Epidemiological profile of enterococcus SPP infection in a regional hospital

Perfil epidemiológico de la infección por Enterococcus SPP en un hospital regional

Introduction: enterococci can cause multiple infections and due to their increasing resistance to antibiotics they have become of national and global concern. Objective: to characterize infections caused by Enterococcus spp. Methodology: descriptive, retrospective observational cross-sectional study conducted from January 2015 to January 2018 in a regional hospital. Results: the prevalence of Enterococcus spp. infections was 0.154%. E. faecalis was the most commonly isolated, followed by E. faecium. Antibiotic resistance was 19% and 10% for ampicillin and vancomycin respectively, 32% of patients received empirical therapy with vancomycin and 22% with piperacillin tazobactam. The median duration of antibiotic therapy was 10 days. Discussion: interest in Enterococcus spp. has increased for they are recognized as an important burden in healthcare-associated infections (HAIs). Enterococcal infection occurs mainly among men, median age 40 to 60 years, hospitalized in the ICU, with urinary tract infections and comorbidities such as immunosuppression and previous surgeries. Conclusion: as an increased rate of vancomycin and ampicillin resistance in enterococci has been reported, a responsible use of antibiotic therapy is recommended in order to effectively eradicate the pathogen and prevent the emergence of new bacterial resistances.

1. Zheng J xin, Li H, Pu Z ya, Wang H yan, Deng X bin, Liu X jun, et al. Bloodstream infections caused by Enterococcus spp: A 10-year retrospective analysis at a tertiary hospital in China. J Huazhong Univ Sci Technol - Med Sci. 2017;37(2):257–63. doi: 10.1007/s11596-017-1725-9
2. Strateva T, Atanasova D, Savov E, Petrova G, Mitov I. Incidence of virulence determinants in clinical Enterococcus faecalis and Enterococcus faecium isolates collected in Bulgaria. Brazilian J Infect Dis. 2016;20(2):127–33. doi: 10.1016/j.bjid.2015.11.011
3. Álvarez-Artero E, Campo-Nuñez A, García-García I, García-Bravo M, Cores O, Galindo I, et al. Urinary tract infection caused by enterococcus spp: risk factors and mortality. Rev Clin Esp (Barc). 2021;221(7):375-383. doi: 10.1016/j.rceng.2020.09.004
4. García JLA, Flores AME, Barbosa PA, Cortina JHM. Susceptibilidad antimicrobiana de Enterococcus faecalis y faecium en un hospital de tercer nivel. Rev Latin Infect Pediatr. 2018;31(2):56-61.
5. Rivera Contreras G, Abaca Castillo EP (Prof. G. Mecanismos de resistencia antibiótica y métodos de detección en Enterococcus. Univ Talca (Chile) Esc Tecnol Médica. 2018.
6. Oliveira Lima FL, Carneiro Almeida P, Lopes de Oliveira Oliveira GA. Enterococcus spp. resistentes à vancomicina e a sua disseminação em infecções no ambiente hospitalar. Res Soc Dev. 2020;9(8):e738986404. doi: https://doi.org/10.33448/rsd-v9i8.6404
7. Piezzi V, Gasser M, Atkinson A, Kronenberg A, Vuichard-Gysin D, Harbarth S, et al. Increasing proportion of vancomycin resistance among enterococcal bacteraemias in Switzerland: a 6-year nation-wide surveillance, 2013 to 2018. Euro Surveill. 2020;25(35):1900575. doi: 10.2807/1560-7917.ES.2020.25.35.1900575
8. Gaca AO, Lemos JA. Adaptation to Adversity: the Intermingling of Stress Tolerance and Pathogenesis in Enterococci. Microbiol Mol Biol Rev. 2019;83(3). doi: https://doi.org/10.1128/MMBR.00008-19
9. Zhang Y, Du M, Chang Y, Chen L an, Zhang Q. Incidence, clinical characteristics, and outcomes of nosocomial Enterococcus spp. bloodstream infections in a tertiary-care hospital in Beijing, China: A four-year retrospective study. Antimicrob Resist Infect Control. 2017;6(1):1–11. doi: 10.1186/s13756-017-0231-y
10. Falcone M, Tiseo G, Foglia E, Campanini M, Falcone M, Tiseo G, et al. Early alert from microbiology laboratory improves the outcome of elderly patients with Enterococcus spp bacteremia: results from a multicenter prospective study. 2019:139-144. doi: 10.1016/j.jgar.2019.02.014
11. Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston K V., Sader HS, et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother. 2019;63(7):e00355-19. doi: 10.1128/AAC.00355-19
12. Gaschignard J, Bidet P, Faye A. Infecciones por estreptococos y enterococos. EMC - Pediatría. 2020;55(2):1–25. doi: https://doi.org/10.1016/S1245-1789(20)43833-8
13. Seyedeh Marzieh JS, Pormohammad A, Hashemi A, Lak P. Global prevalence of antibiotic resistance in blood-isolated Enterococcus faecalis and Enterococcus faecium: a systematic review and meta-analysis. Infect Drug Resist. 2019;12: 2713–2725. doi: 10.2147/IDR.S206084
14. Shrestha LB, Baral R, Poudel P, Khanal B. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC Pediatr. 2019;19(1):36. doi: 10.1186/s12887-019-1410-1
15. Sigilfredo Ospina JR, Gómez C, Mejia G, Serna L, Carmen Leonor Oviedo LAP. Infección nosocomial por enterococo resistente a la vancomicina: características clinico epidemiologícas y factores de riesgo. | Ospina | Infectio. Infectio. 2001;5(1):14-20.
