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Archana Rao K, Deepa S, Venkatesha D. Enterococci: A journey of a successful pathogen. IAIM, 2014; 1(4): 49-57.
Citation preview
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol.
Copy right © 2014, IAIM, All Rights Reserved.
Original Research Article
Enterococci: A journey of a successful
Archana Rao K1Department of Microbiology, Mysore Medical College and Research Institute, Karnataka, India
2Assistant Professor, Department of Microbiology, Mysore Medical College and Research Institute,
3Professor and Head, Department of Microbiology, Mysore Medical College and Research Institute,
*Corresponding author email:
How to cite this article: Archana Rao K, Deepa S, Venkatesha D
pathogen. IAIM, 2014; 1(4): 49-57.
Available online at
Received on: 26-11-2014
Abstract
Introduction: A dynamic homeostasis is maintained between the host
gastrointestinal tract in humans, but migration of bacteria from the gut to other organs can lead to
disease or death. Enterococci, traditionally viewed as commensal bacteria are now acknowledged to
be organisms capable of causing life
environment. The existence of Enterococci in such a dual role is facilitated by its intrinsic and
acquired resistance to virtually all antibiotics currently in use.
Objective: The present pilot study was taken up to compare the multidrug resistance prevalence in
commensal Enterococci and pathogenic Enterococci.
Material and methods: A total of 50 commensal Enterococci isolated from stool samples and 50
clinical samples yielding Enterococci were taken for the study. An
done using Kirby Bauer’s disk diffusion method.
was tested by using E- strip.
Results: Among 50 commensal Enterococci
Erythromycin 38 (76%), Clindamycin 30
(28%), Linezolid 6 (12%), vancomycin 3
(resistance to ≥ 3 categories of antibiotics). Among 50 clinical isolates, majority showed resistance to
Ampicillin 50 (100%), Clindamycin 46
resistance was seen in 8 (16%) and Vancomycin resistance in 5
showed multi drug resistance.
Conclusion: Boundary line between pathogenic and commensal Enterococci is blurred due to
exchange of resistant traits. Regular screening of enterococcal isolates for resistance detection should
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Rights Reserved.
Enterococci: A journey of a successful
pathogen
Archana Rao K1, Deepa S
2*, Venkatesha D
Department of Microbiology, Mysore Medical College and Research Institute, Karnataka, India
Department of Microbiology, Mysore Medical College and Research Institute,
Karnataka, India
Department of Microbiology, Mysore Medical College and Research Institute,
Karnataka, India
*Corresponding author email: [email protected]
Archana Rao K, Deepa S, Venkatesha D. Enterococci: A journey of a successful
57.
Available online at www.iaimjournal.com
2014 Accepted on:
: A dynamic homeostasis is maintained between the host and native bacteria of the
gastrointestinal tract in humans, but migration of bacteria from the gut to other organs can lead to
disease or death. Enterococci, traditionally viewed as commensal bacteria are now acknowledged to
ng life-threatening infections in humans, especially in the nosocomial
environment. The existence of Enterococci in such a dual role is facilitated by its intrinsic and
acquired resistance to virtually all antibiotics currently in use.
ent pilot study was taken up to compare the multidrug resistance prevalence in
pathogenic Enterococci.
