Occurrence of high-level aminoglycoside resistance (HLAR) among Enterococcus species strains

• Authors: A. Sieńko , P. Wieczorek , A. Wieczorek , P. Sacha , P. Majewski , D. Ojdana , A. Michalska , E. Tryniszewska
• Languages of publication: EN

Abstracts

Purpose: Today, Enterococcus species are one of the most frequent etiological agents in nosocomial infections. The aim of this study was to determine the susceptibility to antibiotics and the prevalence of high-level aminoglycoside resistance (HLAR) among Enterococcus strains. Materials and methods: The susceptibility of 85 isolates of Enterococcus (47 E. faecalis and 38 E. faecium) was determined using the disk diffusion method. The results were interpreted according to European Committee on Antimicrobial Suscepti-bility Testing (EUCAST) guidelines. PASW Statistics 17.0 was used for statistical analysis. Results: E. faecalis strains showed the highest susceptibility to ampicillin, tigecycline, vanco-mycin, imipenem, and linezolid and E. faecium to linezolid, tigecycline, and quinupristin/dalfopristin. Among all tested strains, high-level gentamicin resistance (HLGR) was found in 4% of E. faecalis and 8% of E. faecium strains, high-level strepto-mycin resistance (HLSR) in 45% and 42%, and HLAR in 50% and 32% of strains, respectively. HLGR was detected only in vancomycin-resistant Enterococcus (VRE)− strains (12%), while HLSR in 76.9% of VRE+ and 24% of VRE− strains, and HLAR in 23.1% of VRE+ and 64% of VRE− strains. The tested strains were also divided into two groups: HLSR+ and HLAR+. In both groups, statistically significant susceptibility differences (p<0.05) were found for ampicillin, imipenem and trimethoprim/sulfamethoxazole. The most frequent antibiotic resistance profile among E. faecalis strains was SR (resistance phenotype to strepto-mycin), and among E. faecium, AMPR, IMPR, CNR, SR, SXTR (ampicillin, imipenem, gentamicin, streptomycin, trimethoprim/sulfamethoxazole). Conclusions: This study showed the slowly increasing prevalence of HLAR and resistance to newer antibiotics (linezolid and tigecycline) among Enterococcus strains. It is necessary to search for new directions in the treatment of enterococcal infections.

Keywords

EN

enterococcus; aminoglycoside resistance; vancomycin-resistant; enterococcus (VRE)

• Publisher: Uniwersytet Medyczny w Białymstoku
• Journal: Progress in Health Sciences
• Year: 2014
• Volume: 4
• Issue: 1
• Pages: 179-187

