Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey
Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey
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DOI：
10.2147/idr.s191881
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Otlu, Baris
中科院分区：
文献类型：
--
作者：
Asgin, Nergis;Otlu, Baris
目的：万古霉素耐药肠球菌（VRE）在过去二十年中已成为全球性的健康威胁。方法：采用BD PhoenixTM全自动微生物分析系统对2014 - 2015年从卡拉布克大学医院住院患者中分离的47株VRE菌株进行鉴定和药敏试验。聚合酶链反应检测万古霉素耐药基因（货车A和B）。结果：从直肠（n=35）、血液（n=7）和尿液（n=5）中分离的47株VRE均为屎肠球菌，对氨苄西林、庆大霉素、万古霉素和替考拉宁耐药。一种大肠埃希屎肠分离株对利奈唑胺中度耐药。没有菌株对奎奴普汀-达福普汀或达托霉素耐药。菌株中仅检测到vanA。PFGE结果显示，47株分离株中有31株具有克隆相关性，聚类率为66%。结论：VRE感染与高死亡率、高发病率和高医疗费用相关。VRE菌株对最后一线药物（如利奈唑胺和达托霉素）的耐药性增加是一个非常令人担忧的问题。因此，应采取综合措施减少VRE定植。虽然没有常见的克隆VRE爆发，但在我院观察到多克隆传播。高聚集率表明交叉污染。因此，应实施更有效的感染控制方案。
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 PhoenixTM 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.