Year 2025,
Volume: 42 Issue: 2, 113 - 118, 30.06.2025
Abolfazl Jafarı-sales
,
Sadra Valipour
,
Maryam Farahnaki-sadabadi
,
Ghazal Kadkhodaei-ilkhechi
,
Farnaz Ghanbari-ilkhechi
,
Mehrdad Pashazadeh
,
Kosar Soleymanpour
,
Kosar Hosseini-karkaj
,
Behboud Jafari
Project Number
22030507931003
References
-
Macovei L, Zurek L. Ecology of antibiotic resistance genes: characterization of enterococci from houseflies collected in food settings. Appl Environ Microbiol. 2006 Jun;72(6):4028-35.
-
Zhou W, Zhou H, Sun Y, Gao S, Zhang Y, Cao X, et al. Characterization of clinical enterococci isolates, focusing on the vancomycin-resistant enterococci in a tertiary hospital in China: based on the data from 2013 to 2018. BMC Infect Dis. 2020;20(1):356.
-
Deng F, Yao C, Ke L, Chen M, Huang M, Wen J, et al. Emerging threat to antibiotic resistance: Impact of mycotoxin deoxynivalenol on gut microbiota and clonal expansion of extensively drug-resistant enterococci. Environ Int. 2025;197:109353.
-
Teferi A, Tamrat R, Fufa D, Gorems K, Diriba TA, Tadesse M. Intestinal colonisation of vancomycin-resistant enterococci among patients with cancer at Jimma University Medical Center, Ethiopia: A comparative cross-sectional study. J Glob Antimicrob Resist. 2025;41:144–150.
-
Zhao M, He S, Wen R, Li C, Chen X, Lin X, et al. Membrane vesicles derived from Enterococcus faecalis promote the co-transfer of important antibiotic resistance genes located on both plasmids and chromosomes. J Antimicrob Chemother. 2024 Feb 1;79(2):320-326.
-
Chen P, An B, Hu Y, Tao Y. 2,4-Bisphenol S triggers physiological changes, oxidative stress and lipidome alterations in Gram-positive Enterococcus faecalis at environmental concentrations. Environ Pollut. 2025 Feb 1;366:125475.
Said MS, Tirthani E, Lesho E. Enterococcus Infections. 2024 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
-
Schleifer KH. Transfer of Streptococcus faecalis and Streptococcus faecium to the Genus Enterococcus nom. rev. as Enterococcus faecalis comb. nov. and Enterococcus faecium comb. nov. Int J Syst Evol Microbiol. 1984;34(1):31–34.
-
Yusuf-Omoloye NA, Adeyemi FM, Sule WF, Yusuf W, Ajigbewu OH, Adegbite-Badmus MK, et al. Culture-dependent and molecular characterization of Vancomycin-Resistant Enterococci from clinical, food, and water samples across Osun State, Southwest Nigeria. Sci Afr. 2023;21:e01813.
-
Masoumi Zavaryani S, Mirnejad R, Piranfar V, Moosazadeh Moghaddam M, Sajjadi N, Saeedi S. Assessment of Susceptibility to Five Common Antibiotics and Their Resistance Pattern in Clinical Enterococcus Isolates. Iran J Pathol. 2020 Spring;15(2):96-105.
-
Erdene E, Munkhjargal O, Batnasan G, Dorjbal E, Oidov B, Byambaa A. Evaluation of Liposome-Encapsulated Vancomycin Against Methicillin-Resistant Staphylococcus aureus. Biomedicines. 2025 Feb 6;13(2):378.
-
Eltayeb LB. Vancomycin‑resistant enterococci (VRE) isolated from hospitalized patients: Molecular characterization of the van B gene. J Adv Pharm Educ Res. 2022;12(3):87–92.
-
Courvalin P. Vancomycin resistance in gram-positive cocci. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S25-34.
-
Boudrioua A, Baëtz B, Desmadril S, Goulard C, Groo AC, Lombard C, et al. Lasso peptides sviceucin and siamycin I exhibit anti-virulence activity and restore vancomycin effectiveness in vancomycin-resistant pathogens. iScience. 2025 Jan 30;28(3):111922.
-
Sfaciotte RAP, Parussolo L, Melo FD, Schneider MF, da Costa UM, Schwarz DGG, et al. Vancomycin-resistant Enterococcus (VRE) isolates from dogs and cats in veterinary hospitals in Brazil. BMC Vet Res. 2025 Feb 25;21(1):99.