: A total of 50 commensal Enterococci isolated from stool samples and 50
Enterococci were taken for the study. Antibiotic susceptibility testing
Bauer’s disk diffusion method. Minimum inhibitory concentration of V
: Among 50 commensal Enterococci, majority showed resistance to Ampicillin 50
lindamycin 30 (60%), higher level of resistance to high level G
(12%), vancomycin 3 (6%). 23 (46%) isolates showed multi drug resistance
ries of antibiotics). Among 50 clinical isolates, majority showed resistance to
(100%), Clindamycin 46 (92%), Tetracycline 46 (92%), Erythromycin 41
resistance was seen in 8 (16%) and Vancomycin resistance in 5 (10%) clinical
: Boundary line between pathogenic and commensal Enterococci is blurred due to
exchange of resistant traits. Regular screening of enterococcal isolates for resistance detection should
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Page 49
Enterococci: A journey of a successful
, Venkatesha D3
Department of Microbiology, Mysore Medical College and Research Institute, Karnataka, India
Department of Microbiology, Mysore Medical College and Research Institute,
Department of Microbiology, Mysore Medical College and Research Institute,
Enterococci: A journey of a successful
Accepted on: 02-12-2014
and native bacteria of the
gastrointestinal tract in humans, but migration of bacteria from the gut to other organs can lead to
disease or death. Enterococci, traditionally viewed as commensal bacteria are now acknowledged to
threatening infections in humans, especially in the nosocomial
environment. The existence of Enterococci in such a dual role is facilitated by its intrinsic and
ent pilot study was taken up to compare the multidrug resistance prevalence in
: A total of 50 commensal Enterococci isolated from stool samples and 50
tibiotic susceptibility testing was
um inhibitory concentration of Vancomycin
ed resistance to Ampicillin 50 (100%),
high level Gentamycin 14
23 (46%) isolates showed multi drug resistance
ries of antibiotics). Among 50 clinical isolates, majority showed resistance to
(92%), Erythromycin 41 (82%), Linezolid
(10%) clinical isolates. 48 (96%)
: Boundary line between pathogenic and commensal Enterococci is blurred due to
exchange of resistant traits. Regular screening of enterococcal isolates for resistance detection should
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol.
Copy right © 2014, IAIM, All Rights Reserved.
be implemented. It is very important to consider infection control measures, screening of health care
workers, surveillance cultures which can control spread of multidrug resistant Enterococci.
Key words
Antibiotic resistance, Commensal Enterococc
resistance.
Introduction
Until recently bowel commensals including
Enterococci were perceived as bacteria with no
harm. For long time, commensal Enterococci
were frequently ignored when isolated in clinical
laboratory. But recently Enterococci have
attracted much attention due to its capability of
causing variety of infections, especially in
hospitalized patients and higher
various antibiotics has led to understanding the
importance of identification of Enterococcus
Enterococci have evolved over the past century
from being an intestinal commensal organism of
little clinical significance to becoming the sec
most common nosocomial pathogen associated
with significant morbidity and mortality
Enterococci are frequently used as positive
resistance indicator bacteria, because of their
high prevalence in the feces of healthy
population and their ability to harbor several
resistance determinants [3]. Administration of
antimicrobial agents affects both targeted
pathogenic organisms as well as non
commensals. Thus frequent antimicrobial use
creates a pool of resistant commensal bacteria.
This contributes to the general increase and
dissemination of bacterial resistance worldwide
and can be a source of resistance genes for
pathogens [4].
Until recently commensal Enterococci
represented an underappreciated means of
assessing resistance [5]. But the abil
organism to acquire newer traits makes it virulent
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Rights Reserved.
nted. It is very important to consider infection control measures, screening of health care
workers, surveillance cultures which can control spread of multidrug resistant Enterococci.
Antibiotic resistance, Commensal Enterococci, Multi drug resistance, Linezolid resistance, Vancomycin
Until recently bowel commensals including
Enterococci were perceived as bacteria with no
For long time, commensal Enterococci
were frequently ignored when isolated in clinical
laboratory. But recently Enterococci have
attracted much attention due to its capability of
causing variety of infections, especially in
hospitalized patients and higher resistance to
various antibiotics has led to understanding the
importance of identification of Enterococcus [1].
Enterococci have evolved over the past century
from being an intestinal commensal organism of
little clinical significance to becoming the second
most common nosocomial pathogen associated
with significant morbidity and mortality [2].
Enterococci are frequently used as positive
resistance indicator bacteria, because of their
high prevalence in the feces of healthy
o harbor several
. Administration of
antimicrobial agents affects both targeted
pathogenic organisms as well as non-target
commensals. Thus frequent antimicrobial use
creates a pool of resistant commensal bacteria.
es to the general increase and
dissemination of bacterial resistance worldwide
and can be a source of resistance genes for
Until recently commensal Enterococci
represented an underappreciated means of
. But the ability of the
organism to acquire newer traits makes it virulent
to invade extra intestinal regions and cause
infections [6]. With this background, the present
pilot study was taken up to compare the
multidrug resistance prevalence in
Enterococci and pathogenic Enterococci.
