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

• Published in: Infection and drug resistance 2019-05, Vol.12, p.1113-1125
• Main Authors: Said, Heba Shehta, Abdelmegeed, Eman Salama
• Format: Article
• Language: English
• Subjects: Aminoglycosides; Antibacterial agents; antibiotic resistance; Antibiotics; biofilm formation; Drug resistance; Drug therapy; Egypt; Enterococcal infections; Enterococci; Gastrointestinal system; Genes; Health aspects; Hospital patients; Hospitals; Imipenem; Infection; Linezolid; Linezolid resistant enterococci; MDR enterococci; Meropenem; Microbial drug resistance; Morbidity; Original Research; RAPD typing; Tetracyclines; Vancomycin; VRE; XDR enterococci
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S189341

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. 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. Antibiotic sensitivity testing revealed elevated levels of resistance among enterococcal clinical isolates (N=103). All (N=32) and 74.6% of (N=71) were MDR, while two and four isolates were XDR. High level gentamicin resistance was detected in 79.6%, most of them carried the gene. High level streptomycin resistance was seen in 36.9%, of which 52.6% carried the gene. Resistance to macrolides and lincosamides were mediated by (92.2%) and (42.7%). , , and genes were detected among tetracyclines resistant isolates. Resistance to vancomycin was detected in 15.5%, where and gene clusters were detected in VRE isolates. Ten isolates (9.7%) were resistant to linezolid, eight of which harbored the gene. Vancomycin and linezolid resistant enterococci were more likely to exhibit strong/moderate biofilm formation than vancomycin and linezolid sensitive ones. 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.