16. Pulido Gil EA, Bonilla González DA, Rojas Garzón A. Infección nosocomial por enterococcus: Hospital de San José, 2005-2007. Rev Repert Med Cir. 2009;18(3):135-143. Doi: https://doi.org/10.31260/RepertMedCir.v18.n3.2009.545
17. Corredor NC, López C, Aguilera PA. et al. An epidemiological and molecular study regarding the spread of vancomycin-resistant Enterococcus faecium in a teaching hospital in Bogotá, Colombia 2016. BMC Infect Dis. 2019;19(1):258. https://doi.org/10.1186/s12879-019-3877-7
18. Cemnalianskis L, Vitkauskienė A, Vitkauskas L, Kareivienė V. Risk factors for vancomycin resistant Enterococcus spp. infection development. 2019 [cited 2020 Dec 11]; Disponible en: https://www.lsmuni.lt/cris/handle/20.500.12512/20989
19. Shah KJ, Cherabuddi K, Shultz J, Borgert S, Ramphal R, Klinker KP. Ampicillin for the treatment of complicated urinary tract infections caused by vancomycin–resistant Enterococcus spp (VRE): a single-center university hospital experience. Int J Antimicrob Agents. 2018;51(1):57–61. doi: 10.1016/j.ijantimicag.2017.06.008
20. Hospital Universitario Hernando Moncaleano Perdomo De Neiva. 2019 [cited 2020 Dec 11]; Disponible en: http://hospitalneiva.gov.co/
21. Mateus JC, Varela MT, Caicedo DM, Arias NL, Jaramillo CD, et al. ¿Responde la Resolución 8430 de 1993 a las necesidades actuales de la ética de la investigación en salud con seres humanos en Colombia?. Biomédica. 2019;39(3):448-63. doi: https://doi.org/10.7705/biomedica.4333
22. Barrios Osuna I, Anido Escobar V, Morera Pérez M. Declaración de Helsinki: cambios y exégesis. Rev Cuba salud publica. 2016;42(1):132-142.
23. Rivas Clerici GY. Portadores de gérmenes multirresistentes en un hospital para adultos mayores [Internet]. Fac Estud Postgrado Univ del Norte Paraguay; 2018 [cited 2020 Dec 11]; Disponible en: http://investigacion.uninorte.edu.py/wp-content/uploads/2020/10/MED-0802-08.pdf
24. Johnstone J, Chen C, Rosella L Et al. Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada. Am Journal of infect Control 2018;46(11):1266-1271. doi: 10.1016/j.ajic.2018.05.003
25. Beganovic M, Luther MK, Rice LB, Arias CA, Rybak MJ, LaPlante KL. A Review of Combination Antimicrobial Therapy for Enterococcus faecalis Bloodstream Infections and Infective Endocarditis. Clin Infect Dis. 2018;67(2):303-309. doi: https://doi.org/10.1093/cid/ciy064.
26. Flores Paredes WH. Características clínico-epidemiológicas de 14 casos con aislamiento clínico de enterococo resistente a Vancomicina en el Hospital Nacional Edgardo Rebagliati Martins. Rev Med Hered. 2007;18(2):68-75.
27. Ayobami O, Willrich N, Reuss A, Eckmanns T, Markwart R. The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections. Emerg Microbes Infect. 2020;9(1):1180-1193. doi: 10.1080/22221751.2020.1769500
28. Lopez-Luis BA, Sifuentes-Osorio J, Lambraño-Castillo D Et al. Risk factors and outcomes associated with vancomycin-resistant Enterococcus faecium and ampicillin-resistant Enterococcus faecalis bacteraemia: A 10-year study in a tertiary-care centre in Mexico City. J Glob Antimicrob Resist. 2021;24:198-204. doi: 10.1016/j.jgar.2020.12.005
29. Rita maria meras jauregui, JOSE ANTONIO RR, Teresa Maria MJ. Título: Aislamientos de Enterococcus en el Hospital Universitario “Arnaldo Milián Castro”. Estudio de cinco años. 8th Cuba Congr Microbiol Parasitol 5th Natl Congr Trop Med 5th Int Symp HIV/aids Infect Cuba. 2014.