Contributors

author

A. Sieńko

author

P. Wieczorek

author

A. Wieczorek

author

P. Sacha

author

P. Majewski

author

D. Ojdana

author

A. Michalska

author

E. Tryniszewska

References

• Amyes SG. Enterococci and streptococci. Int J Antimicrob Agents. 2007 May;29(3):43-52.
• Bronk M, Samet A. Szpitalne bakteriemie enterokokowe. Post Mikrob. 2008; 47(3):339-44. (Polish)
• Cesar A, Contreas MD, German A. Antibiotic Discovery and Development: Springer US; 2012. Chapter 19, Clinical Aspects of Multi-drug Resistant Enterococci; pp. 617-48.
• Chen AY, Zerros JM. Antimicrobial Drug Resistance and Infectious Disease: Humana Press; 2009. Chapter 49, Enterococcus: Anti-microbial Resistance in Enterococci. Epi-demiology, Treatment and Control; pp. 715-33.
• Chow JW. Aminoglycoside Resistance in Enterococci. Clin Infect Dis. 2000 Aug; 31 (2): 586-9.
• Hryniewicz W, Zaremba T. Kliniczne znaczenie zakażeń Enterococcus sp. Nowa Med. 1997;4: 30-3. (Polish)
• Kuch A, Żabicka D, Hryniewicz W. Rekomendacje doboru testów do oznaczania wrażliwości bakterii na antybiotyki i chemio-terapeutyki 2009. Oznaczanie wrażliwości Enterococcus spp. KORLD [Internet]. 2009. [cited 2014 May 12] Available from: http://www.korld.edu.pl/ spec_rekomendacje. php
• European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters. [Internet]. Version 3.1. [cited 2014 May 12] Available from: http://www.eucast.org/clinical_ breakpoints/
• Kowalska-Krochmal B, Dolna I, Szufnarowski K, Dworniczek E, Franiczek R, Daszkowska H, Gościniak G, Choroszy-Król I. Frequency and Antibiotic Susceptibility of Enterococcal Strains Isolated from Patients of Different Departments of a University Teaching Hospital in Wrocław. Adv Clin Exp Med. 2008;17(3):259-68.
• Diarmaid H. Exploiting genomics, genetics and chemistry to combat antibiotic resistance. Nat Rev Gen. 2003 Jun;4(6):432-41.
• Hryniewicz W, Wardal E. Enterokoki oporne na wankomycynę – groźny patogen zakażeń szpitalnych. Nowa Klin. 2009; 7(8):711-16. (Polish)
• Hollenbeck BL, Rice LB. Intrinsic and acquired resistance mechanisms in enterococcus. Virulence. 2012 Aug;3(5):421-33.
• Scheetz MH, Knechtel SA, Malczynski M, Postelnick MJ, Qi C. Increasing incidence of linezolid-intermediate or -resistant, vanco-mycin-resistant Enterococcus faecium strains parallels increasing linezolid consumption. Antimicrob Agents Chemother. 2008 Jun;52 (6):2256-9.
• Magdziak A, Ławrynowicz-Paciorek M, Piekar-ska K. Lekowrażliwość szczepów Enterococcus sp. Izolowanych z materiału klinicznego oraz od osób zdrowych. Med Dośw Mikrobiol. 2002; 54:305-15. (Polish)
• Kożuszko S, Białucha A, Bogiel T, Gospodarek E. Oporność na wysokie stężenia amino-glikozydów wśród szczepów Enterococcus fae-calis i Enterococcus faecium wyoso-bnionych z materiału klinicznego. Med Dośw Mikrobiol. 2011; 63:105-13. (Polish)
• Zarrilli R, Tripodi M, Di Popolo A, Fortunato R, Bagattini M, Crispino M, Florio A, Triassi M, Utilli R. Molecular epidemiology of high-level aminoglycoside-resistant enterococci isolated from patient in a university hospital in southern Italy. J Antimicrob Chemother. 2005 Nov; 56(5):827-35.
• Denys A, Łysakowska EM. Lekowrażliwość i pokrewieństwo szczepów Enterococcus sp. Izolowanych od pacjentów i ze środowiska szpitalnego. Med Dośw Mikrobiol. 2008; 60: 219-62. (Polish)
• Rodriguez-Bano J, Ramirez E, Muniain MA, Santos J, Joyanes P, Gonzales F, Garcia-Sanchez M, Martinez-Martinez L. Colonization by high-level aminoglycoside-resistant entero-cocci in intensive care unit patients: epi-demiology and clinical relevance. J Hosp Infect. 2005 Aug; 60(4):353-59.
• Rudy M, Zientara M, Bek T, Martirosian G. Occurrence of Antibiotic Resistant Enterococci in Clinical Specimens from a Pediatric Hospital. Pol J Microbiol. 2005;54(1):77-80.
• Behnood A, Ebrahimi N, Moaddab S. A comparison of Vancomycin resistance and high level aminoglicoside resistance in clonal enterococcus species from Tabriz hospitals. In: Proceedings of The First International Congress of Medical Bacteriology; 2011 Sep 6-8; Tabriz, Iran: [cited 2014 May 12] Available from: http://congress.tbzmed.ac.ir/cmb/Abstract/2315
• Yazgi H, Ertek M, Erol S, Ayyildiz A. A comparison of High-level Aminoglycoside Resistance in Vancomycin-sensitive and Vancomycin-resistant Enterococcus Species. J Int Med Res. 2002 Sep-Oct; 30:529-34.
• European Centre for Disease Prevention and Control. [Internet]. Antimicrobial resistance surveillance in Europe 2011. Stockholm: ECDC; 2012. [cited 2014 May 12] Available from:http://www.ecdc. europa. eu/en/ activities/ surveillanc e/EARS-Net/Pages/index.aspx
• Kawalec M, Pietras Z, Daniłowicz E, Jakubczak A, Gniadkowski M, Hryniewicz W, Willems RJ. Clonal structure of Enteroccus faecalis isolated from polish hospitals: characterization of epidemic clones. J Clin Microbiol. 2007 Jan; 45(1):147-53.
• Schouten MA, Voss A, Hoogkamp-Korstanje A. Antimicrobial Susceptibility Patterns of Enterococci Causing Infections in Europe. Antimicrob Agents Chemother. 1999; 43(10): 2542-46.
• Franiczek R, Dolna I., Dworniczek E. Krzyżanowska B, Seniuk A,Piątkowska E. In vitro activity of Tigecycline against clinical isolates of Gram-positive and Gram-negative bacteria displaying different resistance phenol-types. Adv Clin Exp Med. 2008;17(5): 545-51.
• Freitas AR, Novais C, Correia R, Morteiro M, Coque TM, Peixe L. Non-susceptibility to tigecycline in enterococci from hospitalized patients, food products and community sources. Int J Antimicrob Agents. 2011 Aug; 38(2):174-6.
• Rakowska-Chmielniak MA. Using new anti-biotics in therapy of infections caused by multi-drug resistant strains of gram-positive cocci. Farm Współ. 2010;3:73-81.
• Werner G, Grforer S, Fleige C, Witte W, Klare I. Tigecycline-resistant Enterococcus faecalis strain isolated from a German Intensive Care Unit Patient. J Antimicrob Chemother. 2008; 61(5):1182-83.