High-Level Aminoglycoside Resistance in Enterococcus Faecalis and Enterococcus Faecium; as a Serious Threat in Hospitals

Author(s): Mahmoud Khodabandeh, Mohsen Mohammadi, Mohammad Reza Abdolsalehi, Meysam Hasannejad-Bibalan, Mehrdad Gholami, Azadeh Alvandimanesh, Abazar Pournajaf, Ramazan Rajabnia*

Journal Name: Infectious Disorders - Drug Targets
Formerly Current Drug Targets - Infectious Disorders

Volume 20 , Issue 2 , 2020


Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Abstract:

Aims and Objectives: The present work aimed to evaluate the frequency of aminoglycoside- modifying enzymes encoding genes in the E. faecalis and E. faecium and their antibiotic resistance profile.

Methods: A total of 305 different clinical samples were subjected for identification and antibiotic susceptibility test. The high-level aminoglycoside resistance was identified by MIC and Kirby Bauer disc diffusion method. The prevalence of aac (6')-Ie-aph (2'')-Ia, aph (3')-IIIa and ant (4')- Ia genes was determined by multiplex- PCR. In total, 100 enterococci strains were isolated. The prevalence of E. faecalis and E. faecium isolates was 78% and 22%, respectively.

Results: All isolates were susceptible to linezolid. So, all E. faecalis were susceptible to vancomycin but, 36.4% of E. faecium were resistant to it. The prevalence of multiple drug resistance strains was 100% and 67.9% of E. faecium and E. faecalis, respectively. High-level-gentamicin and streptomycin resistant rates were as follows; 26.9% and 73.1% of E. faecalis and 77.3% and 90.1% of E. faecium.

Conclucion: The results of the current study showed a high frequency of aac (6')-Ie-aph (2'')-Ia genes among enterococcal isolates. A high rate of resistance to antimicrobials in Enterococcus is obviously problematic, and a novel policy is needed to decrease resistance in these microorganisms.

Keywords: Enterococcus, aminoglycoside-modifying enzymes, resistance, E. faecium, Enterococcus Faecalis, microgranism.

