Gastrointestinal Colonization with Vancomycin-Resistant Enterococci In Hospitalized and Outpatients

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 μg/ml. Three vanB genotypes of E. faecium and one vanB genotype of E. faecalis had MICs of 32 μg/ml. All six vanC genotypes of E. gallinarum had MICs of 8 μg/ml. All vanA genotypes of VRE were highly resistant to vancomycin, with MICs above 256 μg/ml. Three vanB genotypes of VR E. faecium and one VR E. fecalis were resistant, with MICs 32 μg/ml. vanC genotypes of VR E. gallinarum were intermediate resistant to vancomycin with MICs of 8 μg/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 μg/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.