Prevalence , Phenotypic and Genotypic Characterization of Vancomycin Resistant Enterococci ( VRE ) Isolated from Children with Infective Endocarditis in Mansoura University Children's Hospital ( MUCH ) , Mansoura , Egypt

N. A. Elwakeel; A. A. Elwakeel; Ibrahim Elmorsy; Heba Eldegla

doi:10.12816/0004903

Article Details

Prevalence , Phenotypic and Genotypic Characterization of Vancomycin Resistant Enterococci ( VRE ) Isolated from Children with Infective Endocarditis in Mansoura University Children's Hospital ( MUCH ) , Mansoura , Egypt

Authors:

N. A. Elwakeel | A. A. Elwakeel | Ibrahim Elmorsy | Heba Eldegla

Publisher:

The Egyptian Society of Medical Microbiology

Main Topics:

Medicine

Journal:

The Egyptian Journal of Medical Microbiology 2012 Vol.21 Issue 4, pp.21-30

Document Type:

Article

Publication Date:

10/2012

Document Language:

English

Document ID (Org No.):

49059

Frequency:

Quarterly

pISSN:

11102179

DOI:

10.12816/0004903

Descriptors:

Abstract:

 Introduction: Despite improvements in medical and surgical therapies, infective endocarditis among children, is still associated with poor prognosis and remains as a strong therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the causative microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. Vancomycin-resistant enterococci (VRE) pose an emerging and truly, a serious problem in hospitals worldwide. Aim of the work: This study was undertaken to determine the occurrence, species prevalence, antibacterial resistance, phenotypic and genetic characteristics of VRE isolated from children with infective endocarditis in Mansoura, Egypt. Material and Methods: Fifty isolates of enterococcal species were obtained from 358 blood samples collected from 350 patients of suspected infective endocarditis among children admitted to Mansoura University Children’s Hospital (MUCH) cardiology unit and pediatric intensive care unit (PICU) over 6 years of study. The antibiotic susceptibility of isolates and minimum inhibitory concentration (MIC) tests for vancomycin and teicoplanin were determined. Molecular typing of VRE isolates was carried out by using pulsed field gel electrophoresis (PFGE) and the resistance genotype was determined by polymerase chain reaction (PCR). Results: Over the six years of our retrospective study; Total enterococcal infection rate represented (13.97%) of which, VRE accounted for 8% of total enterococcal isolates from PICU, and cardiology unit of MUCH. All strains were identified to species level and were found to consist of E. faecalis 30(60%), E. faecium 10 (20%), E. avium 3 (6%), E. hirae 3(6%), E. casseliflavus 2(4%) and E. gallinarum 2(4%) species. According to the susceptibility data obtained, 4 (8%) out of 50 isolates were found to be VRE (MICs > 32 μg/ml). The vanA, vanB gene fragments of E. faecalis, E. faecium were amplified from isolates and were detected. PFGE patterns of the VRE isolates revealed homogenous patterns with dominant clone (A), suggesting the possibility of horizontal transmission among patients. According to local MUCH protocols, monitored doses of various antibiotic combinations as ampicillin/sulbactam and a third generation cephalosporin can be used in serious VRE infections, empirically. In our current study, the use of combinations of teicoplanin (Teichomycin) and amoxicillin had shown great success in treating the isolated VRE strains (2 out of 4 “50%” were sensitive with MICs ≤ 4 μg/ml) or a combination of ampicillin, imipenem, and vancomycin (3 out of 4 “75%” [p<0.05] were sensitive with MICs ≤ 4 μg/ml) . Discussion and conclusion: This study shows an emergence of VRE along with increased rate of multidrug-resistant enterococci in infective endocarditis patients at MUCH. The empirical use or, rather misuse, of antibiotics to treat or to combat the consequences of infective endocarditis in children poses a serious threat rather than benefit the patient and community by increasing the chances of developing new resistant and possibly transmissible genes among enterococci and related species. Although, VRE antibiotic susceptibilities being done for each infection should help guide the selection of treatment protocols, yet surveillance of antimicrobial susceptibilities should be done regularly and the risk factors should be determined and more importantly set up a tight plan of VRE infection prevention and early control, to be followed thoroughly, audited and updated regularly, at the Cardiology Unit and PICU of MUCH.

Article Details

Prevalence , Phenotypic and Genotypic Characterization of Vancomycin Resistant Enterococci ( VRE ) Isolated from Children with Infective Endocarditis in Mansoura University Children's Hospital ( MUCH ) , Mansoura , Egypt

Authors:

N. A. Elwakeel | A. A. Elwakeel | Ibrahim Elmorsy | Heba Eldegla

Publisher:

The Egyptian Society of Medical Microbiology

Main Topics:

Medicine

Journal:

The Egyptian Journal of Medical Microbiology 2012 Vol.21 Issue 4, pp.21-30

Document Type:

Article

Publication Date:

10/2012

Document Language:

English

Document ID (Org No.):

49059

Frequency:

Quarterly

pISSN:

11102179

DOI:

10.12816/0004903

Descriptors:

ENDOCARDITIS

ENTEROCOCCUS

CARDIOVASCULAR DISEASES

CHILDREN DISEASES

VACCINES

DISEASE RESISTANCE

EGYPT

Issues

Article Details

Authors: N. A. Elwakeel | A. A. Elwakeel | Ibrahim Elmorsy | Heba Eldegla

Publisher: The Egyptian Society of Medical Microbiology

Main Topics: Medicine

Journal: The Egyptian Journal of Medical Microbiology 2012 Vol.21 Issue 4, pp.21-30

Document Type: Article

Publication Date: 10/2012

Document Language: English

Document ID (Org No.): 49059

Frequency: Quarterly

pISSN: 11102179

DOI: 10.12816/0004903

Descriptors:

Issues

Authors:

N. A. Elwakeel | A. A. Elwakeel | Ibrahim Elmorsy | Heba Eldegla

Publisher:

The Egyptian Society of Medical Microbiology

Main Topics:

Medicine

Journal:

The Egyptian Journal of Medical Microbiology 2012 Vol.21 Issue 4, pp.21-30

Document Type:

Article

Publication Date:

10/2012

Document Language:

English

Document ID (Org No.):

49059

Frequency:

Quarterly

pISSN:

11102179

DOI:

10.12816/0004903