[1]
Bibalan, M.H.; Eshaghi, M.; Sadeghi, J.; Asadian, M.; Narimani, T.; Talebi, M. Clonal Diversity in Multi Drug Resistant (MDR) Enterococci Isolated from Fecal Normal Flora. Int. J. Mol. Cell. Med., 2015, 4(4), 240-244.
[PMID: 27014649]
[2]
Komiyama, E.Y.; Lepesqueur, L.S.S.; Yassuda, C.G.; Samaranayake, L.P.; Parahitiyawa, N.B.; Balducci, I.; Koga-Ito, C.Y. Enterococcus species in the oral cavity: prevalence, virulence factors and antimicrobial susceptibility. PLoS One, 2016, 11(9)e0163001
[http://dx.doi.org/10.1371/journal.pone.0163001] [PMID: 27631785]
[3]
Fisher, K.; Phillips, C. The ecology, epidemiology and virulence of Enterococcus. Microbiology, 2009, 155(Pt 6), 1749-1757.
[http://dx.doi.org/10.1099/mic.0.026385-0] [PMID: 19383684]
[4]
Cetinkaya, Y.; Falk, P.; Mayhall, C.G. Vancomycin-resistant enterococci. Clin. Microbiol. Rev., 2000, 13(4), 686-707.
[http://dx.doi.org/10.1128/CMR.13.4.686] [PMID: 11023964]
[5]
Jia, W.; Li, G.; Wang, W. Prevalence and antimicrobial resistance of Enterococcus species: a hospital-based study in China. Int. J. Environ. Res. Public Health, 2014, 11(3), 3424-3442.
[http://dx.doi.org/10.3390/ijerph110303424] [PMID: 24662964]
[6]
Beganovic, M.; Luther, M.K.; Rice, L.B.; Arias, C.A.; Rybak, M.J.; LaPlante, K.L. A Review of Combination Antimicrobial Therapy for Enterococcus faecalis Bloodstream Infections and Infective Endocarditis. Clin. Infect. Dis., 2018, 67(2), 303-309.
[http://dx.doi.org/10.1093/cid/ciy064] [PMID: 29390132]
[7]
Chow, J.W. Aminoglycoside resistance in enterococci. Clin. Infect. Dis., 2000, 31(2), 586-589.
[http://dx.doi.org/10.1086/313949] [PMID: 10987725]
[8]
van Harten, R.M.; Willems, R.J.L.; Martin, N.I.; Hendrickx, A.P.A. Multidrug-resistant enterococcal infections: new compounds, novel antimicrobial therapies? Trends Microbiol., 2017, 25(6), 467-479.
[http://dx.doi.org/10.1016/j.tim.2017.01.004] [PMID: 28209400]
[9]
Hollenbeck, B.L.; Rice, L.B. Intrinsic and acquired resistance mechanisms in enterococcus. Virulence, 2012, 3(5), 421-433.
[http://dx.doi.org/10.4161/viru.21282] [PMID: 23076243]
[10]
Shete, V.; Grover, N.; Kumar, M. nalysis of Aminoglycoside Modifying Enzyme Genes Responsible for High-Level Aminoglycoside Resistance among Enterococcal Isolates. J. Pathog, 2017, 2017
[11]
Qu, T.T.; Zhang, Y.; Yu, Y.S.; Chen, Y.G.; Wei, Z.Q.; Li, L.J. [Genotypes of aminoglycoside-modifying enzyme and clinical study of high-level gentamycin resistant enterococcus]. Zhejiang Da Xue Xue Bao Yi Xue Ban, 2006, 35(1), 76-82.
[PMID: 16470925]
[12]
Li, W.; Li, J.; Wei, Q.; Hu, Q.; Lin, X.; Chen, M.; Ye, R.; Lv, H. Characterization of aminoglycoside resistance and virulence genes among Enterococcus spp. isolated from a hospital in China. Int. J. Environ. Res. Public Health, 2015, 12(3), 3014-3025.
[http://dx.doi.org/10.3390/ijerph120303014] [PMID: 25768240]
[13]
Feizabadi, M.M.; Maleknejad, P.; Asgharzadeh, A.; Asadi, S.; Shokrzadeh, L.; Sayadi, S. Prevalence of aminoglycoside-modifying enzymes genes among isolates of Enterococcus faecalis and Enterococcus faecium in Iran. Microb. Drug Resist., 2006, 12(4), 265-268.
[http://dx.doi.org/10.1089/mdr.2006.12.265] [PMID: 17227212]
[14]
Khani, M.; Fatollahzade, M.; Pajavand, H.; Bakhtiari, S.; Abiri, R. Increasing Prevalence of Aminoglycoside-Resistant Enterococcus faecalis Isolates Due to the aac(6′)-aph(2") Gene: A Therapeutic Problem in Kermanshah, Iran. Jundishapur J. Microbiol., 2016, 9(3)e28923
[http://dx.doi.org/10.5812/jjm.28923] [PMID: 27217920]
[15]
Performance Standards for Antimicrobial Susceptibility Testing. In: CLSI supplement M100; Clinical and Laboratory Standards Institute: Wayne, PA, 2018.
[16]
Padmasini, E.; Padmaraj, R.; Ramesh, S.S. High level aminoglycoside resistance and distribution of ami-noglycoside resistant genes among clinical isolates of Entero-coccus specie in Chennai, India. Sci. World. J.,, 2014, 2014
[17]
