Vancomycin-resistant Enterococci In Songklanagarind Hospital: Molecular Epidemiology And Infection Control

Vancomycin-resistant enterococci are important causes of healthcare-associated infections that have recently become the major nosocomial pathogen exhibiting resistance to many antimicrobials especially to vancomycin with increasing frequency. However, the epidemiology data of VRE in Thailand is limited. This study aimed at determining the prevalence, antibiotic resistance patterns, and molecularly characterize of VRE among patients admitted in a tertiary care hospital, in southern part of Thailand. We collected VRE isolates from various clinical samples of a 7-year period (March 2011 to April 2018) in Songklanagarind Hospital. VRE isolates were identified by Kirby Bauer disc diffusion method with Clinical and Laboratory Standards Institute guidelines. Vancomycin-resistance genes and virulence genes were detected by multiplex PCR and the sequence verified by the blast. The highest rate of VRE infection was in 2014 (39.4%). Most VRE isolates originated from the patient's digestive tract or urogenital tract that was positive for 17 (24.3%), followed by body fluid 14 (20.0%). The highest incidence of VRE infection was in Medical wards 29 (40.8%) and followed by surgical ward 16 (22.5%), operation theatres 7 (9.9%), Intensive Care Units (ICUs) 5 (7.0%), and emergency room 6 (8.5%). All the VRE isolates exhibited multidrug resistance, with the rates of resistance to ampicillin, imipenem, gentamicin and ceftazidime reaching high levels. It also found that 5.6% of E. faecium isolates were resistant to colistin. Most of these VRE isolates carried the vanA gene possed the esp genes (enterococcal surface protein), where rates were 100% and 74.6%, respectively. The study showed a high prevalence of diverse VRE strains with threatening resistance phenotypes in clinical sections among different medical wards in Songklanagarind hospitals. These findings indicated that the molecular detection of various glycopeptide resistance genes among VRE isolates are important information that useful to prevent and control of VRE infections

Resistance of Asian Cryptococcus neoformans Serotype A Is Confined to Few Microsatellite Genotypes

Contains fulltext : 109375.pdf (publisher's version ) (Open Access)BACKGROUND: Cryptococcus neoformans is a pathogenic yeast that causes cryptococcosis, a life threatening disease. The prevalence of cryptococcosis in Asia has been rising after the onset of the AIDS epidemic and estimates indicate more than 120 cases per 1,000 HIV-infected individuals per year. Almost all cryptococcal disease cases in both immunocompromised and immunocompetent patients in Asia are caused by C. neoformans var. grubii. Epidemiological studies on C. neoformans in pan-Asia have not been reported. The present work studies the genetic diversity of the fungus by microsatellite typing and susceptibility analysis of approximately 500 isolates from seven Asian countries. METHODOLOGY/PRINCIPAL FINDINGS: Genetic diversity of Asian isolates of C. neoformans was determined using microsatellite analysis with nine microsatellite markers. The analysis revealed eight microsatellite complexes (MCs) which showed different distributions among geographically defined populations. A correlation between MCs and HIV-status was observed. Microsatellite complex 2 was mainly associated with isolates from HIV-negative patients, whereas MC8 was associated with those from HIV-positive patients. Most isolates were susceptible to amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole, but 17 (3.4%) and 10 (2%) were found to be resistant to 5-flucytosine and fluconazole, respectively. Importantly, five Indonesian isolates (approximately 12.5% from all Indonesian isolates investigated and 1% from the total studied isolates) were resistant to both antifungals. The majority of 5-flucytosine resistant isolates belonged to MC17. CONCLUSIONS: The findings showed a different distribution of genotypes of C. neoformans var. grubii isolates from various countries in Asia, as well as a correlation of the microsatellite genotypes with the original source of the strains and resistance to 5-flucytosine

Molecular epidemiology of vancomycin-resistant Enterococcus faecium clinical isolates in a tertiary care hospital in southern Thailand: a retrospective study

Objective Vancomycin-resistant enterococci are nosocomial pathogens that are responsible for commonly causing healthcare-associated infections, and they exhibit increased resistance to many antimicrobials, particularly to vancomycin. The epidemiological data available on vancomycin-resistant enterococci (VRE) in Thailand are inadequate. Methods Using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR), this study investigated genes that encode antimicrobial resistance and genetic relatedness to further understand VRE prevalence. Ninety VRE isolates were collected between 2011 and 2019 from a tertiary care hospital in southern Thailand. Antimicrobial susceptibility was determined using the disk diffusion method and E-test methods. Multiplex PCR was performed to detect the van gene and virulence genes. Results The study showed a high prevalence of diverse multidrug-resistant VRE strains. The prevalence of VRE infection was the highest in 2014 (28 isolates, 39.4%). VRE were mostly found in the urogenital tract (26 isolates, 28.9%), followed by the digestive tract (20%), body fluid, i.e., pancreatic cyst fluid, peritoneal dialysis fluid, Jackson–Pratt (JP) drain (20%), and blood specimens (10%). Patients in medical and surgical wards had 71.1% multi-drug-resistant and 28.9% extensively drug-resistant (XDR) VRE strains, respectively. The most prevalent antibiotic resistance was to ampicillin (74.4%). Susceptibility to gentamicin and meropenem were similar (7% and 10%, respectively). Four isolates (4.4%) were resistant to colistin. Only vanA was detected among the strains. The virulence gene test showed that the detection rates of enterococcal surface protein (esp) and hyaluronidase (hyl) genes were 91.1% and 5.6%, respectively. According to ERIC-PCR analysis, 51 of 90 strains had clonality, with a similarity rate of 95%. Conclusions We conclude that there is a need to implement infection control practices and active surveillance. Molecular techniques can effectively detect antibiotic-resistant genes, which would allow monitoring to control VRE infection in hospitals

Genotypic variation of <i>C. neoformans</i> isolates from different Asian countries by microsatellite typing.

<p>(A) Minimum spanning tree based on a multistate categorical analysis representing 429 <i>C. neoformans</i> var. <i>grubii</i> isolates from different countries. Each circle represents a unique genotype. The size of the circle corresponds to the number of isolates within that genotype. Numbers and connecting lines correspond to the number of different markers between genotypes. Genotypes with identical colors are part of a microsatellite complex (MC). Circles without color are unique genotypes that are not part of a MC.; (B) Same as A, but now showing the genotypes from different geographic locations. Different colors correspond to different countries.; (C) Same as A and B, but now showing the genotypes from clinical and environmental sources.; (D) Same as A, B and C, but now showing the genotypes of Thai and Japanese population from clinical and environmental sources.</p

Distribution of microsatellite complexes (MCs) between different countries.

<p>The predominant MCs in each country are indicated in bold.</p

The MIC range, MIC₅₀, MIC₉₀, and geometric mean for all 493 <i>C. neoformans</i> isolates for seven antifungals according to clinical and environmental origin of isolates.

<p>The MIC range, MIC₅₀, MIC₉₀, and geometric mean for all 493 <i>C. neoformans</i> isolates for seven antifungals according to clinical and environmental origin of isolates.</p