Prevalence and resistance trends of Gram positive cocci Staphylococcus aereus and Enterococcus spp. in a tertiary care hospital

Hatice Hale Gümüş

doi:10.17826/cumj.1350843

EN TR

Prevalence and resistance trends of Gram positive cocci Staphylococcus aereus and Enterococcus spp. in a tertiary care hospital

Abstract

Purpose: Antimicrobial resistance is a silent pandemic. In this study, it was aimed to determine the distribution and resistance trends of Staphylococcus aureus (S. aureus), Enterococcus faecium (E. faecium) and Enterococcus faecalis (E. faecalis) isolates, which are among the priority pathogens of the World Health Organization in bloodstream infections. Materials and Methods: This was a retrospective study conducted between January 1, 2021 and March 31, 2023. The blood cultures (n=1261), of which microbiologically tested by using an automated system, were screened in the relevant period via laboratory information system. Results: Of the total 941 isolates, 51.9% were S. aureus (n=488), 22.9% were E. faecalis (n=216), and 25.2% were E. faecium (n=237). Of the patients, 89.1% were inpatients (n=838), and 10.9% were outpatients (n=103). The most of patients were hospitalized in internal medicine departments (53.3%) and in intensive care units (35%). Among S. aureus isolates, the resistance rate to benzylpenicillin was 93.8%, to methicillin 44.3%, to teicoplanin 3.7%, and to linezolid 0.4%. Vancomycin and tigecycline resistances were not detected. Of the E. faecalis isolates, 5.5% were resistant to ampicillin, 3.3% to vancomycin, 3.2% to linezolid, and 0.7% to tigecycline. The resistance rates for E. faecium strains were 90.9% for ampicillin, 28.7% for vancomycin, 17.7% for tigecycline, 4.3% for linezolid, and 0.8% for teicoplanin. When the susceptibilities of all three bacteria were compared, a statistically significant difference was found between teicoplanin, vancomycin, tigecycline and linezolid susceptibilities. The methicillin resistance was higher in internal medicine and intensive care units. The levofloxacin and vancomycin resistance were more prevalent in intensive care units. Conclusion: MRSA (44.3%), vancomycin (28.7%) and tigecycline (17.7%) resistant E. faecium rates are well above the national data. The epidemiology on resistance trends, which will guide clinicians in the management of bloodstream infections, should be carried out periodically.

Keywords

Enterococcus faecium , Enterococcus faecalis , antimicrobial resistance , methicillin resistance , vancomycin resistance , linezolid resistance , tigecycline resistance , MRSA , VRSA , VRE

Üçüncü basamak bir hastanede Gram pozitif koklar Staphylococcus aereus ve Enterococcus spp. prevalansı ve direnç eğilimleri

