Enterococci: Emerging Drug Resistant Bacteria In Hospital Acquired Infections At Hospital Kuala Lumpur, Malaysia

摘要

Enterococci are the most common pathogens in hospital acquired infections. Some of them are resistant to Vancomycin(VRE) and some are susceptible to Vancomycin (VSE). The present study was carried out to identify enterococci from clinical cases and to illustrate their clinical features and drug resistance characteristics. Antibiotics susceptibility of the identified bacteria was determined by disk diffusion method and E-test. Drug resistance properties were evaluated against ampicillin, gentamicin, vancomycin, teicoplanin and linezolid. Relating to clinical features, 244 cases of enterococci infected patients were identified at hospital Kuala Lumpur (HKL) Malaysia based on clinical information from the hospital. Of the patients 21% had history of urinary tract infections, 17.2% end stage renal disease, 12.2% sepsis, 8.4% malignancy, 12.2% had head injury and neurological problems, 4.2% diabetes mellitus and other clinical manifestations .In case of Vancomycin resistant enterococci infection, the clinical features of the patients were: end stage renal failure 3/6 (50%) and others with diabetes mellitus, interstitial lung disease and nephrotic syndrome. The patients of the enterococci infections were more prevalent in nephrology-urology unit (39%) and medical wards (including ICU, 23%) The findings would serve as an alert to the clinicians of the emergence of infections by enterococci and encourage implementation of appropriate infection control measures in order to curb further rise in prevalence. Introduction Enterococci normally present in the human intestines and in the female genital tract and are often found in the environment. Recent National Nosocomial Infections Surveillance1 reveals that these enterococci remain in the top 3 most common pathogens that cause nosocomial infections. These are: urinary tract infections, bloodstream infections, and wound infections in hospitalized patients. Enterococci infections typically occur in very ill debilitated patients who have been exposed to broad-spectrum antibiotics. According to NNIS2 data from January 2003 through December 2003, more than 28% of enterococci isolates were found to be associated infections in incentive care unit (ICU) of 300 participating hospitals.The acquisition of vancomycin resistance by enterococci has seriously affects treatment and infection control program which leaves clinicians treating VRE infections with limited therapeutic options (Fraser, 2010)NNIS2 reported that more than 25% of health care-associated enterococcal infections were associated with organisms resistant to vancomycin. In Malaysia 2006, a confirmed case of vancomycin resistant Enterococci isolated from blood culture of a young woman with chronic renal failure was first reported in Hospital Kuala Lumpur (HKL).3 However, later on, no systematic study was undertaken to determine the prevalence of enterococci infections from the hospitalized patients in Malaysia. Therefore, the present study was undertaken to determine the prevalence of enterococci infections in hospitalized patients and determination of their clinical features and drug resistance nature. Materials and Methods Study areaThe study was carried out during May 2007 to April 2008 at Hospital Kuala Lumpur (HKL), Malaysia. The hospital consists of 3000 beds and 90 wards and provides services and acts as a reference centre for the hospitals of other states, in Malaysia. Study population and sample collectionA total number of 244 samples obtained from the patients of different infections during the period. The samples included blood, urine, pus, tissue, body fluids and swabs from wound and placenta. The samples were sent to the Microbiology Laboratory, Department of Medical Microbiology and Immunology, Faculty of Medicine, University Kebangsaan Malaysia for identification and characterization.Information on clinical dataInformation on patient’s profiles :age, diagnosis, risk factors such as duration of hospitalization (prolonged >2