Utility of bile esculin azide agar for screening of stool samples for vancomycin resistant enterococci from patients with gut colonization

Background: Due to increased prevalence of vancomycin resistant enterococci (VRE) in hospital settings as an important nosocomial pathogen, microbiology laboratories should be prepared with test protocol for prompt detection and reporting of these resistant organisms. This helps in appropriate treatment of patients without delay and implementation of infection control measures in order to prevent spread of such infections. With this background present study was conducted to demonstrate utility of bile esculin azide agar with vancomycin (BEAV) for screening of enterococci for vancomycin drug resistance.Methods: Over a period of one year 200 stool samples were collected from hospitalized patients in a tertiary care hospital. Samples were inoculated on bile esculin azide agar with vancomycin (6ug/ml) to screen for vancomycin drug resistance in enterococci isolated from stool samples. Vancomycin drug resistance was confirmed by agar dilution method.Results: Out of 200 stool samples collected from hospitalized patients, 13 (6.5%) samples showed growth on bile esculin azide agar with vancomycin (6 µg/ml). Of these 13 isolates, 12 (92.3%) isolates were confirmed as VRE by agar dilution method and demonstrated minimum inhibitory concentration (MIC) of ≥32 µg/ml and all 12 isolates were identified as E. faecium. One (7.7%) isolate grown on BEAV was identified as E. gallinarum and showed MIC value of 8 µg/ml.Conclusions: Present study recommends use of bile esculin azide agar with vancomycin (6 µg/ml) as a screening medium for isolation of VRE from stool samples which usually carries mixed commensal flora of gastrointestinal tract

Tracking Vancomycin MIC Creep: A Five Year Analysis

Methicillin resistant Staphylococcus aureus (MRSA) is a known human pathogen capable of causing community and hospital acquired infections worldwide. Treatment options available for MRSA infections are limited, with vancomycin being one of the most common drugs used. It is described in the literature that vancomycin can be ineffective against MRSA isolates with MIC values between 1-2 mg/litre. This slow and steady shift of vancomycin MIC values towards higher side over a period of time is known as “MIC creep”. The present retrospective study was carried out over five year period from January 2019 to June 2023. Staphylococcus aureus isolates from all clinical samples isolated during study period were included in the study. MIC50, MIC90, geometric mean MIC values were determined and analysed using Microsoft Excel. In the present study, the prevalence of MRSA was high (79.6%) in pus and tissue samples followed by blood sample (9.7%). Most of the MRSA isolates (55.80%) in present study exhibited vancomycin MIC of 1 µg/ml, there is no increasing trend of MIC values over a five year period. MIC creep is a slow and steady process which is multifactorial in origin. Regular monitoring of vancomycin MIC trend is advisable as vancomycin is the first-line treatment for culture proven severe infection with MRSA

Utility of Minimum Inhibitory Concentration values and Antibiotyping for Epidemiological study of Vancomycin Resistant Enterococci in a Tertiary Care Hospital

Vancomycin-resistant enterococci (VRE) have emerged as an important nosocomial infection. Three important vancomycin resistance types namely, VanA, VanB, VanC are very commonly found in enterococci. VanA and VanB are plasmid-encoded, transferable types of resistance and VanC is chromosomally mediated nontransferable resistance. So for infection control purpose, it is important to know the type of vancomycin resistance to prevent the spread of drug resistance. Enterococci isolated from clinical samples were tested for vancomycin resistance by disc diffusion and macro broth dilution (MIC) method. Vancomycin resistance gene was detected by the polymerase chain reaction (PCR) method. Antimicrobial susceptibility for penicillin, erythromycin, ciprofloxacin, high-level gentamicin, nitrofurantoin, tetracycline, teicoplanin and linezolid was performed by disc diffusion method. Antibiotyping of VRE strains was done based on their antimicrobial susceptibility pattern. Over a period of one year out of 246 clinical isolates of enterococci, seven (2.8%) isolates showed vancomycin resistance. Based on MICs and PCR, all the isolates demonstrated VanA type of resistance. Analysis of antibiogram showed three different antibiotype patterns for VRE labelled as 1,2,3. The majority of VRE isolates (72%) belonged to “Pattern 1”. Also clustering of cases of “Pattern 1” was observed in medicine ICU and medicine ward. These areas were identified as a potential reservoir for VRE infection and appropriate infection control measures were taken to curtail the spread of infection. The present study recommends a macro broth dilution method for detection of the type of vancomycin resistance in enterococci and “antibiotyping” as a basic typing method for VRE in resource-poor health care settings specifically in outbreak situations.</jats:p

Clinical and microbiological study of vancomycin-resistant enterococci isolated from colonized and infected patients with special reference to risk factors