Material and methods
The present study was conducted in
Department of Microbiology, Mysore Medical
College and Research Institute, Mysore.
study was cross sectional prospective study
which included 50 isolates of
stool samples of the patients who attended the
outpatient departments in our hospital
other 50 isolates of Enterococci
clinical samples such as burn wound swabs,
ascitic fluids, surgical and non
umbilical stumps, abdominal drain fluids,
synovial fluids and Foley's catheters followed by
subsequent urine specimens of the same
patient, (except stool specimens) obtained in
the Microbiology Department were processed
for the isolation of Enterococci.
Enterococcal isolates were identified according
to the standard protocols. Antibiogram was
done using Kirby Bauer’s disk diffusion test as
per latest Clinical and Laboratory Standards
Institute (CLSI) guidelines. The drug
groups tested were Ampicillin
Amoxycalv (30 mcg), Erythromycin
Clindamycin (2 mcg), Ciprofloxacin
Tigecycline (15 mcg), high level Gentamycin (120
mcg), Cotrimaxozole (25 mcg), Tetracycline (30
mcg), Linezolid (15 mcg) and Vancomycin (30
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Page 50
nted. It is very important to consider infection control measures, screening of health care
workers, surveillance cultures which can control spread of multidrug resistant Enterococci.
i, Multi drug resistance, Linezolid resistance, Vancomycin
to invade extra intestinal regions and cause
With this background, the present
pilot study was taken up to compare the
multidrug resistance prevalence in commensal
pathogenic Enterococci.
The present study was conducted in the
epartment of Microbiology, Mysore Medical
College and Research Institute, Mysore. This
study was cross sectional prospective study
which included 50 isolates of Enterococci from
stool samples of the patients who attended the
outpatient departments in our hospital and
50 isolates of Enterococci from various
clinical samples such as burn wound swabs,
ascitic fluids, surgical and non-surgical wounds,
stumps, abdominal drain fluids,
synovial fluids and Foley's catheters followed by
specimens of the same
stool specimens) obtained in
the Microbiology Department were processed
for the isolation of Enterococci.
isolates were identified according
to the standard protocols. Antibiogram was
done using Kirby Bauer’s disk diffusion test as
per latest Clinical and Laboratory Standards
ute (CLSI) guidelines. The drug of different
Ampicillin (10 mcg),
mcg), Erythromycin (15 mcg),
mcg), Ciprofloxacin (5 mcg),
mcg), high level Gentamycin (120
mcg), Tetracycline (30
mcg) and Vancomycin (30
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol.
Copy right © 2014, IAIM, All Rights Reserved.
mcg). The isolates which show
three or more than three prototype of drugs
were considered as multi drug resistant
Enterococci [7]. The minimum inhibitory
concentration levels of Vancomycin were
determined by E strip as per latest CLSI
Results
Total of 100 samples were processed. 50 isolates
of Enterococci obtained from the stool samples
were considered as commensal Enterococci. The
other 50 Enterococci from the clinical samples
were considered as pathogenic Enterococci.
Ampicillin showed 50 (100%) resistance in both
commensal and pathogen Enterococci.
of commensal Enterococci showed resistance to
Erythromycin 38 (76%), Clindamycin 30
and Ciprofloxacin 22 (44%) as
Commensal Enterococci showed
resistance to high level Gentamycin 14
Linezolid 6 (12%), Vancomycin 3
Among pathogen Enterococci, majority showed
resistance to Clindamycin 46 (92%), Tetracycline
46 (92%), and Erythromycin 41
Graph - 2. High level Gentamycin showe
resistance in 16 (32%), Linezolid in 8
Vancomycin 5 (10%) of the isolates.
resistance in commensal Enterococci
Table - 1. Multi drug resistance in Pathogen
Enterococci was as per Table - 2
resistance pattern of various antibiotics in
commensal and pathogenic Enterococci
per Graph - 3.
Discussion
Antimicrobial agents are grossly misused in
many developing countries including India
leading to high selective pressure on
microorganisms. Today, the
bacterial strains which display resistance to a
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Rights Reserved.
which showed resistance to
three or more than three prototype of drugs
were considered as multi drug resistant
The minimum inhibitory
levels of Vancomycin were
determined by E strip as per latest CLSI [8].
samples were processed. 50 isolates
of Enterococci obtained from the stool samples
were considered as commensal Enterococci. The
other 50 Enterococci from the clinical samples
were considered as pathogenic Enterococci.