Osuka, H.; Nakajima, J.; Oishi, T.; Funayama, Y.; Ebihara, T.; Ishikawa, H.; Saito, K.; Koganemaru, H.; Hitomi, S. High-level aminoglycoside resistance in Enterococcus faecalis and Enterococcus faecium causing invasive infection: Twelve-year surveillance in the Minami Ibaraki Area. J. Infect. Chemother., 2016, 22(1), 61-63.
[http://dx.doi.org/10.1016/j.jiac.2015.09.003] [PMID: 26492859]
[18]
Jahansepas, A.; Aghazadeh, M.; Rezaee, M.A.; Hasani, A.; Sharifi, Y.; Aghazadeh, T.; Mardaneh, J. Occurrence of Enterococcus faecalis and Enterococcus faecium in various clinical infections: detection of their drug resistance and virulence determinants. Microb. Drug Resist., 2018, 24(1), 76-82.
[http://dx.doi.org/10.1089/mdr.2017.0049] [PMID: 28525287]
[19]
Saifi, M.; Dallal, M.S.; Pourshafie, M. High-level resistance of Enterococcus faecium and E. faecalis isolates from municipal sewage treatment plants to gentamicin. Iran. J. Public Health, 2008, 37, 103-107.
[20]
Arshadi, M.; Mahmoudi, M.; Motahar, M.S.; Soltani, S.; Pourmand, M.R. Virulence Determinants and Antimicrobial Resistance Patterns of Vancomycin-resistant Enterococcus faecium Isolated from Different Sources in Southwest Iran. Iran. J. Public Health, 2018, 47(2), 264-272.
[PMID: 29445637]
[21]
Shokoohizadeh, L.; Ekrami, A.; Labibzadeh, M.; Ali, L.; Alavi, S.M. Antimicrobial resistance patterns and virulence factors of enterococci isolates in hospitalized burn patients. BMC Res. Notes, 2018, 11(1), 1.
[http://dx.doi.org/10.1186/s13104-017-3088-5] [PMID: 29291749]
[22]
Behnood, A.; Farajnia, S.; Moaddab, S.R.; Ahdi-Khosroshahi, S.; Katayounzadeh, A. Prevalence of aac(6′)-Ie-aph(2″)-Ia resistance gene and its linkage to Tn5281 in Enterococcus faecalis and Enterococcus faecium isolates from Tabriz hospitals. Iran. J. Microbiol., 2013, 5(3), 203-208.
[PMID: 24475324]
[23]
Chotinantakul, K.; Chansiw, N.; Okada, S. Antimicrobial resistance of Enterococcus spp. isolated from Thai fermented pork in Chiang Rai Province, Thailand. J. Glob. Antimicrob. Resist., 2018, 12, 143-148.
[http://dx.doi.org/10.1016/j.jgar.2017.09.021] [PMID: 29030312]
[24]
Mohammadi, F.; Ghafourian, S.; Mohebi, R.; Taherikalani, M.; Pakzad, I.; Valadbeigi, H.; Hatami, V.; Sadeghifard, N. Enterococcus faecalis as multidrug resistance strains in clinical isolates in Imam Reza Hospital in Kermanshah, Iran. Br. J. Biomed. Sci., 2015, 72(4), 182-184.
[http://dx.doi.org/10.1080/09674845.2015.11665750] [PMID: 26738400]
[25]
Dadfarma, N.; Imani Fooladi, A.A.; Oskoui, M.; Mahmoodzadeh Hosseini, H. High level of gentamicin resistance (HLGR) among enterococcus strains isolated from clinical specimens. J. Infect. Public Health, 2013, 6(3), 202-208.
[http://dx.doi.org/10.1016/j.jiph.2013.01.001] [PMID: 23668465]
[26]
Jabalameli, F.; Emaneini, M.; Shahsavan, S. Evaluation of antimicrobial susceptibility patterns of enterococci isolated from patients in Tehran University of Medical Sciences Teaching Hospitals. Acta Med. Iran., 2009, 47, 325-328.
[27]
Amini, F.; Krimpour, H.A.; Ghaderi, M. Prevalence of Aminoglycoside Resistance Genes in Enterococcus Strains in Kermanshah, Iran. Iran. J. Med. Sci., 2017, 41, 2.
[28]
Choukhachian, M.; Nahaei, M.R.; Rezaee, M.A. High-level Gentamicin Resistance and Detection of aac (6′) Ie-aph (2”) Ia Gene in enterococci Isolated from Pediatric Hospital in Northwest of Iran. Arch. Clin. Infect. Dis., In Press.
[http://dx.doi.org/10.5812/archcid.62921]
[29]
Rosvoll, T.C.; Lindstad, B.L.; Lunde, T.M.; Hegstad, K.; Aasnaes, B.; Hammerum, A.M.; Lester, C.H.; Simonsen, G.S.; Sundsfjord, A.; Pedersen, T. Increased high-level gentamicin resistance in invasive Enterococcus faecium is associated with aac(6′)Ie-aph(2″)Ia-encoding transferable megaplasmids hosted by major hospital-adapted lineages. FEMS Immunol. Med. Microbiol., 2012, 66(2), 166-176.
[http://dx.doi.org/10.1111/j.1574-695X.2012.00997.x] [PMID: 22672387]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 20
ISSUE: 2
Year: 2020
Page: [223 - 228]
Pages: 6
DOI: 10.2174/1871526519666181130095954
Price: $65

Article Metrics

PDF: 28
HTML: 2