Background: Vancomycin-resistant enterococci (VRE) has become a growing concern in healthcare settings as a major cause of many nosocomial infections worldwide.  Risk factors associated with VRE are important to study. High-risk patients need to be screened and isolated to prevent the spread of infection and colonization. The present study aims to investigate the clinical spectrum, risk factors, and source of transmission of VRE in infected and colonized patients. Methods: A prospective observational study was carried out for 1 year. A total of 200 Enterococcus species isolated from clinical samples such as urine, pus, blood, sterile body fluids, and stool from 200 patients without infection were included in the study. Stool samples were screened to measure the prevalence of VRE colonization. All samples were screened for vancomycin resistance using the Kirby-Bauer disc diffusion method. Vancomycin MIC was detected using the macrobroth dilution method. Demographic and clinical history of the patients were recorded. Results: Vancomycin resistance was detected in 7 (3.5%) of 200 enterococci isolates from clinical samples. Urinary tract infection (n = 5, 71.4%) was the most common clinical illness caused by VRE. Gut colonization was found in 12 (6%) out of 200 patients screened for VRE. A history of previous antibiotic exposure was a significant risk factor in the current study and was associated with VRE infection and colonization. Endogenous bloodstream infection caused by VRE was found in one patient with VRE colonization. Conclusion: The findings of this study highlight the significant burden of VRE on patients, both those infected and colonized. The emergence of multidrug-resistant bacteria in healthcare settings, a consequence of inappropriate antibiotic use, is a serious concern that warrants further research and our continued attention

Comparison of Different Phenotypic Methods for Detection of Vancomycin Drug Resistance in Enterococcus Species

Introduction: Vancomycin resistant enterococci have emerged as an important cause of nosocomial infection worldwide. Vancomycin drug resistance needs to be detected accurately in all Enterococcus species in order to prevent its spread in health care setting. Present study was conducted to compare three different phenotypic methods for detection of vancomycin resistance in enterococci. Material and methods: Study was conducted in a tertiary care hospital over a period of one year. Enterococcus species isolated from clinical samples like urine, pus, blood and sterile body fluids were tested by three different methods namely disk diffusion, E-strip and Phoenix automated system for detection of vancomycin resistance. Results: 400 Enterococcus species were isolated from clinical samples. 19(4.8%) Enterococcus species were found to be vancomycin resistant and one (0.25%) strain was found to be intermediate resistant to vancomycin by all three methods resulting in 100% sensitivity and 100%specificity. Conclusion: Present study recommends vancomycin disk diffusion as screening and E-strip as good confirmatory tests in resource poor settings for detection of vancomycin drug resistance. Keywords: VRE, vancomycin, disk diffusion, E strip, Phoenix automated system..</jats:p

Utility of bile esculin azide agar for screening of stool samples for vancomycin resistant enterococci from patients with gut colonization

Background: Due to increased prevalence of vancomycin resistant enterococci (VRE) in hospital settings as an important nosocomial pathogen, microbiology laboratories should be prepared with test protocol for prompt detection and reporting of these resistant organisms. This helps in appropriate treatment of patients without delay and implementation of infection control measures in order to prevent spread of such infections. With this background present study was conducted to demonstrate utility of bile esculin azide agar with vancomycin (BEAV) for screening of enterococci for vancomycin drug resistance.Methods: Over a period of one year 200 stool samples were collected from hospitalized patients in a tertiary care hospital. Samples were inoculated on bile esculin azide agar with vancomycin (6ug/ml) to screen for vancomycin drug resistance in enterococci isolated from stool samples. Vancomycin drug resistance was confirmed by agar dilution method.Results: Out of 200 stool samples collected from hospitalized patients, 13 (6.5%) samples showed growth on bile esculin azide agar with vancomycin (6 µg/ml). Of these 13 isolates, 12 (92.3%) isolates were confirmed as VRE by agar dilution method and demonstrated minimum inhibitory concentration (MIC) of ≥32 µg/ml and all 12 isolates were identified as E. faecium. One (7.7%) isolate grown on BEAV was identified as E. gallinarum and showed MIC value of 8 µg/ml.Conclusions: Present study recommends use of bile esculin azide agar with vancomycin (6 µg/ml) as a screening medium for isolation of VRE from stool samples which usually carries mixed commensal flora of gastrointestinal tract.</jats:p

Analysis of Haematological Parameters Correlates with the Physiological Variables among Mild COVID-19 Patients Admitted in the Tertiary Care Hospital of Pune District

Background: The COVID-19 pandemic has put global health at stake by creating havoc all over the world, due to which the world, as well as health agencies, are experiencing the greatest challenges of all times. This disease is a health emergency due to its high level of infectiousness and due to the non-availability of any specific treatment. COVID 19 is a health emergency due to its high infectiousness, as currently, there is no treatment available&#x0D; Objectives: To determine the significance of physiological and haematological parameters in the diagnosis of COVID 19 infection and compare these parameters according to comorbid conditions during the disease progression among mild COVID 19 patients.&#x0D; Methodology: This retrospective, observational study was carried out in a designated tertiary care hospital to address COVID19 patients in the Pune district. Various parameters like age, height, weight, BMI, various physiological variables, haematological parameters, and CRP levels were assessed among 202 COVID 19 diagnosed patients on day one and on day 10 of the hospital stay. Results: Out of the total study participants, 112 were male, and 90 were females with an average age of (43.43±15.07) and (51.8±16.35) respectively.&#x0D; Conclusion: Study of physiological and haematological parameters and their interrelation will help in understanding the impact of COVID 19 infection on the reactive inflammatory responses and will help in understanding the prognosis of the disease.</jats:p