PREVALENCE OF VANCOMYCIN-RESISTANT ENTEROCOCCUS ISOLATED FROM VARIOUS CLINICAL SPECIMENS AND ITS ANTIMICROBIAL PROFILE AT TERTIARY CARE HOSPITAL, AHMEDABAD, GUJARAT, WESTERN INDIA
Main Article Content
Keywords
Vancomycin-resistant enterococci (VRE), prevalence, antimicrobial resistance, linezolid
Abstract
Aims & Objective: Vancomycin-resistant Enterococci (VRE) represent a critical medical and public health concern due to their association with serious nosocomial infections and a high risk of mortality. Understanding the exact prevalence rate, virulence factors, and related risk factors among enterococci isolated from various clinical specimens is essential for controlling the spread of bacterial resistance and for epidemiological surveillance. This study aims to determine the prevalence of VRE and antimicrobial resistance profiles among enterococci isolates from clinical specimens at the institute.
Material & methods: This study was carried out on enterococci isolated from clinical specimens at the GCS Medical College, Hospital and Research Centre, from January 2024 to June 2025. Direct microscopic examination was done using wet film for urine specimens and Gram stain for other specimens, like pus and body fluids.. Inoculation was done on blood agar and MacConkey agar. Additionally, chocolate agar was inoculated for CSF specimens. Identification of enterococci by biochemical tests & antimicrobial susceptibility testing of enterococcal Isolates was done. Data was collected in an Excel sheet & analysed.
Result: On susceptibility testing, the prevalence of VRE was found to be 3.9 %. The maximum number of VRE isolates was from blood culture (52.38%), followed by Urine (28..57%) , tissue (9.53%), pus(4.76%), and body fluid (4.76%). Among VRE, 57.14% isolates were E. Faecium, followed by E. Faecalis (33.33%) and other enterococci (9.55%), respectively. Highest resistance was found for ampicillin, ampicillin-sulbactam, HLG, and teicoplanin, while the most sensitive was linezolid (95%).
Conclusion: A multi-disciplinary approach is urgently needed, including regular surveillance for the local epidemiology, early detection, and management, especially in the face of high-risk settings. Proper implementation of antimicrobial stewardship & infection control programs in the hospital is the best way to overcome the increasing trend of resistance.
References
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27. Yadav G, Thakuria B, Madan M, Agwan V, Pandey A. Linezolid and Vancomycin Resistant Enterococci: A Therapeutic Problem. Journal of clinical and diagnostic research: JCDR. 2017 Aug;11(8):GC07.
28. Yilema A, Moges F, Tadele S, Endris M, Kassu A, Abebe W, Ayalew G. Isolation of enterococci, their antimicrobial susceptibility patterns and associated factors among patients attending at the University of Gondar Teaching Hospital. BMC infectious diseases. 2017 Dec;17(1):276
29. Fernandes SC, Dhanashree B. Drug resistance & virulence determinants in clinical isolates of Enterococcus species. The Indian journal of medical research. 2013 May;137(5):981.
30. Sundaram M, Kavita Y, Mohiddin SK. Antibiogram of enterococcal species isolated from clinical specimens in a tertiary care teaching hospital. Blood. 2016 Jun 13;14:13-08.
31. Nautiyal S, Jauhari S, Joshi G, Kataria V.K Characterization of Enterococcus species in a tertiary care hospital IOSR Journal Of PharmacyVolume 6, ( 2016), PP. 48-51.
32. Maj Puneet Bhatt a, Anubha Patel, et al. Emergence of multidrug resistant enterococci at a tertiary care Centre edical journal armed forces India 71 (2015)139-144.
33. Mukherjee K, Bhattcharjee D, Chakraborti G, Chatterjee S.Prevalence and antibiotic susceptibility pattern of Enterococcus species from various clinical samples in a tertiary care hospital in Kolkata. International Journal of Contemporary Medical Research. 2016;3(6):1565–7.
34. S. Sreeja, Sreenivasa Babu P.R, A.G. Prathab. The Prevalence and the Characterization of the Enterococcus Species from Various Clinical Samples in a Tertiary Care Hospital Journal of Clinical and Diagnostic Research. 2012 November, Vol-6(9): 1486-1488.
35. Eliopoulos GM, Gold HS. Vancomycin-resistant enterococci: mechanisms and clinical observations. Clinical Infectious Diseases. 2001 Jul 15;33(2):210-9.
36. Moemen D, Tawfeek D, Badawy W. Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt. Brazilian Journal of Microbiology. 2015 Sep;46(3):777-83
37. Shettima SA, Iregbu KC. Antimicrobial resistance pattern of enterococci isolated from stool samples in a tertiary hospital in Nigeria. Annals of Tropical Pathology. 2019;10(2):126–31.
