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Enterococci: A journey of International Archives of Integra Copy right © 2014, IAIM, All Righ Original Research Article Enterococc Archana 1 Department of Microbiology 2 Assistant Professor, Departme 3 Professor and Head, Departme *Correspon How to cite this article: Archana pathogen. IAIM, 2014; 1(4): 49-5 Availab Received on: 26-11-2014 Abstract Introduction: A dynamic home gastrointestinal tract in humans disease or death. Enterococci, tr be organisms capable of causin environment. The existence of acquired resistance to virtually a Objective: The present pilot stu commensal Enterococci and path Material and methods: A tota clinical samples yielding Entero done using Kirby Bauer’s disk d was tested by using E- strip. Results: Among 50 commensal Erythromycin 38 (76%), Clindam (28%), Linezolid 6 (12%), vanc (resistance to ≥ 3 categories of a Ampicillin 50 (100%), Clindamyc resistance was seen in 8 (16% showed multi drug resistance. Conclusion: Boundary line bet exchange of resistant traits. Reg a successful pathogen ated Medicine, Vol. 1, Issue. 4, December, 2014. hts Reserved. ci: A journey of a succe pathogen a Rao K 1 , Deepa S 2* , Venkatesha D y, Mysore Medical College and Research Institute ent of Microbiology, Mysore Medical College and Karnataka, India ent of Microbiology, Mysore Medical College and Karnataka, India nding author email: [email protected] a Rao K, Deepa S, Venkatesha D. Enterococci: A jo 57. ble online at www.iaimjournal.com Accep eostasis is maintained between the host and n s, but migration of bacteria from the gut to oth raditionally viewed as commensal bacteria are n ng life-threatening infections in humans, especia f Enterococci in such a dual role is facilitated all antibiotics currently in use. udy was taken up to compare the multidrug res hogenic Enterococci. al of 50 commensal Enterococci isolated from s ococci were taken for the study. Antibiotic susc diffusion method. Minimum inhibitory concentr l Enterococci, majority showed resistance to A mycin 30 (60%), higher level of resistance to high comycin 3 (6%). 23 (46%) isolates showed m antibiotics). Among 50 clinical isolates, majority cin 46 (92%), Tetracycline 46 (92%), Erythromyc %) and Vancomycin resistance in 5 (10%) clinic tween pathogenic and commensal Enterococc gular screening of enterococcal isolates for resista ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Page 49 essful D 3 e, Karnataka, India d Research Institute, d Research Institute, ourney of a successful pted on: 02-12-2014 native bacteria of the her organs can lead to now acknowledged to ally in the nosocomial d by its intrinsic and sistance prevalence in stool samples and 50 ceptibility testing was ration of Vancomycin Ampicillin 50 (100%), h level Gentamycin 14 multi drug resistance showed resistance to cin 41 (82%), Linezolid cal isolates. 48 (96%) ci is blurred due to ance detection should

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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)

ISSN: 2394-0034 (O)

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.

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80%

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120%

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Series1

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Aukland C, Teare L, Cook F, Kaufmann

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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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Page 56

Comparison of resistance pattern of various antibiotics in commensal and pathogenic

Enterococci: A journey of a successful pathogen

International Archives of Integrated Medicine, Vol.

Copy right © 2014, IAIM, All Rights Reserved.

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.

Rights Reserved.

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