Öz

Amaç: Antimikrobiyal direnç sessiz bir salgındır. Bu çalışmada Dünya Sağlık Örgütü'nün kan dolaşımı enfeksiyonlarında öncelikli patojenler arasında yer verdiği Staphylococcus aureus (S. aureus), Enterococcus faecium (E. faecium) ve Enterococcus faecalis (E. faecalis) izolatlarının dağılımı ve direnç eğilimlerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Retrospektif olan bu çalışma, 1 Ocak 2021 ile 31 Mart 2023 tarihleri arasında gerçekleştirildi. Otomatik sistem kullanılarak mikrobiyolojik incelemesi yapılan kan kültürleri (n=1261) ilgili dönemde laboratuvarı bilgi sistemi ile tarandı. Bulgular: Çalışmaya dahil edilen toplam 941 izolatın %51.9'u S. aureus (n=488), %22.9'u E. faecalis (n=216) ve %25.2'si E. faecium (n=237) idi. Hastaların %89.1'i yatan (n=838), %10.9'u ayaktan (n=103) hastalardı. Hastaların büyük çoğunluğu dahili servislerde (%53.3) ve yoğun bakım ünitelerinde (%35) yatmaktaydı. S. aureus izolatlarında benzilpenisiline direnç oranı %93.8, metisilin'e %44.3, teikoplanine %3.7 ve linezolide %0.4 direnç gösterdi. Vankomisin ve tigesiklin direnci saptanmadı. E. faecalis izolatlarının %5.5'inin ampisiline, %3.3'ünün vankomisine, %3.2'sinin linezolide ve %0.7'sinin tigesikline dirençli olduğu belirlendi. E. faecium suşlarında direnç oranları ampisilin için %90.9, vankomisin için %28.7, tigesiklin için %17.7, linezolid için %4.3 ve teikoplanin için %0.8 olarak belirlendi. Her üç bakterinin duyarlılıkları karşılaştırıldığında, teikoplanin, vankomisin, tigesiklin ve linezolid duyarlılıkları arasında istatistiksel olarak anlamlı farklılık bulunduğu saptandı. Metisilin direnci dahiliye ve yoğun bakım ünitelerinde daha yüksekti. Levofloksasin ve vankomisin direnci yoğun bakım ünitelerinde daha yaygındı. Sonuç: Metisiline dirençli S. aureus (%44.3), vankomisin (%28.7) ve tigesikline (%17.7) dirençli E. faecium oranları ulusal verilerin oldukça üzerindedir. Kan dolaşımı enfeksiyonlarının tedavisinde klinisyenlere yol gösterecek direnç eğilimlerine ilişkin epidemiyolojik çalışmaların periyodik olarak yapılması gerekmektedir.

Anahtar Kelimeler

Enterococcus faecium , Enterococcus faecalis , antimikrobiyal direnç , metisilin direnci , vankomisin direnci , linezolid direnci , tigesiklin direnci , MRSA , VRSA , VRE.

Kaynakça

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a system analysis. Lancet. 2022;399:629-55.
World Health Organization. Health and economic impacts of antimicrobial resistance in the Western Pacific Region, 2020-2030. Manila, World Health Organization, 2023.
World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed (accessed June 2023).
European Society of Clinical Microbiology and Infectious Diseases. Clinical breakpoints and dosing of of antibiotics; Clinical breakpoints and guidance. https://www.eucast.org/clinical_breakpoints (accessed July 2023).
Chiang HY, Chen TC, Lin CC, Ho LC, Kuo CC, Chi CY. Trend and predictors of short-term mortality of adult bacteremia at emergency departments: A 14-Year Cohort Study of 14 625 Patients. Open Forum Infect Dis. 2021;8:ofab485.
Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother. 2019;63:e00355-19.
IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.
Shorr AF, Tabak YP, Killian AD, Gupta V, Liu LZ, Kollef MH. Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database. Crit Care Med. 2006;34:2588-95.
Arora HS, Khan H, Ailumerab H, Natarajan G, Meert K, Salimnia H et al. A tale of two intensive care units (ICUs): Baseline Staphylococcus aureus colonization and mupirocin susceptibility in neonatal and pediatric patients requiring intensive care. Infect Control Hosp Epidemiol. 2023;44:447-52.
Edwin Erayil S, Palzer E, Kline S. An evaluation of risk factors for Staphylococcus aureus colonization in a pre-surgical population. Access Microbiol. 2022;4:000316.