38. Mukherjee K, Bhattcharjee D, Chakraborti G, Chatterjee S. Prevalence and antibiotic susceptibility pattern of Enterococcus species from various clinical samples in a tertiary care hospital in Kolkata. International Journal of Contemporary Medical Research. 2016;3(6):1565–7.
39. Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Hayek SA, et al. Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom. Investig Clin Urol. 2016;57(2):129–34.
40. 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.
41. Gold HS. Vancomycin-Resistant Enterococci: Mechanisms and Clinical Observations. Clin Infect Dis. 2001;33(2):210–9.
42. Mac S, Fitzpatrick T, Johnstone J, Sander B. Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis. Antimicrob Resist Infect Control. 2019;8(168).
43. Bhuyan B, Das P. Antimicrobial resistance pattern in Enterococcus species and detection of vanA gene among vancomycin resistant isolates in a tertiary care hospital. Int J Med Health Res. 2018;4(2):137–40.
44. Raza T, Ullah SR, Mehmood K, Andleeb S. Vancomycin resistant Enterococci: A brief review. JPMA. The Journal of the Pakistan Medical Association. 2018 May 1;68(5):768-72.
45. Salem-Bekhit MM, Moussa IM, Muharram MM, Alanazy FK, Hefni HM. Prevalence and antimicrobial resistance pattern of multidrug-resistant enterococci isolated from clinical specimens. Indian journal of medical microbiology. 2012 Jan 1;30(1):44.
46. Tripathi A, Shukla SK, Singh A, Prasad KN. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India. Indian journal of medical microbiology. 2016 Jan 1;34(1):38.
47. Sujata B, Ghosh R, Chatterjee S, Bhattacharya K. EnterococcalInfections And Its Antimicrobial Resistance With Special Reference To VRE And HLAR In A Tertiary Care Hospital In Eastern India. IOSR Journal of Dental and Medical SciencesVolume 13, Issue 2 Ver. III. (Feb. 2014), PP 17-22.
2. Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of enterococci. Microbiol Spectr. 2019;7(4).
3. Guzman Prieto AM, van Schaik W, Rogers MRC, et al. Global emergence and dissemination of enterococci as nosocomial pathogens: attack of the clones? Front Microbiol [Internet]; 2016, 7. Available from: https://www.frontiersin.org/articles/10.3389/fmicb.2016.00788. Accessed August 28, 2023.
4. Ahmed MO, Baptiste KE. Vancomycin-resistant enterococci: a review of antimicrobial resistance mechanisms and perspectives of human and animal health. Microb Drug Resist Larchmt N. 2018 Jun;24(5):590–606.
5. Kristich CJ, Rice LB, Arias CA. Enterococcal infection—treatment and antibiotic resistance [Internet]. Boston: Massachusetts Eye and Ear Infirmary. In: Gilmore MS, Clewell DB, Ike Y, Shankar N, eds. Enterococci: From Commensals to Leading Causes of Drug Resistant Infection; 2014. Available from: http://www.ncbi.nlm.nih.gov/books/NBK190420/. Accessed August 28, 2023.
6. Dubler S, Lenz M, Zimmermann S, et al. Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study. Antimicrob Resist Infect Control. 2020 Jan 31; 9:22
7. Smout E, Palanisamy N, Valappil SP. Prevalence of vancomycin-resistant Enterococci in India
8. between 2000 and 2022: A systematic review and meta-analysis. Antimicrob Resist Infect Contro 2023;12:79.
9. Johnstone J, Chen C, Rosella L, Adomako K, Policarpio ME, Lam F, et al. Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada. Am J Infect Control 2018;46:1266-71.
10. Sivaradjy M, Gunalan A, Priyadarshi K, Madigubba H, Rajshekar D, Sastry AS. Increasing trend of vancomycin-resistant Enterococci bacteremia in a tertiary care hospital of South India: A three-year prospective study. Indian J Crit Care Med 2021;25:881-5.
11. O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: Epidemiology, clinical manifestations, and optimal management. Infect Drug Resist 2015;8:217-30.
12. Tripathi A, Shukla SK, Singh A, Prasad KN. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a tertiary care hospital in Northern India. Indian J Med Microbiol 2016;34:38-45.
13. Gold HS. Vancomycin-resistant Enterococci: mechanisms and clinical observa¬tions. Clin Infect Dis. 2001;33:210–9. https://doi.org/10.1086/321815.
14. Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, et al. Emergence and spread of vancomycin resistance among Enterococci in Europe. Euro Surveill. 2008; 13:19046.