-
Fujii A, Kawada-Matsuo M, Le MN, Suzuki Y, Nishihama S, Shiba H, et al. Comprehensive analysis of bacteriocins produced by clinical enterococcal isolates and their antibacterial activity against enterococci including VRE. Sci Rep. 2025;15(1):4846.
-
Hota S, Patil SR, Mane PM. Enterococcus: Understanding Their Resistance Mechanisms, Therapeutic Challenges, and Emerging Threats. Cureus. 2025 Feb 25;17(2):e79628.
-
Huang C, Moradi S, Sholeh M, Tabaei FM, Lai T, Tan B, et al. Global trends in antimicrobial resistance of Enterococcus faecium: a systematic review and meta-analysis of clinical isolates. Front Pharmacol. 2025 Apr 7;16:1505674.
-
Facklam RR, Collins MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol. 1989;27(4):731–734.
-
Saifi M, Dallal MS, Pourshafie MR, Eshraghian MR, Pourmand MR, Salari MH, et al. High Level Resistance of Enterococcus faecium and E. faecalis Isolates from Municipal Sewage Treatment Plants to Gentamicin. Iran J Public Health. 1970;37(1):103–107.
-
Khan SA, Nawaz MS, Khan AA, Hopper SL, Jones RA, Cerniglia CE. Molecular characterization of multidrug-resistant Enterococcus spp. from poultry and dairy farms: detection of virulence and vancomycin resistance gene markers by PCR. Mol Cell Probes. 2005 Feb;19(1):27-34.
-
Chang S, Sievert DM, Hageman JC, Boulton ML, Tenover FC, Downes FP, et al. Vancomycin-Resistant Staphylococcus aureus Investigative Team. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med. 2003 Apr 3;348(14):1342-7.
-
Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiology (Reading). 2009 Jun;155(Pt 6):1749-1757.
-
Mohammadi F, Tabaraie B, Sadeghifard N, Ghafoorian S, Maleki A, Davoodian E, et al. Evaluation of drug resistance frequency among Enterococcus faecium and E. faecalis strains and detection of vanA/B genes in vancomycin resistance isolated by PCR method in Ilam and Kermanshah hospitals. Iran J Med Microbiol. 2011;5(1):14–18.
-
Shahraki S, Rabi Nezhad Mousavi M, Dahmarde B, Atashgah M. Molecular evaluation of vanA and vanB genes of enterococci isolates resistant to vancomycin and teicoplanin. J Gorgan Univ Med Sci. 2017;19(2):84–90.
-
Tacconelli E, Cataldo MA. Vancomycin-resistant enterococci (VRE): transmission and control. Int J Antimicrob Agents. 2008;31(2):99–106.
-
Sulaiman AM, Hussein SA, Husain VI. Detection of antibiotic resistance genes (CTX‑M, Van A and Van B) of Enterococcus faecalis isolated from children with bacteremia by RT‑PCR. Arch Razi Inst. 2023;78(1):73–77.
-
Hosseini F, Kargar M. Study of frequency of VanA, VanB and VanC1/C2 genes in vancomycin resistant enterococci strains isolated from hospitalized and non-hospitalized patients in south of Fars province. J Shahid Sadoughi Univ Med Sci. 2017;24(12):963–971.
-
Alatrouny AM, Amin MA, Shabana HS. Prevalence of vancomycin-resistant enterococci among patients with nosocomial infection in intensive care unit. Al-Azhar Med J. 2020;49(4):1955–1964.
-
Hammerum AM, Karstensen KT, Roer L, Kaya H, Lindegaard M, Porsbo LJ, et al. Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022. Euro Surveill. 2024;29(23):2300633.
-
Adeyemi FM, Yusuf NA, Adeboye RR, Oluwajide OO, Ako-Nai AK. Comparative Analysis of Prevalence and Antibiotic Resistance in Vancomycin‑Resistant Enterococcus from Clinical Samples – Demographics and Phenotypes. Avicenna J Clin Microbiol Infect. 2021;8(2):57–65.
-
Dadashi M, Sharifian P, Bostanshirin N, Hajikhani B, Bostanghadiri N, Khosravi-Dehaghi N, et al. The Global Prevalence of Daptomycin, Tigecycline, and Linezolid-Resistant Enterococcus faecalis and Enterococcus faecium Strains From Human Clinical Samples: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021 Sep 10;8:720647.
