Emergence of Drug Resistant Enterococcus Species from Patients with Urinary Tract Infections in a Tertiary Care CentreA Retrospective Analysis

Abstract

Introduction: Urinary Tract Infection (UTI) is one of the most common infections, among patients who are hospitalised. Enterococci are one of the frequent isolates among UTI patients, gaining considerable clinical importance, due to their escalating drug resistance, affecting debilitated patients or patients with prolonged hospital stay. Among Multi-Drug Resistant (MDR) enterococci, glycopeptide-resistant enterococci are being increasingly reported. The intrinsic resistance of enterococci and their ability to acquire and disseminate antibiotic resistant genes to other organisms pose a challenge in the treatment of enterococcal infections with MDR. Aim: To investigate the prevalence of MDR, Extensively-Drug Resistant (XDR) and Pan-Drug Resistant (PDR) Enterococci spp. isolated from urine samples in a tertiary care centre. Materials and Methods: The present retrospective study was conducted to find the burden of drug resistant Enterococcus spp. in urine samples, analyse their antibiogram and patients’ socio-demographic information from January 2019 to December 2019. Records of microscopic observations to antibiogram of each isolate was noted down from the register for urine samples, and further analysed. The data was coded, verified, entered and analysed using Statistical Package for Social Sciences (SPSS) version 18.0. Results: The majority of patients (127, 20%) belonged to the age group of 21-30 years of age. Among 10,535 urine samples received, 635 culture isolates were identified as Enterococcus spp., of which 17.95%, 3.30% and 0.62% were identified as MDR, XDR and PDR enterococci, respectively. The antimicrobial susceptibility was found to be least for High Level Gentamicin (HLG) (66.14%), and Penicillin (68.81%), followed by Ampicillin (81.10%) and Nitrofurantoin (86.40%). Twenty eight isolates (7.9%) were identified as Vancomycin Resistant Enterococci (VRE), 9 (2.5%) as linezolid resistant and 12 (3.4%) as linezolid intermediate enterococci. Conclusion: Identification and prevention of the alarming increase in MDR, XDR and PDR Enterococci spp. is cardinal to prevent morbidity and mortality of affected patients. Analysis of antibiogram periodically, is important in selection of appropriate drugs to prevent the incoherent use of antibiotics.

Keywords

• antibiogram
• extensively-drug resistant
• multi-drug resistance
• pan-drug resistance
• vancomycin resistant enterococci