FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W18739995> ?p ?o ?g. }

• W18739995 endingPage "628" @default.
• W18739995 startingPage "625" @default.
• W18739995 abstract "Original ArticlesVancomycin-Resistant Enterococci (VRE) as Normal Flora of the Intestine in Patients at a Tertiary Care Hospital S.M. Hussain Qadri and PhD, FRCPath, Diplomate ABMM, FAAM A. Gerald PostleRT (CSLT) S.M. Hussain Qadri Address reprint requests and correspondence to Dr. Qadri: King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, MBC 10, Riyadh 11211, Saudi Arabia. From the Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh Search for more papers by this author and A. Gerald Postle From the Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh Search for more papers by this author Published Online:1 Nov 1996https://doi.org/10.5144/0256-4947.1996.625SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractThere has been a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) in American and European hospitals in the last six to seven years, with fecal carriage reported to be as high as 86% on some services. In order to determine the frequency of VRE as normal flora of the intestine in Saudi patients, microbiological analysis of stool specimens from 4276 patients from a tertiary care referral hospital was performed. VRE, identified as Enterococcus faecium, was found in six patients. None of the patients had any clinical disease associated with VRE. Five were hospitalized patients, four with severe underlying diseases; five had a history of prior antimicrobial therapy with broad-spectrum antibodies and two of them were treated with vancomycin.IntroductionEnterococci constitute normal flora of the human intestine. Although considered as bacteria of low virulence, they have been associated with urinary tract infections, intraabdominal infections, bacteremia and endocarditis, especially in compromised patients. They account for 12% of all nosocomial infection reported in the USA, second only to Escherichia coli in incidence.1,2 During the last 15 years, these bacteria have become more resistant to ampicillin and have acquired a high level of resistance to aminoglycosides.3–5 The most disturbing trend to emerge is vancomycin resistance. Since the initial report of vancomycin-resistant enterococci (VRE) from France in 1988,6 their occurrence has been reported from the USA, the UK, Germany, the Netherlands, Spain and Saudi Arabia.7–14 A rapid increase in the incidence of infection and colonization with VRE has been seen in US hospitals in the last five years, with a fecal carriage rate of as high as 86% in Pittsburgh.15 Since no one has reported the colonization of Saudi patients with VRE, we did a prospective study to determine the prevalence of its fecal carriage in patients at a tertiary care center. Our findings are presented in this paper.MATERIAL AND METHODSStool specimens from 4276 patients at King Faisal Specialist Hospital and Research Centre were collected during the period from March 1, 1995, to February 29, 1996. The specimens were received in the laboratory in wide-mouthed, water-tight plastic containers with tightfitting lids. All stool specimens received during the study period of one year for bacterial cultures from both outpatients as well as inpatients from all services (e.g., ICU, oncology, surgery, ob/gyn, medicine, etc.) were analyzed for the presence of VRE. The hospital is a 500-bed tertiary care facility which also serves as a referral center for Saudi Arabia and the Middle East. Specimens were inoculated on 5% sheep blood agar (BAP), McConkey agar and Campy BAP (containing 10 mg vancomycin/L). All plates were incubated at 35°C for 24-48 hours, BAP and McConkey under aerobic and Campy BAP under microaerophilic conditions. Suspected colonies of enterococci were selected from either BAP and/or Campy BAP, and identified by morphology, cultural characteristics and biochemical tests as per standard procedure16 and confirmed by the GPI (Gram positive identification) system (Vitek Systems, Inc., Hazelwood, MO, USA). Initial susceptibility to antimicrobial agents was tested by disk-diffusion test according to the recommendations of the National Committee for Clinical Laboratory Standards.17 Minimum inhibitory concentration (MIC) of Enterococcus against antimicrobials was determined by Vitek Systems and confirmed by standard broth dilution method.18 For MIC determination, Mueller-Hinton broth, pH 7.2-7.4, was used as the test medium and inoculated with the turbidity-adjusted suspension of the isolate to achieve a final inoculum of 105 CFU/mL.18S. faecalis ATCC 29212 was used as a quality control organism during MIC determination. Results were found to be within the expected ranges.18RESULTS AND DISCUSSIONDuring the period from March 1, 1995, to