30. Isabel de la Concepción Gorrín Alemán D, Rodríguez Pérez R, Rodríguez Rodríguez JA, Dianelys Quiñones Pérez DC. Aislamientos de Enterococcus en muestras clínica. Acta Med Cent. 2012;6(3):1-7
31. Panesso D, Ospina S, Robledo J, Vela MC, Peña J, Hernández O, et al. First Characterization of a Cluster of VanA-Type Glycopeptide-Resistant Enterococcus faecium, Colombia. Emerg Infect Dis. 2002;8(9):961-965. doi: 10.3201/eid0809.010435
32. Reyes K, Bardossy AC, Zervos M. Vancomicyn-Resitant Enterococci. Infectious Desease Clinics. 2016;30(4):953-965. doi: https://doi.org/10.1016/j.idc.2016.07.009
33. Silva AJ, Asserella RL, Bolados GN, Herrera HN, Leyton OJ. Resistencia a antimicrobianos en cepas de Enterococcus sp aisladas en hospitales del Norte de Chile. Rev Chil Infectol. 2006;23(3):226–31. doi: http://dx.doi.org/10.4067/S0716-10182006000300005
34. Martínez-Odriozola P, Muñoz-Sánchez J, Gutiérrez-Macías A, Arriola-Martínez P, Montero-Aparicio E, Ezpeleta-Baquedano C, et al. Análisis de 182 episodios de bacteriemia por enterococo: Estudio de la epidemiología, microbiología y evolución clínica. Enferm Infecc Microbiol Clin. 2007;25(8):503–507. doi: 10.1157/13109986
35. Bazet C, Blanco J, Seija V. Enterococos resistentes a vancomicina: Un problema emergente en Uruguay. Rev Méd Urug. 2005;21(2):151-158.
36. Molano-Franco D, Villabón M, et al. Determinacion de los factores de riesgo en sepsis por Enterococcus vancomicino resistente. Estudio de casos y controles en pacientes criticamente enfermos. Infecti. 2020;24(4):248-254. Doi: https://doi.org/10.22354/in.v24i4.884
37. Alvarez C, Cortes J, Arango Á, Correa C, Leal A. Resistencia Antimicrobiana en Unidades de Cuidado Intensivo de Bogotá, Colombia, 2001-2003. Rev Salud Pública. 2006;8(suppl 1):86–101.
38. García-Solache M, Rice LB. The enterococcus: A model of adaptability to its environment [Internet]. Clin Microbiol Rev. 2019;32(2):e00058-18. doi: 10.1128/CMR.00058-18
39. Vitkauskienė A, Cemnalianskis L. Risk factors for development of vancomycin resistant Enterococcus spp. infection. 2017 [cited 2020 Dec 11]; Disponible en: https://www.lsmuni.lt/cris/handle/20.500.12512/19386
40. Duarte L, Arbo A, Gallardo M, Riquelme I, Delgadillo L, Jiménez HJ. Factores asociados a colonización por enterococo sp resistente a vancomicina en una unidad de cuidados intensivos pediátricos del Paraguay: estudio transversal sobre historias clínicas. Medwave. 2019;19(8):e7694. doi: 10.5867/medwave.2019.08.7694
41. Luján Piedrahíta M. Estafilococos y enterococos: ¿amenazas a la salud pública? Epidemiología y Mecanismos de resistencia a los antibióticos. Med UPB. 2001;20(1):49-50.
42. Kilbas I, Ciftci IH. Antimicrobial resistance of Enterococcus isolates in Turkey: A meta-analysis of current studies. J Glob Antimicrob Resist. 2018;12:26–30. doi: 10.1016/j.jgar.2017.08.012
43. Casal Román M, Causse M. Casal MM, Solís F, Rodriguez F. Investigación de las resistencias a antimicrobianos en Enterococcus faecalis. Rev Española Quimioter. 2009;22(3):117–9.