Oksuz S, Yavuz T, Idris S, Yıldırım M, Akgunoglu M, Kaya D et al. Kan kültürlerinden izole edilen mikroorganizmalar ve antibiyotiklere duyarlılıkları. Turk Mikrobiyoloji Cemiyeti Dergisi. 2008;38:117-21.
Ece G. Kan kültüründe üreyen izolatların dağılımı ve antibiyotik duyarlılık profilinin incelenmesi. Haseki Tıp Bülteni. 2013;51:151-6.
Yuce P, Demirdag K, Kalkan A, Ozden M, Denk A, Kılıc SS. Kan kültürlerinde izole edilen mikroorganizmalar ve antibiyotik duyarlılıkları. ANKEM Dergisi. 2005;19:17-21.
Duman Y, Kuzucu Ç, Çuğlan SS. Kan kültürlerinden izole edilen bakteriler ve antimikrobiyal duyarlılıkları. Erciyes Tıp Dergisi. 2011;33:189-96.
Yılmaz S, Gümral R, Güney M, Bedir O, Guclu AU, Duyan S et al. İki yıllık dönemde kan kültürlerinden izole edilen mikroorganizmalar ve antibiyotik duyarlılıkların değerlendirilmesi. Gülhane Tıp Dergisi. 2013;55:247-52.
Imam N, Tempone S, Armstrong PK, Johnson SJ, Worth LJ, Richards MJ.Increased incidence of community-associated Staphylococcus aureus bloodstream infections in Victoria and Western Australia, 2011-2016. Med J Aust. 2019;210:87-8.
Bassetti M, Righi E, Del Giacomo P, Sartor A, Ansaldi F, Trucchi C et al. Predictors of mortality with Staphylococcus aureus bacteremia in elderly adults. J Am Geriatr Soc. 2018;66:1284-9.
Bassetti M, Peghin M, Trecarichi EM, Carnelutti A, Righi E, Del Giacomo P et al. Characteristics of Staphylococcus aureus bacteraemia and predictors of early and late mortality. PLoS One. 2017;12:e0170236.
Yılmaz M, Elaldı N, Balkan II, Arslan F, Batırel AA, Bakıcı MZ et al. Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study. Ann Clin Microbiol Antimicrob. 2016;15:7.
Wu YM, Huang PY, Cheng YC, Lee CH, Hsu MC, Lu JJ et al. Enhanced virulence of Candida albicans by Staphylococcus aureus: Evidence in clinical bloodstream infections and infected zebrafish embryos. J Fungi (Basel). 2021;7:1099.
World Health Organization. Antimicrobial Resistance Surveillance in Europe 2022 – 2020 data. Copenhagen, World Health Organization, 2022. https://apps.who.int/iris/handle/10665/351141 (accessed June 2023).
World Health Organization Regional Office for Europe. Antimicrobial Resistance Map. https://worldhealthorg.shinyapps.io/ WHO-AMR-Dashboard/? ga=2.172166563.1827800992.1668654440 1324205868.1668654440 (accessed June 2023).
Gumus HH. Glikopeptidlere Direnç Mekanizmaları. In Antibiyotiklere Güncel ve Çok Yönlü Yaklaşım, 1st Ed. (Ed İ Ödemiş):255-68. Ankara, Akademisyen Yayınevi, 2023.
Wu Q, Sabokroo N, Wang Y, Hashemian M, Karamollahi S, Koushari E. Systematic review and meta-analysis of the epidemiology of vancomycin-resistance Staphylococcus aureus isolates. Antimicrob Resist Infect Control. 2021;10:101.
Shariati A, Dadashi M, Moghadam MT, van Belkum A, Yaslianifard S, Darban-Sarokhalil D. Global prevalence and distribution of vancomycin resistant, vancomycin intermediate and heterogeneously vancomycin intermediate Staphylococcus aureus clinical isolates: a systematic review and meta-analysis. Sci Rep. 2020;10:12689.
Cusumano JA, Dupper AC, Malik Y, Gavioli EM, Banga J, Caban AB et al. Staphylococcus aureus bacteremia in patients infected with COVID-19: A case series. Open Forum Infect Dis. 2020;7:ofaa518.
Espinosa Perez M, García Fenoll R, Mormeneo Bayo S, Martínez Álvarez RM, Frutos Millán V, Villuendas Usón MC et al. [Impact of Staphylococcus aureus bacteremia in COVID-19 patients]. Rev Esp Quimioter. 2022;35:468-74.
