, XDR enterococci, VRE, linezolid resistant enterococci


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