00%) resistance in both
commensal and pathogen Enterococci. Majority
ci showed resistance to
lindamycin 30 (60%),
(44%) as per Graph - 1.
Commensal Enterococci showed higher level of
entamycin 14 (28%),
ancomycin 3 (6%).
majority showed
(92%), Tetracycline
(92%), and Erythromycin 41 (82%) as per
entamycin showed
(32%), Linezolid in 8 (16%) and
(10%) of the isolates. Multi drug
resistance in commensal Enterococci was as per
ulti drug resistance in Pathogen
2. Comparison of
pattern of various antibiotics in
commensal and pathogenic Enterococci was as
Antimicrobial agents are grossly misused in
many developing countries including India
leading to high selective pressure on
emergence of
bacterial strains which display resistance to a
variety of drugs is a major cause of failure of
treatment of infections worldwide and a serious
concern to animal and public health.
In our study, commensal Enterococci have
shown maximum resistance to Ampicillin 50
(100%), followed by Erythromycin 38
Clindamycin 30 (60%). Another study on
commensal Enterococci has reported 100%
resistance to Ampicillin, Erythromycin.
Ampicillin is the drug of choice in the treatment
of Enterococcal infections, the relatively high
resistance of isolates in this study to A
of great concern, especially in the case of
endocarditis treatment [9]. Though we have not
studied the risk factors, previous exposure to
Ampicillin and urinary cathete
found to be the major risk factors associated
with the emergence of Ampicillin resistance
Enterococci. Bladder catheterization has been
shown to increase urinary Enterococcal
colonization in patients with Ampicillin
Enterococcal bacteremia and a gastrointestinal
origin of urinary colonization has been indicated
by plasmid analysis [10]. The use of antibiotics,
whether for prophylaxis or chemotherapy, does
not only affect the pathogenic bacteria but also
the commensal bacteria. This m
of resistant bacteria with a pool of resistance
genes in the population which further
contributes to the general increase and
dissemination of bacterial resistance and can be
a source of resistance genes for pathogens
12].
Bacteremia due to Vancomycin resistant
Enterococci (VRE) is a significant complication in
surgical patients and is associated with mortality
rates ranging from 33% to 68%
the prevalence of VRE infections in India is much
lower than in the western worl
increasing in the past one decade. In our study
of commensal Enterococci isolated from 50 fecal
samples, 3 (6%) were found to be Vancomycin
ISSN: 2394-0026 (P)
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Page 51
variety of drugs is a major cause of failure of
treatment of infections worldwide and a serious
concern to animal and public health.
In our study, commensal Enterococci have
stance to Ampicillin 50
(100%), followed by Erythromycin 38 (76%),
(60%). Another study on
commensal Enterococci has reported 100%
resistance to Ampicillin, Erythromycin. Since
mpicillin is the drug of choice in the treatment
l infections, the relatively high
e of isolates in this study to Ampicillin is
of great concern, especially in the case of
Though we have not
previous exposure to
mpicillin and urinary catheterization were
found to be the major risk factors associated
with the emergence of Ampicillin resistance
Enterococci. Bladder catheterization has been
shown to increase urinary Enterococcal
colonization in patients with Ampicillin-resistant
and a gastrointestinal
origin of urinary colonization has been indicated
. The use of antibiotics,
whether for prophylaxis or chemotherapy, does
not only affect the pathogenic bacteria but also
the commensal bacteria. This maintains a pool
of resistant bacteria with a pool of resistance
genes in the population which further
contributes to the general increase and
dissemination of bacterial resistance and can be
a source of resistance genes for pathogens [11,
due to Vancomycin resistant
significant complication in
surgical patients and is associated with mortality
rates ranging from 33% to 68% [13]. Although
the prevalence of VRE infections in India is much
lower than in the western world, it has been
increasing in the past one decade. In our study
of commensal Enterococci isolated from 50 fecal
samples, 3 (6%) were found to be Vancomycin
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol.
Copy right © 2014, IAIM, All Rights Reserved.
resistant. These finding mirrors, those of a study
done by Vandana KE, where 3 (6.25%) were VRE
[14].
5 (10%) were found
resistant in pathogen Enterococci which is high
compared to other reports from India.