44. Torres E, Pérez S, Vindel A, Rodríguez-Baño J, Camba V, Villanueva R, et al. Enterococcus faecium resistente a glucopéptidos en un hospital del norte de España. Caracterización molecular y epidemiología clínica. Enferm Infecc Microbiol Clin. 2009;27(9):511–7. doi: 10.1016/j.eimc.2008.09.014
45. Lozano C, Torres C. Actualización en la resistencia antibiótica en Gram positivos. Enferm Infecc Microbiol Clin. 2017;35(S1):2–8. doi: 10.1016/S0213-005X(17)30028-9
46. Moreno-Rovira LY, Tamayo-Quintero MT, Amariles-Tamayo N, Garrido-Zea EF. Infecciones por Enterobacter y Enterococcus resistentes asociadas a la atención en salud en Hispanoamérica 2002-2017. Med y Lab. 2020;24(3):221–32. Doi: https://doi.org/10.36384/01232576.299
47. Gagetti P, Bonofiglio L, García Gabarrot G, Kaufman S, Mollerach M, et al. Resistance to β-lactams in enterococci. Rev Argent Microbiol. 2019;51(2):179-183. doi: 10.1016/j.ram.2018.01.007
48. Faron ML, Ledeboer NA, Buchan BW. Resistance mechanisms, epidemiology, and approaches to screening for vancomycin-resistant Enterococcus in the health care setting. J Clin Microbiol. 2016;54(10):2436-47. doi: 10.1128/JCM.00211-16
49. Raza T, Ullah SR, Mehmood K, Andleeb S. Vancomycin resistant enterococci: A brief review. J Pak Med Assoc. 2018 May;68(5):768-772
50. Tyson GH, Sabo JL, Rice-Trujillo C, Hernandez J, McDermott PF. Whole-genome sequencing based characterization of antimicrobial resistance in Enterococcus. Pathog Dis. 2018;76(2). doi: https://doi.org/10.1093/femspd/fty018
51. Van Hal SJ, Beukers AG et al. Relentless spread and adaptation of non-typeable vanA vancomycin-resistant Enterococcus faecium: a genome-wide investigation. J Antimicrob Chemother. 2018;73(6):1487-1491. doi: https://doi.org/10.1093/jac/dky074
52. Lee T, Pang S, Stegger M, Sahibzada S, Abraham S, et al. A three-year whole genome sequencing perspective of Enterococcus faecium sepsis in Australia. PLOS ONE 2020;15(2): e0228781. doi: https://doi.org/10.1371/journal.pone.0228781
53. Abdelbary, MHH, Senn L, Greub G, Chaillou G, et al. Whole-genome sequencing revealed independent emergence of vancomycin-resistant Enterococcus faecium causing sequential outbreaks over 3 years in a tertiary care hospital. Eur J Clin Microbiol Infect Dis. 2019;38(6):1163–1170. doi: https://doi.org/10.1007/s10096-019-03524-z
54. Leong C KW, Cooley LA, Anderson TL, Gautam SS, et al. Emergence of Vancomycin-Resistant Enterococcus faecium at an Australian Hospital: A Whole Genome Sequencing Analysis. Sci Rep. 2018;8(1):6274. doi: https://doi.org/10.1038/s41598-018-24614-6
55. Farman M, Yasir M, Al-Hindi RR, et al. Genomic analysis of multidrug-resistant clinical Enterococcus faecalis isolates for antimicrobial resistance genes and virulence factors from the western region of Saudi Arabia. Antimicrob Resist Infect Control. 2019;8:55. doi:. https://doi.org/10.1186/s13756-019-0508-4
56. Rao C, Dhawan B, Vishnubhatla S, Kapil A, Das B, Sood S. Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium bacteremia from an Indian tertiary hospital. Eur J Clin Microbiol Infect Dis. 2021;40(2):303-314. doi:. https://doi.org/10.1007/s10096-020-04030-3
57. Salinas Cortes D. Estudio de la resistencia antimicrobiana en el servicio de Medicina Interna del Hospital Universitario Hernando Moncaleano Perdomo en Hemocultivos y Urocultivos durante los años 2003 a 2006 [Tesis]. Neiva: Universidad Surcolombiana; 2006.
58. Perez GC. Caracterización epidemiológica, factores de riesgo, agentes etiológicos y patrones de resistencia de los pacientes con infección urinaria nosocomial que se presentaron en el hospital universitario de neiva hernando moncaleano perdomo desde 1 septiembre 2007 hasta 30 de abril 2008 [Tesis]. Neiva: Universidad Surcolombiana; 2008.
59. Medina ID; Díaz J; Caviedes Pérez G. Vista de Perfil microbiológico de las infecciones Nosocomiales en el Hospital Universitario Hernando Moncaleano Perdomo de Neiva. RFS - Rev Fac SALUD. 2013;5(2):41-51. doi: https://doi.org/10.25054/rfs.v5i2.141