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Open Access Macedonian Journal of Medical Sciences.
http://dx.doi.org/10.3889/oamjms.2015.002
Basic Science
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Gastrointestinal Colonization
with Vancomycin-Resistant Enterococci In Hospitalized and Outpatients
Elena Trajkovska-Dokic1, Ana Kaftandzieva1,
Snezana Stojkovska2, Aneta Kuzmanovska1, Nikola
Panovski1
1Institute for Microbiology and Parasitology, Medical Faculty, Ss
Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia;
2University Clinic for Infective Diseases and Febrile Conditions,
Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
BACKGROUND: The incidence of infection and intestinal colonization
with vancomycin resistant enterococci (VRE) is increasing in many countries
in the last decade. Concerning the difficult antimicrobial treatment of
infections caused by VRE, decreasing the incidence and prevalence of these
infections is an important factor in VRE-induced morbidity and mortality
control.
AIM: To determine the prevalence of gastrointestinal colonization
with vancomycin resistant enterococci in hospitalized and outpatients, and
to determine the genetic base of the vancomycin resistance in VRE isolates.
MATERIAL AND METHODS: Seven hundred and eighty stool specimens were
investigated for the gastrointestinal carriage of vancomycin-resistant
enterococci (VRE). Susceptibility to vancomycin was tested in all isolates
by disk-diffusion test and E-test (AB Biodisk, Sweden). Determined
vancomycin resistant enterococci were than tested for detection of vanA,
vanB and vanC genes by PCR.
RESULTS: Vancomycin resistant strains of enterococci were isolated
from 46 (16.1 %) of the 285 hospitalized patients and 5 (7.7 %) of the 65
patients living in the community (p < 0.05). The most of the highly
resistant enterococci strains to vancomycin (95.2 %), were identified as
E. faecium. Minimal inhibitory concentrations (MICs) to vancomycin in
all 39 vanA genotypes of E. faecium and two vanA
genotypes of E. fecalis were > 256
g/ml. Three vanB genotypes of
E. faecium and one vanB genotype of E. faecalis had MICs
of 32
g/ml. All six vanC genotypes of
E. gallinarum had MICs of 8
g/ml. All vanA genotypes of VRE
were highly resistant to vancomycin, with MICs above 256
g/ml. Three vanB genotypes of VR
E. faecium and one VR E. fecalis were resistant, with MICs 32
g/ml. vanC genotypes of VR E.
gallinarum were intermediate resistant to vancomycin with MICs of 8
g/ml.
CONCLUSIONS: The prevalence of vancomycin resistant enterococci in
Republic of Macedonia was 2-fold higher in hospitalized than in outpatients.
VanA genotype was dominant in isolates of E. faecium and it
was highly associated with the MIC values above the 256
g/ml. Since most of the enterococcal infections are endogenous,
there is a need for screening the colonization of patient’s intestinal flora
with VRE at the hospital entry. Identification and genotyping of faecal
enterococci, together with their susceptibility testing to vancomycin, could
be useful marker for the infection control.
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Citation: Trajkovska-Dokic E, Kaftandzieva A,
Stojkovska S, Kuzmanovska A, Panovski N. Gastrointestinal Colonization with
Vancomycin-Resistant Enterococci In Hospitalized and Outpatients. OA Maced J
Med Sci. http://dx.doi.org/10.3889/oamjms.2015.002.
Key words: colonization; vancomycin; resistance; Enterococcus;
genotypes.
*Correspondence: Prof. Elena Trajkovska-Dokic. Institute of
Microbiology and Parasitology, Medical Faculty, Ss Cyril and Methodius
University of Skopje, 50 Divizija No 6, Skopje 1109, Republic of Macedonia.
E-Mail: elenatdokic@gmail.com
Received: 22-Sep-2014; Revised: 26-Oct-2014; Accepted: 27-Oct-2014; Online
first: 05-Nov-2014
Copyright: © 2014 Elena Trajkovska-Dokic, Ana Kaftandzieva, Snezana
Stojkovska, Aneta Kuzmanovska, Nikola Panovski. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.
Competing Interests: The authors have declared that no competing
interests exist.
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