Glycopeptide resistance among our isolates is
high, probably reflecting the increased use of
Vancomycin in our hospital over the past few
years. This fact highlights the impor
strict enforcement of antibiotic policies co
with greater adherence to infection control
measures to prevent emergence and
antibiotic resistant bacteria. Widespread use of
vancomycin and extended
Cephalosporin in hospitals likely contributed to
the emergence and dramatic increase of VRE
over the past 20 years [15].
The prevalence of VRE has dramatically
increased worldwide [16].
Nosocomial Infection Surveillance (NNIS) system
in the USA has revealed a significant increase in
the percentage of invasive nosocomial
Enterococcus strains displaying high
vancomycin resistance [17]. To a larger or lesser
extent, non-microbiological factors such as
antibiotic consumption (particular classes and in
general); “colonization pressure”,
“understaffing”, compliance with hand hygiene
and other infection control measures also
influence the development of VRE
Nosocomial outbreaks of vancomycin
Enterococci (VRE) are thought to occur when a
patient already carrying VRE in his/her bowel
sheds VRE, which are then transmitted by health
care workers or via the environment to other
patients. This model predicts that interventions
based on screening and isolati
colonized patients, improved hand hygiene, and
enhanced hospital cleaning will limit cross
transmission [19]. Millions of dollars are spent
each year by health care systems trying to
contain antibiotic-resistant bacteria and prevent
cross-transmission [20]. The use of antibiotics as
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Rights Reserved.
resistant. These finding mirrors, those of a study
(6.25%) were VRE
to
Vancomycin
resistant in pathogen Enterococci which is high
compared to other reports from India.
Glycopeptide resistance among our isolates is
high, probably reflecting the increased use of
over the past few
fact highlights the importance of
antibiotic policies coupled
infection control
sures to prevent emergence and spread of
antibiotic resistant bacteria. Widespread use of
omycin and extended-spectrum
ephalosporin in hospitals likely contributed to
the emergence and dramatic increase of VRE
The prevalence of VRE has dramatically
The National
illance (NNIS) system
in the USA has revealed a significant increase in
the percentage of invasive nosocomial
Enterococcus strains displaying high-level
. To a larger or lesser
microbiological factors such as
c consumption (particular classes and in
general); “colonization pressure”,
“understaffing”, compliance with hand hygiene
and other infection control measures also
influence the development of VRE [18].
Nosocomial outbreaks of vancomycin-resistant
cci (VRE) are thought to occur when a
patient already carrying VRE in his/her bowel
sheds VRE, which are then transmitted by health
care workers or via the environment to other
patients. This model predicts that interventions
based on screening and isolation of VRE-
colonized patients, improved hand hygiene, and
enhanced hospital cleaning will limit cross-
Millions of dollars are spent
each year by health care systems trying to
resistant bacteria and prevent
The use of antibiotics as
feed additives for growth enhancement in
animals may be associated with the emergence
of VRE. Enterococci can reach human consumers
via food chain [21]. In countries using avoparcin,
a glycopeptide antibiotic, as a gro
Vancomycin-resistant Enterococci (VRE) are
commonly found in the commensal flora of food
animals, on meat from these animals and in the
commensal flora of healthy huma
limited use of Vancomycin in hospitals
The emergence of Linezolid resistant
Enterococci is a dangerous fact
study, Linezolid resistance was 6
(16%) in commensal and pathogen Enterococci
respectively. Though Linezolid has been used in
clinical practice for a relatively short period
time, there are already several reports of
Linezolid-resistant Enterococci, which is
of concern. As Linezolid is the final resort,
sometimes even for VRE it is recommended to
do a susceptibility testing of clinically significant
gram-positive pathogens before starting
Linezolid therapy so as to shorten the course of
Linezolid treatment [24].
In our study, the multi drug resistance in
commensal and pathogen Enterococci is 46%
and 96% respectively. The emergence of multi
drug resistant Enterococci has lead to a scenario
which is almost as bad as the preantibiotic era
since many of these multi-drug resistant (MDR)
strains have developed resistance to practically
all available antibiotics [25].
Community awareness of the issues involved in
antibiotic therapy is poor and this is
compounded by over the counter drug
availability and self medication. Various
contributing factors other than these included
like the combination of poverty and ignorance
making the ground perfect for the development
of resistance.