-
Ghalavand Z, Alebouyeh M, Ghanati K, Azimi L, Rashidan M. Genetic relatedness of the Enterococcus faecalis isolates in stool and urine samples of patients with community-acquired urinary tract infection. Gut Pathog. 2020 Sep 9;12:42.
-
Karna A, Baral R, Khanal B. Characterization of Clinical Isolates of Enterococci with Special Reference to Glycopeptide Susceptibility at a Tertiary Care Center of Eastern Nepal. Int J Microbiol. 2019 Jul 1;2019:7936156.
-
Goudarzi M, Mobarez AM, Peerayeh SN, Mirzaee MOHSEN. Prevalence of Multidrug Resistance in Enterococcus faecium Isolated from Patients and Environment of Hospitals in Lorestan Province, Iran. Qom Univ Med Sci J. 2018;12(5):71–78.
-
Moghimbeigi A, Moghimbeygi M, Dousti M, Kiani F, Sayehmiri F, Sadeghifard N, et al. Prevalence of vancomycin resistance among isolates of enterococci in Iran: a systematic review and meta-analysis. Adolesc Health Med Ther. 2018 Nov 15;9:177-188.
A study to determine the frequency of van A and van B genes in vancomycin-resistant Enterococcus faecalis strains obtained from clinical specimens in northwestern Iran
Year 2025,
Volume: 42 Issue: 2, 113 - 118, 30.06.2025
Abolfazl Jafarı-sales
,
Sadra Valipour
,
Maryam Farahnaki-sadabadi
,
Ghazal Kadkhodaei-ilkhechi
,
Farnaz Ghanbari-ilkhechi
,
Mehrdad Pashazadeh
,
Kosar Soleymanpour
,
Kosar Hosseini-karkaj
,
Behboud Jafari
Abstract
One of the significant global challenges today is the increasing prevalence of vancomycin-resistant enterococci (VRE). This study aims to understand the antibiotic resistance patterns, investigate the prevalence of VRE-causing genes in clinical samples, and evaluate the prevalence of enterococcal strains. For this study, 200 urine and blood samples were collected from patients visiting healthcare centers in Tabriz. Antibiotic susceptibility was determined using the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, and the minimum inhibitory concentration (MIC) for vancomycin was assessed using the E-Test method. Additionally, polymerase chain reaction (PCR) techniques were employed for precise bacterial identification and to examine the presence of vancomycin resistance genes van A and van B. Molecular analysis revealed that 100 out of 200 samples (50%) belonged to Enterococcus faecalis (E. faecalis). The isolates exhibited the highest resistance to penicillin (83%), tetracycline (43%), and ciprofloxacin (41%), while they showed the greatest sensitivity to linezolid (87%), imipenem (85%), and teicoplanin (70%). A total of 31 samples were identified as resistant to vancomycin, with 18 strains (58.06%) containing the vanA genotype, 8 strains (25.81%) containing the vanB genotype, and 5 strains (16.13%) harboring both van A and van B genes. Given the high prevalence of VRE strains, it is essential to evaluate these organisms in all clinical samples.
Ethical Statement
The study protocol was approved by the Clinical Research Ethics Committee of Islamic Azad University, Ahar Branch (Date: 2024, No: 22030507931003).
Project Number
22030507931003
References
-
Macovei L, Zurek L. Ecology of antibiotic resistance genes: characterization of enterococci from houseflies collected in food settings. Appl Environ Microbiol. 2006 Jun;72(6):4028-35.
-
Zhou W, Zhou H, Sun Y, Gao S, Zhang Y, Cao X, et al. Characterization of clinical enterococci isolates, focusing on the vancomycin-resistant enterococci in a tertiary hospital in China: based on the data from 2013 to 2018. BMC Infect Dis. 2020;20(1):356.
-
Deng F, Yao C, Ke L, Chen M, Huang M, Wen J, et al. Emerging threat to antibiotic resistance: Impact of mycotoxin deoxynivalenol on gut microbiota and clonal expansion of extensively drug-resistant enterococci. Environ Int. 2025;197:109353.