15. Tripathi A, Shukla SK, Singh A, Prasad KN. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcusfaecium at a Tertiary Care Hospital in Northern India. Indian J Med Microbiol. 2016; 34(1):38–45.
16. Cairns KA, Udy AA, Peel TN, Abbott IJ, Dooley MJ, Peleg AY. Therapeutics for vancomycin-resistant enterococcal bloodstream infections. Clin Microbiol Rev 2023;36:e0005922.
17. Procop GW, Church DL, Koneman EW et al. Koneman'sColor Atlas and Textbook of Diagnostic Microbiology. 7th ed. Philadelphia: Wolters Kluwer Health; 2017. Ch.1: The Role of the Microbiology Laboratory in the Diagnosis of Infectious Diseases: Guidelines to Practice and Management; p.23.
18. Performance standards for antimicrobial susceptibility testing, the informational supplement. 27th ed. Wayne; 2017.
19. S. Sreeja, Sreenivasa Babu P.R, A.G. Prathab. The Prevalence and the Characterization of the Enterococcus Species from Various Clinical Samples in a Tertiary Care Hospital Journal of Clinical and Diagnostic Research. 2012 November, Vol-6(9): 1486-1488.
20. Mathur P, Kapil A, Chandra R, Sharma P, Das B. Antimicrobial resistance in Enterococcus faecalis at a tertiary care centre in Northern India. Indian J Med Res. 2003;118:25-28.
21. Parameswarappa J, Basavaraj VP, Basavaraj CM. Isolation, identification and antibiogram of enterococci isolated from International Journal of Health Sciences & Research (www.ijhsr.org) 26 Vol.9; Issue: 4; April 2019 patients with urinary tract infection. AnnAfr Med. 2013;12:176-81.
22. Chitnis S, Katara G, Hemvani N, Pareek S, Chitnis DS. In vitro activity of daptomycin & linezolid against methicillin resistant Staphylococcus aureus & vancomycin resistant enterococci isolated from hospitalized cases in Central India. Indian J Med Res 2013; 137: 191-6.
23. A Tripathi, SK Shukla, A Singh, KN Prasad. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India. Indian Journal of Medical Microbiology, (2016) 34(1): 38-45
24. Simner PJ, Adam H, Baxter M, Mccracken M, Golding G, Karlowsky JA, et al. Canadian Antimicrobial Resistance Alliance (CARA), Hoban DJ, Zhanel GG. Epidemiology of vancomycin-resistant enterococci in Canadian hospitals (CANWARD study. Antimicrob Agents Chemother. 2015;59(7):4315–7.
25. Kampmeier S, Kossow A, Clausen LM, Knaack D, Ertmer C,Gottschalk A, et al. Hospital acquired vancomycin resistant enterococci in surgical intensive care patients – a prospective longitudinal study. Antimicrob Resist Infect Control. 2018;7:103.
26. Jada S, Jayakumar K. Prevalence of enterococcus species from various clinical specimens in shrisathyasai medical college and research institute with special reference to speciation & their resistance to vancomycin. Int J med Clin Res. 2012;3(4):154–60.
27. Yadav G, Thakuria B, Madan M, Agwan V, Pandey A. Linezolid and Vancomycin Resistant Enterococci: A Therapeutic Problem. Journal of clinical and diagnostic research: JCDR. 2017 Aug;11(8):GC07.
28. Yilema A, Moges F, Tadele S, Endris M, Kassu A, Abebe W, Ayalew G. Isolation of enterococci, their antimicrobial susceptibility patterns and associated factors among patients attending at the University of Gondar Teaching Hospital. BMC infectious diseases. 2017 Dec;17(1):276
29. Fernandes SC, Dhanashree B. Drug resistance & virulence determinants in clinical isolates of Enterococcus species. The Indian journal of medical research. 2013 May;137(5):981.
30. Sundaram M, Kavita Y, Mohiddin SK. Antibiogram of enterococcal species isolated from clinical specimens in a tertiary care teaching hospital. Blood. 2016 Jun 13;14:13-08.
31. Nautiyal S, Jauhari S, Joshi G, Kataria V.K Characterization of Enterococcus species in a tertiary care hospital IOSR Journal Of PharmacyVolume 6, ( 2016), PP. 48-51.
32. Maj Puneet Bhatt a, Anubha Patel, et al. Emergence of multidrug resistant enterococci at a tertiary care Centre edical journal armed forces India 71 (2015)139-144.
33. Mukherjee K, Bhattcharjee D, Chakraborti G, Chatterjee S.Prevalence and antibiotic susceptibility pattern of Enterococcus species from various clinical samples in a tertiary care hospital in Kolkata. International Journal of Contemporary Medical Research. 2016;3(6):1565–7.