Patient’s pressure, aggressive
marketing by pharmaceutical companies, lack of
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Page 52
feed additives for growth enhancement in
animals may be associated with the emergence
of VRE. Enterococci can reach human consumers
. In countries using avoparcin,
a glycopeptide antibiotic, as a growth promoter,
nterococci (VRE) are
commonly found in the commensal flora of food
animals, on meat from these animals and in the
commensal flora of healthy humans despite very
ancomycin in hospitals [22].
of Linezolid resistant
Enterococci is a dangerous fact [23]. In our
Linezolid resistance was 6 (12%) and 8
(16%) in commensal and pathogen Enterococci
respectively. Though Linezolid has been used in
clinical practice for a relatively short period of
time, there are already several reports of
resistant Enterococci, which is a matter
of concern. As Linezolid is the final resort,
sometimes even for VRE it is recommended to
do a susceptibility testing of clinically significant
pathogens before starting
Linezolid therapy so as to shorten the course of
the multi drug resistance in
commensal and pathogen Enterococci is 46%
and 96% respectively. The emergence of multi-
cci has lead to a scenario
which is almost as bad as the preantibiotic era
drug resistant (MDR)
d resistance to practically
Community awareness of the issues involved in
otic therapy is poor and this is
compounded by over the counter drug
availability and self medication. Various
contributing factors other than these included
like the combination of poverty and ignorance
making the ground perfect for the development
Patient’s pressure, aggressive
marketing by pharmaceutical companies, lack of
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol.
Copy right © 2014, IAIM, All Rights Reserved.
uniformity among the physicians to follow
antibiotic policy, causing the recurrence of the
disease also have added to the practice
Effective control of multiple
Enterococci will require better understanding of
the interaction between Enterococci, the
hospital environment, and humans, prudent
antibiotic use and better contact isolation in
hospitals and other patient care environments
[27].
Antimicrobial resistance is a natural biological
phenomenon that often results from antibiotic
pressure in humans, animals and the
widespread use of disinfectants in farm and
household chores. When it gets amplified many
times, it results in serious public
and long term shifts in resistance levels
essence, the situation is alarming. This emerging
threat has to be tackled at the initial phase itself,
which could be done through active surveillance
of antimicrobial resistance in the c
Education of the professionals and public,
accessibility of microbial investigation and its
results to the practitioners to rationalize the
choice of antimicrobial therapy is also required
to combat this problem.
Last but not the least, co-ordi
surveillance of the antibiotic resistance in
human and animal health sectors along with
regulating the antibiotic use, restriction of
antibiotic as growth promoters in animals
should be equally considered. Multi
resistant Enterococci have become a serious
threat to public health. Enterococci with raised
MIC to penicillin and high level resistance to
amino glycosides are being reported. Although
the incidence of vancomycin resistance was low,
its presence is a cause of concern. It is impo
to maintain regular surveillance of antibiotic
susceptibilities so that changes in their pattern
can be detected early.
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Rights Reserved.
uniformity among the physicians to follow
antibiotic policy, causing the recurrence of the
also have added to the practice [26].
Effective control of multiple-drug resistant
Enterococci will require better understanding of
the interaction between Enterococci, the
hospital environment, and humans, prudent
antibiotic use and better contact isolation in
hospitals and other patient care environments
Antimicrobial resistance is a natural biological
phenomenon that often results from antibiotic
pressure in humans, animals and the
widespread use of disinfectants in farm and
household chores. When it gets amplified many
times, it results in serious public health concerns
and long term shifts in resistance levels [22]. In
essence, the situation is alarming. This emerging
threat has to be tackled at the initial phase itself,
which could be done through active surveillance
of antimicrobial resistance in the community.
Education of the professionals and public,
accessibility of microbial investigation and its
oners to rationalize the
choice of antimicrobial therapy is also required
ordination of the
surveillance of the antibiotic resistance in
human and animal health sectors along with
regulating the antibiotic use, restriction of
antibiotic as growth promoters in animals
should be equally considered. Multi-drug
e become a serious
threat to public health. Enterococci with raised
MIC to penicillin and high level resistance to
amino glycosides are being reported. Although
the incidence of vancomycin resistance was low,
its presence is a cause of concern. It is important
to maintain regular surveillance of antibiotic
susceptibilities so that changes in their pattern
Conclusion
Boundary line between pathogenic and
commensal Enterococci is blurred due to
exchange of resistant traits. In our study
multidrug resistant traits are seen in both
commensal and pathogenic Enterococci with
various percentages. So it becomes necessary to
Screen-Isolate-Destroy Enterococci at various
levels. At a minimum, a successful program for
control of multidrug resistant Enterococci
requires effective surveillance to identify
colonized and infected patients. Equally
important is renewed vigor in the sea
additional drugs, accompanied by the evolution
of new therapeutic paradigms less vulnerable to
the cycle of drug introduction and drug
resistance.