Billington EO, Phang SH, Gregson DB, Pitout JD, Ross T, Church DLL et al. Incidence, risk factors, and outcomes for Enterococcus spp. bloodstream infections:a population-based study. Int J Infect Dis. 2014;26:76-82.
Rosselli Del Turco E, Bartoletti M, Dahl A, Cervera C, Pericàs JM. How do I manage a patient with enterococcal bacteraemia?. Clin Microbiol Infect 2021;27:364-71.
Turk Mikrobiyoloji Cemiyeti. EUCAST dirençli olması beklenen fenotipler sürüm 1.1 Mart 2022. https://www.tmc-online.org/index.php?func=Content&ID=8 (accessed June 2023).
Bender JK, Cattoir V, Hegstad K, Sadowy E, Coque TM, Westh H et al. Update on prevalence and mechanisms of resistance to linezolid, tigecycline and daptomycin in enterococci in Europe: Towards a common nomenclature. Drug Resist Updat. 2018;40:25-39.
Stogios PJ, Savchenko A. Molecular mechanisms of vancomycin resistance. Protein Sci. 2020;29:654-69.
Marshall SH, Donskey CJ, Hutton-Thomas R, Salata RA, Rice LB. Gene dosage and linezolid resistance in Enterococcus faecium and Enterococcus faecalis. Antimicrob Agents Chemother. 2002;46:3334-6.
Pfaller MA, Mendes RE, Streit JM, Hogan PA, Flamm RK.Five-year summary of in vitro activity and resistance mechanisms of linezolid against clinically important Gram positive cocci in the United States from the LEADER Surveillance Program (2011 to 2015). Antimicrob Agents Chemother. 2017;61:e00609-17.
Afsar I, Barıs II, Sener AG, Koksal V, Demirci M. Linezolide dirençli Enterococcus faecium: Türkiye’deki ilk G2576T mutasyonu. Mikrobiyol Bul. 2012;46:516-8.
Odemis I, Kose S, Ersan G, Celik D, Akbulut I. Evaluation of antibiotic susceptibilities of enterococcus strains isolated from clinical samples of hospitalized patients. Turk Hij Den Biyol Derg. 2018;75:345-52.
Comoglu S, Kaya S, Ceran N, Aksoz S, Ozturk S, Karagoz G. Determination of in vitro activity of linezolid in resistance Gram positive bacteria by E-test method. Haydarpasa Numune Med J. 2019;59:25-30.
Sig AK, Kula Atik T, Çetin Duran A. Antibiotic resistance of Enterococcus species: 3-year data. J Health Sci Med. 2021;4:670-4.
Sun Y, Cai Y, Liu X, Bai N, Liang B, Wang R. The emergence of clinical resistance to tigecycline. Int J Antimicrob Agents. 2013;41:110-6.
Cattoir V, Isnard C, Cosquer T, Odhiambo A, Bucquet F, Guérin F et al. Genomic analysis of reduced susceptibility to tigecycline in Enterococcus faecium. Antimicrob Agents Chemother. 2015;59:239-44.
Marco F, Dowzicky MJ. Antimicrobial susceptibility among important pathogens collected as part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.) in Spain, 2004-2014. J Glob Antimicrob Resist. 2016;6:50-6.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Bulaşıcı Hastalıklar , Klinik Mikrobiyoloji , Tıbbi Bakteriyoloji , Tıbbi Enfeksiyon Ajanları

Bölüm

Araştırma Makalesi

Yazarlar

Hatice Hale Gümüş ^*
0000-0001-9071-9606
Türkiye

Erken Görünüm Tarihi

27 Eylül 2023

Yayımlanma Tarihi

30 Eylül 2023

Gönderilme Tarihi

27 Ağustos 2023

Kabul Tarihi

22 Eylül 2023

Yayımlandığı Sayı

Yıl 2023 Cilt: 48 Sayı: 3

DOI

https://doi.org/10.17826/cumj.1350843

IZ

https://izlik.org/JA26JU39FA

MLA

Gümüş, Hatice Hale. “Prevalence and resistance trends of Gram positive cocci Staphylococcus aereus and Enterococcus spp. in a tertiary care hospital”. Cukurova Medical Journal, c. 48, sy 3, Eylül 2023, ss. 1177-86, doi:10.17826/cumj.1350843.