34. S. Sreeja, Sreenivasa Babu P.R, A.G. Prathab. The Prevalence and the Characterization of the Enterococcus Species from Various Clinical Samples in a Tertiary Care Hospital Journal of Clinical and Diagnostic Research. 2012 November, Vol-6(9): 1486-1488.
35. Eliopoulos GM, Gold HS. Vancomycin-resistant enterococci: mechanisms and clinical observations. Clinical Infectious Diseases. 2001 Jul 15;33(2):210-9.
36. Moemen D, Tawfeek D, Badawy W. Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt. Brazilian Journal of Microbiology. 2015 Sep;46(3):777-83
37. Shettima SA, Iregbu KC. Antimicrobial resistance pattern of enterococci isolated from stool samples in a tertiary hospital in Nigeria. Annals of Tropical Pathology. 2019;10(2):126–31.
38. Mukherjee K, Bhattcharjee D, Chakraborti G, Chatterjee S. Prevalence and antibiotic susceptibility pattern of Enterococcus species from various clinical samples in a tertiary care hospital in Kolkata. International Journal of Contemporary Medical Research. 2016;3(6):1565–7.
39. Toner L, Papa N, Aliyu SH, Dev H, Lawrentschuk N, Hayek SA, et al. Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom. Investig Clin Urol. 2016;57(2):129–34.
40. 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.
41. Gold HS. Vancomycin-Resistant Enterococci: Mechanisms and Clinical Observations. Clin Infect Dis. 2001;33(2):210–9.
42. Mac S, Fitzpatrick T, Johnstone J, Sander B. Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis. Antimicrob Resist Infect Control. 2019;8(168).
43. Bhuyan B, Das P. Antimicrobial resistance pattern in Enterococcus species and detection of vanA gene among vancomycin resistant isolates in a tertiary care hospital. Int J Med Health Res. 2018;4(2):137–40.
44. Raza T, Ullah SR, Mehmood K, Andleeb S. Vancomycin resistant Enterococci: A brief review. JPMA. The Journal of the Pakistan Medical Association. 2018 May 1;68(5):768-72.
45. Salem-Bekhit MM, Moussa IM, Muharram MM, Alanazy FK, Hefni HM. Prevalence and antimicrobial resistance pattern of multidrug-resistant enterococci isolated from clinical specimens. Indian journal of medical microbiology. 2012 Jan 1;30(1):44.
46. Tripathi A, Shukla SK, Singh A, Prasad KN. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India. Indian journal of medical microbiology. 2016 Jan 1;34(1):38.
47. Sujata B, Ghosh R, Chatterjee S, Bhattacharya K. EnterococcalInfections And Its Antimicrobial Resistance With Special Reference To VRE And HLAR In A Tertiary Care Hospital In Eastern India. IOSR Journal of Dental and Medical SciencesVolume 13, Issue 2 Ver. III. (Feb. 2014), PP 17-22.
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Oct 02, 2025
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Heer Patel, Dr. Falguni Patel, Dr. Leena Leuva, & Dr. Urvesh Shah. (2025). PREVALENCE OF VANCOMYCIN-RESISTANT ENTEROCOCCUS ISOLATED FROM VARIOUS CLINICAL SPECIMENS AND ITS ANTIMICROBIAL PROFILE AT TERTIARY CARE HOSPITAL, AHMEDABAD, GUJARAT, WESTERN INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(8), 1355-1368. https://doi.org/10.53555/j45s7j90
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Author Biographies
Heer Patel
Second MBBS students, GCS Medical College , Ahmedabad
Dr. Falguni Patel
Associate Professor, Microbiology Department, GCS Medical College, Hospital & Research Centre, Ahmedabad
Dr. Leena Leuva
Assistant Professor, Microbiology Department, GCS Medical College, Hospital & Research Centre, Ahmedabad
Dr. Urvesh Shah
Professor & HOD, Microbiology Department, GCS Medical College, Hospital & Research Centre, Ahmedabad
How to Cite
Heer Patel, Dr. Falguni Patel, Dr. Leena Leuva, & Dr. Urvesh Shah. (2025). PREVALENCE OF VANCOMYCIN-RESISTANT ENTEROCOCCUS ISOLATED FROM VARIOUS CLINICAL SPECIMENS AND ITS ANTIMICROBIAL PROFILE AT TERTIARY CARE HOSPITAL, AHMEDABAD, GUJARAT, WESTERN INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(8), 1355-1368. https://doi.org/10.53555/j45s7j90