References
1. Desai PJ, Pandit D, Mathur M, Gogate A.
Prevalence, identification and
distribution of v
enterococci isolated from clinical
specimens with special reference to
urinary tract infection in catheterized
patients. Indian J Med Microbiol., 2001;
19(3): 132-7.
2. Schouten MA, Hoogkamp
Meis JF, Voss A. Prevalence of
vancomycin resistant Enterococci in
Europe. Eur J Clin Microbiol Infect Dis,
2000; 19: 816-22.
3. Byarugaba DK, Kisame R, Olet S.
drug resistance in commensal bacteria
of food of animal origin in Uganda,
African Journal of Microbiology
Research, 2011; 5(12): 1539
4. Andremont A. Commensal flora may
play a key role in spreading antibiotic
resistance. ASM News, 2003; 69: 601
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Page 53
Boundary line between pathogenic and
commensal Enterococci is blurred due to
exchange of resistant traits. In our study
multidrug resistant traits are seen in both
commensal and pathogenic Enterococci with
various percentages. So it becomes necessary to
Destroy Enterococci at various
levels. At a minimum, a successful program for
control of multidrug resistant Enterococci
requires effective surveillance to identify
colonized and infected patients. Equally
important is renewed vigor in the search for
additional drugs, accompanied by the evolution
of new therapeutic paradigms less vulnerable to
the cycle of drug introduction and drug
Desai PJ, Pandit D, Mathur M, Gogate A.
Prevalence, identification and
distribution of various species of
enterococci isolated from clinical
specimens with special reference to
urinary tract infection in catheterized
Indian J Med Microbiol., 2001;
Schouten MA, Hoogkamp-Korstanje JA,
Meis JF, Voss A. Prevalence of
mycin resistant Enterococci in
Europe. Eur J Clin Microbiol Infect Dis,
Byarugaba DK, Kisame R, Olet S. Multi-
drug resistance in commensal bacteria
of food of animal origin in Uganda,
African Journal of Microbiology
Research, 2011; 5(12): 1539-48.
Andremont A. Commensal flora may
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International Archives of Integrated Medicine, Vol.
Copy right © 2014, IAIM, All Rights Reserved.
Graph - 2: Drug resistance in pathogen Enterococci.
Graph - 3: Comparison of resistance pattern of various antibiotics in commensal and pathogenic
Enterococci.
0%
20%
40%
60%
80%
100%
120%
0%
20%
40%
60%
80%
100%
120%
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
Rights Reserved.
Drug resistance in pathogen Enterococci.
Comparison of resistance pattern of various antibiotics in commensal and pathogenic
Series1
COMMENSAL
ENTEROCOCCI
PATHOGENIC
ENTEROCOCCI
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Comparison of resistance pattern of various antibiotics in commensal and pathogenic
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol.
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Table – 1: Multi drug resistance in commensal Enterococci
Table - 2: Multi drug resistance in p
Number of isolates
48(96%)
38 (76%)
24 (48%)
Source of support: Nil
Number of isolates
23 (46%)
8(16%)
Enterococci: A journey of a successful pathogen
International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.
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Multi drug resistance in commensal Enterococci.
: Multi drug resistance in pathogen Enterococci.
Multi drug resistance
Resistance to ≥ 3 categories
Resistance to ≥ 4 categories
Resistance to ≥ 5 categories
Nil Conflict of interest:
Multi drug resistance
Resistance to ≥ 3 categories of antibiotics
Resistance to ≥ 4 categories of antibiotics
ISSN: 2394-0026 (P)
ISSN: 2394-0034 (O)
Page 57
Conflict of interest: None declared.
≥ 3 categories of antibiotics
≥ 4 categories of antibiotics