-
Teferi A, Tamrat R, Fufa D, Gorems K, Diriba TA, Tadesse M. Intestinal colonisation of vancomycin-resistant enterococci among patients with cancer at Jimma University Medical Center, Ethiopia: A comparative cross-sectional study. J Glob Antimicrob Resist. 2025;41:144–150.
-
Zhao M, He S, Wen R, Li C, Chen X, Lin X, et al. Membrane vesicles derived from Enterococcus faecalis promote the co-transfer of important antibiotic resistance genes located on both plasmids and chromosomes. J Antimicrob Chemother. 2024 Feb 1;79(2):320-326.
-
Chen P, An B, Hu Y, Tao Y. 2,4-Bisphenol S triggers physiological changes, oxidative stress and lipidome alterations in Gram-positive Enterococcus faecalis at environmental concentrations. Environ Pollut. 2025 Feb 1;366:125475.
Said MS, Tirthani E, Lesho E. Enterococcus Infections. 2024 Feb 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
-
Schleifer KH. Transfer of Streptococcus faecalis and Streptococcus faecium to the Genus Enterococcus nom. rev. as Enterococcus faecalis comb. nov. and Enterococcus faecium comb. nov. Int J Syst Evol Microbiol. 1984;34(1):31–34.
-
Yusuf-Omoloye NA, Adeyemi FM, Sule WF, Yusuf W, Ajigbewu OH, Adegbite-Badmus MK, et al. Culture-dependent and molecular characterization of Vancomycin-Resistant Enterococci from clinical, food, and water samples across Osun State, Southwest Nigeria. Sci Afr. 2023;21:e01813.
-
Masoumi Zavaryani S, Mirnejad R, Piranfar V, Moosazadeh Moghaddam M, Sajjadi N, Saeedi S. Assessment of Susceptibility to Five Common Antibiotics and Their Resistance Pattern in Clinical Enterococcus Isolates. Iran J Pathol. 2020 Spring;15(2):96-105.
-
Erdene E, Munkhjargal O, Batnasan G, Dorjbal E, Oidov B, Byambaa A. Evaluation of Liposome-Encapsulated Vancomycin Against Methicillin-Resistant Staphylococcus aureus. Biomedicines. 2025 Feb 6;13(2):378.
-
Eltayeb LB. Vancomycin‑resistant enterococci (VRE) isolated from hospitalized patients: Molecular characterization of the van B gene. J Adv Pharm Educ Res. 2022;12(3):87–92.
-
Courvalin P. Vancomycin resistance in gram-positive cocci. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S25-34.
-
Boudrioua A, Baëtz B, Desmadril S, Goulard C, Groo AC, Lombard C, et al. Lasso peptides sviceucin and siamycin I exhibit anti-virulence activity and restore vancomycin effectiveness in vancomycin-resistant pathogens. iScience. 2025 Jan 30;28(3):111922.
-
Sfaciotte RAP, Parussolo L, Melo FD, Schneider MF, da Costa UM, Schwarz DGG, et al. Vancomycin-resistant Enterococcus (VRE) isolates from dogs and cats in veterinary hospitals in Brazil. BMC Vet Res. 2025 Feb 25;21(1):99.
-
Fujii A, Kawada-Matsuo M, Le MN, Suzuki Y, Nishihama S, Shiba H, et al. Comprehensive analysis of bacteriocins produced by clinical enterococcal isolates and their antibacterial activity against enterococci including VRE. Sci Rep. 2025;15(1):4846.
-
Hota S, Patil SR, Mane PM. Enterococcus: Understanding Their Resistance Mechanisms, Therapeutic Challenges, and Emerging Threats. Cureus. 2025 Feb 25;17(2):e79628.
-
Huang C, Moradi S, Sholeh M, Tabaei FM, Lai T, Tan B, et al. Global trends in antimicrobial resistance of Enterococcus faecium: a systematic review and meta-analysis of clinical isolates. Front Pharmacol. 2025 Apr 7;16:1505674.
-
Facklam RR, Collins MD. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J Clin Microbiol. 1989;27(4):731–734.
-
Saifi M, Dallal MS, Pourshafie MR, Eshraghian MR, Pourmand MR, Salari MH, et al. High Level Resistance of Enterococcus faecium and E. faecalis Isolates from Municipal Sewage Treatment Plants to Gentamicin. Iran J Public Health. 1970;37(1):103–107.