February 29, 1996, we examined stool specimens from 4276 patients for the presence of VRE. Ninety-one percent of the specimens processed were from inpatients, with an age range of one month to 76 years old. VRE were found in six patients and all were identified as E. faecium. Medical records of these six patients were reviewed and their clinical features are summarized in Table 1. The patients ranged from a baby boy of three months with acute lymphocytic leukemia to a 49-year-old female with irregular menstrual bleeding. All the patients except patient #5 were inpatients when VRE was detected in their stool specimen. Patient #5 was grossly obese (height 120 cm, weight 45 kg), with a long history of colic and recurrent diarrhea, who was seen at the hospital employee health clinic as an outpatient. None of the patients grew enterococci or VRE from any other clinical specimens. High resistance to vancomycin (MIC >256 mg/L) was found in all the six isolates, and to gentamicin in five isolates (Table 2). Four and six isolates had therapeutically achievable levels of MICs for ciprofloxacin and augmentin, respectively.Table 1. Clinical features of patients with VRE colonization.Table 2. Antimicrobial susceptibility of VRE isolates.Although the epidemiology of VRE has not been completely elucidated, we know that certain patients are at increased risk for VRE colonization or infection. These include critically sick patients, those with severe underlying disease or immunosuppression, patients in the oncology or transplant wards, those with intra-abdominal or cardiothoracic surgical procedures, patients with indwelling urinary or central venous catheters, and those with prolonged hospitalization or receiving broadspectrum antimicrobial and/or vancomycin therapy.19–22According to the Centers for Disease Control and Prevention (CDC) of Nosocomial Infections Surveillance System, the percentage of nosocomial enterococci resistant to vancomycin increased from 0.3% in 1989 to 7.9% in 1993. Among patients in ICUs with nosocomial infections, the percentage of VRE increased from 0.4% in 1989 to 13.6% in 1993.23 The rate of colonization has varied at different geographic locations. Initially, Uttley et al.9 reported the largest clusters of nosocomial infections or colonization involving 45 strains of three species of VRE in the UK. Jorden et al.24 examined 354 stool specimens at the John Radcliffe Hospital (UK) and found that 19 (5.4%) patients were colonized by VRE. The colonization rate of 3.5% in Belgium and up to 86% in liver transplant and oncology units in the US have been reported.15,25,26 Since our first report describing isolation of VRE from a wound infection three years ago,10 we have isolated VRE from the blood of two patients, and from the mitral valve and the urine of one patient each. We know of only one other report of VRE from Saudi Arabia which described VRE colonization in a patient with acute myeloid leukemia, who subsequently developed VRE septicemia.27 With the exception of one of our patients (#5 in this paper), all other infected or colonized patients in Saudi Arabia had underlying diseases. Only one of them (patient #4 in this report) did not have a history of broad-spectrum antimicrobial administration.Although we have found VRE infection in five patients and fecal colonization in six of the 4276 patients, prevalence of VRE appears to be very low in Saudi Arabia. Informal discussions with the laboratory staff and infectious diseases practitioners of most large hospitals in the Kingdom indicated that none have seen VRE except a reported case in Riyadh Military Hospital.27 However, one of the primary problems in the West in tracing the history of VRE has been failure to look for VRE in many centers until the 1990s. During a 1993 survey of all the accredited New York hospitals and laboratories, Frieden et al.33 found that 76 of the 81 hospitals tested all isolates for VRE, three only blood isolates, and two did not test enterococci for vancomycin susceptibility. Fifteen percent of the 48 nonhospital-based laboratories in the survey did not look for VRE. Similarly, commonly used techniques vary in their ability to detect VRE. In a recent study,34 it was found that NCCLS-recommended methods17,18 showed a specificity and sensitivity of 100%, compared with 98% and 73%, respectively, for Vitek (BioMerieux, Hazelwood, MO, USA) and 98% and 93% respectively, for Microscan (Baxter, West Sacramento, CA, USA). Therefore, disc diffusion or dilution methods17,18 appear to be the preferred procedures for screening VRE.Since most of the enterococcal infections are endogenous, it appears that VRE may be present in the community and become part of the intestinal flora of patients entering hospitals. VRE have been isolated from sewage treatment plants,28,29 from the