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

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

Genomic Characterization of Mobile Genetic Elements Associated with Multidrug-Resistant <i>Acinetobacter</i> Non-<i>baumannii</i> Species from Southern Thailand

This study investigated the genetic diversity, antimicrobial resistance profiles, and virulence characteristics of Acinetobacter non-baumannii isolates obtained from four hospitals in southern Thailand. Clinical data, genome information, and average nucleotide identity (ANI) were analyzed for eight isolates, revealing diverse genetic profiles and novel sequence types (STs). Minimum spanning tree analysis indicated potential clonal spread of certain STs across different geographic regions. Antimicrobial resistance genes (ARGs) were detected in all isolates, with a high prevalence of genes conferring resistance to carbapenems, highlighting the challenge of antimicrobial resistance in Acinetobacter spp. infections. Mobile genetic elements (MGEs) carrying ARGs were also identified, emphasizing the role of horizontal gene transfer in spreading resistance. Evaluation of virulence-associated genes revealed a diverse range of virulence factors, including those related to biofilm formation and antibiotic resistance. However, no direct correlation was found between virulence-associated genes in Acinetobacter spp. and specific clinical outcomes, such as infection severity or patient mortality. This complexity suggests that factors beyond gene presence may influence disease progression and outcomes. This study emphasizes the importance of continued surveillance and molecular epidemiological studies to combat the spread of multidrug-resistant (MDR) Acinetobacter non-baumannii strains. The findings provide valuable insights into the epidemiology and genetic characteristics of this bacteria in southern Thailand, with implications for infection control and antimicrobial management efforts

Antimicrobial Susceptibility and Molecular Features of Colonizing Isolates of <i>Pseudomonas aeruginosa</i> and the Report of a Novel Sequence Type (ST) 3910 from Thailand

Pseudomonas aeruginosa is an important pathogen as it can cause hospital-acquired infections. Additionally, it can also colonize in patients and in other various environments. Hence, this study aimed to investigate the antimicrobial susceptibility, and to study the molecular features, of colonizing isolates of P. aeruginosa from Songklanagarind Hospital, Thailand. Genomic DNA extraction, whole-genome sequencing (WGS), and bioinformatics analysis were performed in all studied isolates. The findings demonstrated that the majority of isolates were non-susceptible to colistin and carbapenem. For in silico study, multilocus sequence typing (MLST) revealed one novel sequence type (ST) 3910 and multiple defined STs. The isolates carried several antimicrobial resistance genes (blaOXA-50, aph(3′)-IIb, etc.) and virulence-associated genes (fleN, waaA, etc.). CRISPR-Cas sequences with different spacers and integrated bacteriophage sequences were also identified in these isolates. Very high SNPs were found in the alignments of the novel ST-3910 isolate with other isolates. A comparative genomic analysis exhibited phylogenetic clustering of our colonizing isolates with clinical isolates from many countries. Interestingly, ST-3981, ST-3982, ST-3983, ST-3984, ST-3985, ST-3986, ST-3986, ST-3986, ST-3987, and ST-3988, the new STs from published genomes, were assigned in this study. In conclusion, this WGS data might be useful for tracking the spread of P. aeruginosa colonizing isolates