Taneja Neelam, Rani Phulan, Emmanuel Rekha, Sharma Meera
Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research Chandigarh, India.
Indian J Med Res. 2004 Feb;119(2):72-4.
BACKGROUND & OBJECTIVES: There is a paucity of information on vancomycin resistance in enterococci from India. In the present study, enterococci isolated from urine specimen were screened for vancomycin resistance.
144 enterococci isolates obtained in pure and significant numbers (>10(5) cfu/ml) from 9664 urine specimens were subjected to agar screen method of National Committee for Clinical Laboratory Standard (NCCLS) for presence/absence of vancomycin resistance. Minimum inhibitory concentration (MIC) was performerd by E-test and agar dilution method.
Eight vancomycin resistant enterococci (VRE) were obtained, namely, 5 Enterococcus faecium, 1 each of Enterococcus faecalis, E. casseliflavus and E. pseudoavium. The MIC ranged from 8 to 32-microgm/ml. The records of these 8 patients were retrospectively reviewed for clinical details. Five patients had nosocomial urinary tract infection (UTI), while in 2 patients UTI was community acquired. One patient had asymptomatic bacteriuria. Two patients with nosocomial UTI developed clinical sepsis and died in spite of vancomycin treatment. Urinary catheterization, surgery on genitourinary tract, prior exposure to third generation cephalosporins and metronidazole were present in 6,5,3 and 2 patients respectively.
INTERPRETATION & CONCLUSION: Although the frequency of isolation of VRE is not very high in our setting as compared to West, this may just be the beginning of the problem. Screening for vancomycin resistance is recommended in all patients with suspected UTI who have significant bacterial counts.
关于印度肠球菌中万古霉素耐药性的信息匮乏。在本研究中，对从尿液标本中分离出的肠球菌进行了万古霉素耐药性筛查。
从9664份尿液标本中获得144株纯培养且数量可观（>10⁵ cfu/ml）的肠球菌分离株，采用美国国家临床实验室标准委员会（NCCLS）的琼脂筛选法检测其是否存在万古霉素耐药性。通过E试验和琼脂稀释法测定最低抑菌浓度（MIC）。
获得8株万古霉素耐药肠球菌（VRE），即5株粪肠球菌、1株屎肠球菌、1株格氏肠球菌和1株伪鸟肠球菌。MIC范围为8至32μg/ml。对这8例患者的记录进行回顾性审查以获取临床细节。5例患者发生医院获得性尿路感染（UTI），2例患者的UTI为社区获得性。1例患者有无症状菌尿。2例医院获得性UTI患者发生临床败血症，尽管接受了万古霉素治疗仍死亡。分别有6例、5例、3例和2例患者存在导尿、泌尿生殖道手术、先前接触过第三代头孢菌素和甲硝唑的情况。
尽管在我们的研究环境中，VRE的分离频率与西方相比不高，但这可能只是问题的开端。建议对所有疑似UTI且细菌计数显著的患者进行万古霉素耐药性筛查。