-
Khan SA, Nawaz MS, Khan AA, Hopper SL, Jones RA, Cerniglia CE. Molecular characterization of multidrug-resistant Enterococcus spp. from poultry and dairy farms: detection of virulence and vancomycin resistance gene markers by PCR. Mol Cell Probes. 2005 Feb;19(1):27-34.
-
Chang S, Sievert DM, Hageman JC, Boulton ML, Tenover FC, Downes FP, et al. Vancomycin-Resistant Staphylococcus aureus Investigative Team. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med. 2003 Apr 3;348(14):1342-7.
-
Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiology (Reading). 2009 Jun;155(Pt 6):1749-1757.
-
Mohammadi F, Tabaraie B, Sadeghifard N, Ghafoorian S, Maleki A, Davoodian E, et al. Evaluation of drug resistance frequency among Enterococcus faecium and E. faecalis strains and detection of vanA/B genes in vancomycin resistance isolated by PCR method in Ilam and Kermanshah hospitals. Iran J Med Microbiol. 2011;5(1):14–18.
-
Shahraki S, Rabi Nezhad Mousavi M, Dahmarde B, Atashgah M. Molecular evaluation of vanA and vanB genes of enterococci isolates resistant to vancomycin and teicoplanin. J Gorgan Univ Med Sci. 2017;19(2):84–90.
-
Tacconelli E, Cataldo MA. Vancomycin-resistant enterococci (VRE): transmission and control. Int J Antimicrob Agents. 2008;31(2):99–106.
-
Sulaiman AM, Hussein SA, Husain VI. Detection of antibiotic resistance genes (CTX‑M, Van A and Van B) of Enterococcus faecalis isolated from children with bacteremia by RT‑PCR. Arch Razi Inst. 2023;78(1):73–77.
-
Hosseini F, Kargar M. Study of frequency of VanA, VanB and VanC1/C2 genes in vancomycin resistant enterococci strains isolated from hospitalized and non-hospitalized patients in south of Fars province. J Shahid Sadoughi Univ Med Sci. 2017;24(12):963–971.
-
Alatrouny AM, Amin MA, Shabana HS. Prevalence of vancomycin-resistant enterococci among patients with nosocomial infection in intensive care unit. Al-Azhar Med J. 2020;49(4):1955–1964.
-
Hammerum AM, Karstensen KT, Roer L, Kaya H, Lindegaard M, Porsbo LJ, et al. Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022. Euro Surveill. 2024;29(23):2300633.
-
Adeyemi FM, Yusuf NA, Adeboye RR, Oluwajide OO, Ako-Nai AK. Comparative Analysis of Prevalence and Antibiotic Resistance in Vancomycin‑Resistant Enterococcus from Clinical Samples – Demographics and Phenotypes. Avicenna J Clin Microbiol Infect. 2021;8(2):57–65.
-
Dadashi M, Sharifian P, Bostanshirin N, Hajikhani B, Bostanghadiri N, Khosravi-Dehaghi N, et al. The Global Prevalence of Daptomycin, Tigecycline, and Linezolid-Resistant Enterococcus faecalis and Enterococcus faecium Strains From Human Clinical Samples: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021 Sep 10;8:720647.
-
Ghalavand Z, Alebouyeh M, Ghanati K, Azimi L, Rashidan M. Genetic relatedness of the Enterococcus faecalis isolates in stool and urine samples of patients with community-acquired urinary tract infection. Gut Pathog. 2020 Sep 9;12:42.
-
Karna A, Baral R, Khanal B. Characterization of Clinical Isolates of Enterococci with Special Reference to Glycopeptide Susceptibility at a Tertiary Care Center of Eastern Nepal. Int J Microbiol. 2019 Jul 1;2019:7936156.
-
Goudarzi M, Mobarez AM, Peerayeh SN, Mirzaee MOHSEN. Prevalence of Multidrug Resistance in Enterococcus faecium Isolated from Patients and Environment of Hospitals in Lorestan Province, Iran. Qom Univ Med Sci J. 2018;12(5):71–78.
-
Moghimbeigi A, Moghimbeygi M, Dousti M, Kiani F, Sayehmiri F, Sadeghifard N, et al. Prevalence of vancomycin resistance among isolates of enterococci in Iran: a systematic review and meta-analysis. Adolesc Health Med Ther. 2018 Nov 15;9:177-188.