fecal samples of broiler chicken, thawing liquids of commercially produced frozen chicken and turkey, chicken and pig farms and minced meat of pigs in Europe.30–32 In almost all the cases, VRE were associated with the use of glycopeptide avoparcin (Avotan, Cyanamid International) as a growth promoter in the animal feed, and were not found in farms or meat samples of chicken that were fed without avoparcin.30–32 These findings suggest that hospitals may not be the only source of VRE and other factors may exert a selective pressure. We believe that investigation of environmental sources, poultry farms and cattle farms in Saudi Arabia for the presence of VRE would indicate the extent of the problem in this part of the world.ARTICLE REFERENCES:1. Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory . Clin Microbiol Rev. 1993; 6: 428–42. Google Scholar2. Schalbern DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection . Am J Med. 1991; I(Suppl 3B): 72S–5S. Google Scholar3. Grayson L, Eliopoulos GM, Wennerstern C, Rouff K, De Girolami P, Fenaro MJ, Moellering R. Increasing resistance to ß-lactam antibiotics among clinical isolates of Enterococcus faecium: a 22-year review at one institution . Antimicrob Agents Chemother. 1991; 35: 2180–4. Google Scholar4. Watanakunakorn W. Enterococci from blood cultures during 1980-1989. Susceptibilities to ampicillin, penicillin and vancomycin . J Antimicrob Chemother. 1990; 26: 602–4. Google Scholar5. Murray BE. The life and times of the Enterococcus . Clin Microbiol Rev. 1990; 3: 46–65. Google Scholar6. Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid mediated resistance to vancomycin and teicoplanin in Enterococcus faecium . N Engl J Med. 1988; 319: 157–61. Google Scholar7. Montecalvo MA, Horowitz H, Gedris C, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit . Antimicrob Agents Chemother. 1994; 38: 1363–7. Google Scholar8. Handwerger S, Perlman DC, Altarac D, McAuliffe V. Concommitant high-level vancomycin and penicillin resistance in clinical isolates of enterococci . Clin Infect Dis. 1992; 14: 655–61. Google Scholar9. Uttley AHC, George RC, Naidoo J, et al. High-level vancomycinresistant enterococci causing hospital infections . Epidemiol Infec. 1989; 103: 173–81. Google Scholar10. Qadri SMH, Quinibi WY, Al-Ballaa SR, Kadhi Y, Burdette JM. Vancomycin-resistant Enterococcus: a case report and review of literature . Ann Saudi Med. 1993; 13: 289–93. Google Scholar11. Leclercq R, Derlot E, Weber M, et al. Transferable vancomycin and teicoplanin resistance in Enterococcus faecium . Antimicrob Agents Chemother. 1989; 33-10–5. Google Scholar12. Shlaes DM, Al-Obeid S, Shlaes JH, Williamson R. Activity of various glycopeptides against an inducibly vancomycin-resistant strain of Enterococcus faecium (D366) . J Infect Dis. 1989; 159: 1132–5. Google Scholar13. Shay DK, Goldman DA, Jarvis WR. Reducing the spread of antimicrobial-resistant microorganisms. Control of vancomycinresistant enterococci . Pediatr Clin North America. 1995; 42: 703–16. Google Scholar14. Spera RV, Farber BF. Multidrug-resistant Enterococcus faecium. An untreatable nosocomial pathogen . Drugs. 1994; 48: 678–88. Google Scholar15. Linden P, Pasculle AW, Kramer DJ, Jusne S, Manez R. The duration of fecal carriage of vancomycin-resistant Enterococcus faecium (VREF) . University of Pittsburgh Medical Center, Pittsburgh, PA. Abstract 34th Interscience Conference on Antimicrob Agents Chemother, Orlando, Fla. 1994;J–150. Google Scholar16. Murray PR, Baron MJ, Pfaller MA, Tenover FC, Yolken RH. Manual of Clinical Laboratory. 6th ed. Washington, DC: American Society for Microbiology, 1995. Google Scholar17. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved Standard M2-A5. National Committee for Clinical Laboratory Standards, Villanova, PA, 1993. Google Scholar18. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. Approved standard M7-A3. National Committee for Clinical Laboratory Standards, Villanova, PA, 1993. Google Scholar19. Rubin LG, Tucci V, Cercenado E, Eliopoulos G, Isenberg HD. Vancomycin-resistant Enterococcus faecium in hospitalized children . Infect Control Hosp Epidemiol. 1992; 13: 700–5. Google Scholar20. Karanfil LV, Murphy M, Josephson A, et al. A cluster of vancomycinresistant Enterococcus faecium in an intensive care unit . Infect Control Hosp Epidemiol. 1992; 13: 195–200. Google Scholar21. Handwerger S, Rancher B, Altarac D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin . Clin Infect Dis. 1993; 16: 750–5. Google Scholar22. Hospital Infection Control Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance . Infec Control Hosp Epidemiol. 1995; 16: 105–13. Google Scholar23. Centers for Disease Control and Prevention. Nosocomial Enterococci resistant to vancomycin—United States, 1989-1993 . MMWR. 1993; 42: 597–9. Google Scholar24. Jorden JZ, Bates J, Griffiths DT. Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium . J Antimicrob Chemother. 1994; 34: 515–28. Google Scholar25. Montecalvo M, Carraher P, Gedris C, Van Horn K, Wormser GP. Persistence of perianal colonization with vancomycin-resistant enterococci (VRE) in adult oncology patients . Abstracts 34th Interscience Conference on Antimicrob Agents Chemother, Orlando, Fla., 1994; J152. Google Scholar26. Gordts B, Clabys K, Jannes H, Van Landuyt HW. Are vancomycinresistant enterococci (VRE) normal inhabitants of the G. I. tract of hospitalized patients? Abstracts 34th Interscience Conference on Antimicrob Agents Chemother, Orlando, Fla., 1994;J151. Google Scholar27. Osoba AO, Jeha MT, Bakheshwain S, Al-Anazi K, Bertlett F. Septicemia due to vancomycin-resistant Enterococcus: a case report . Saudi Med J. 1995; 16: 67–9. Google Scholar28. Klare I, Heier H, Claus H, Witte W. Environmental strains of Enterococcus faecium with inducible high-level resistance to glycopeptides . FEMS Microbiol Lett. 1993; 106: 23–90. Google Scholar29. Klare I, Heier H, Claus H, Reissbrodt R, Witte W. van A-mediated high-level glycopeptide resistance in Enterococcus faecium from animal husbandry . FEMS Microbiol Lett 125: 165–72. Google Scholar30. Torres C, Reguera JA, Sanmartin MJ, Perez-Diaz JC, Baquero F. van A-mediated vancomycin-resistant Enterococcus spp in sewage . J Antimicrob Chemother. 1994; 33: 553–61. Google Scholar31. Klare I, Heier H, Claus H, Bohme G, Marin S, Seltmann G, Hakenbeck R, Antanassova V, Witte W. Enterococcus faecium strains with van Amediated high-level glycopeptide resistance isolated from animal foodstuffs and fecal samples of humans in the community . Microbial Drug Res. 1995; 1: 265–72. Google Scholar32. Aarestrup FM. Occurrence of glycopeptide resistance among Enterococcus faecium isolates from conventional and ecological poultry farms . Microbial Drug Res. 1995; 1: 255–7. Google Scholar33. Frieden TR, Munsiff SS, Lowe DE, et al. Emergence of vancomycinresistant enterococci in New York City . Lancet. 1993; 342: 76–9. Google Scholar34. Willey BM, Kreiswirth BN, Simor AE, et al. Detection of vancomycin resistance in Enterococcus species . J Clin Microbiol. 1992; 30: 1621–4. Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byAl-Tawfiq J (2012) Changes in the pattern of hospital intravenous antimicrobial use in Saudi Arabia, 2006–2008, Annals of Saudi Medicine, 32:5, (517-520), Online publication date: 1-Sep-2012.Qadri S, Postle A, Qari M and Quraishi M (1997) Vancomycin-Resistant Enterococci (VRE) as Intestinal Flora from Poultry in Riyadh, Annals of Saudi Medicine, 17:5, (553-554), Online publication date: 1-Sep-1997. Volume 16, Issue 6November 1996 Metrics History Received26 March 1996Accepted18 June 1996Published online1 November 1996 ACKNOWLEDGMENTSThe authors wish to thank the laboratory staff for technical assistance and Mrs. Amy P. Tullo for secretarial assistance.InformationCopyright © 1996, Annals of Saudi MedicinePDF download" @default.
• W18739995 created "2016-06-24" @default.
• W18739995 creator A5036517573 @default.
• W18739995 creator A5090975264 @default.
• W18739995 date "1996-11-01" @default.
• W18739995 modified "2023-10-01" @default.
• W18739995 title "Vancomycin-Resistant Enterococci (VRE) as Normal Flora of the Intestine in Patients at a Tertiary Care Hospital" @default.
• W18739995 cites W1667417607 @default.
• W18739995 cites W1904634031 @default.
• W18739995 cites W1971759055 @default.
• W18739995 cites W1971826255 @default.
• W18739995 cites W1990753471 @default.
• W18739995 cites W2009418790 @default.
• W18739995 cites W2009889907 @default.
• W18739995 cites W2010604983 @default.
• W18739995 cites W2012311967 @default.
• W18739995 cites W2015617625 @default.
• W18739995 cites W2018117064 @default.
• W18739995 cites W2064678397 @default.
• W18739995 cites W2072749218 @default.
• W18739995 cites W2088875356 @default.
• W18739995 cites W2104019014 @default.
• W18739995 cites W2104923518 @default.
• W18739995 cites W2141981235 @default.
• W18739995 cites W2160112462 @default.
• W18739995 cites W2234454261 @default.
• W18739995 cites W2314897771 @default.
• W18739995 cites W2325812089 @default.
• W18739995 cites W2411086081 @default.
• W18739995 cites W4240285416 @default.
• W18739995 cites W4245575043 @default.
• W18739995 cites W4249148562 @default.
• W18739995 doi "https://doi.org/10.5144/0256-4947.1996.625" @default.
• W18739995 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/17429236" @default.
• W18739995 hasPublicationYear "1996" @default.
• W18739995 type Work @default.
• W18739995 sameAs 18739995 @default.
• W18739995 citedByCount "7" @default.
• W18739995 countsByYear W187399952012 @default.
• W18739995 countsByYear W187399952013 @default.
• W18739995 countsByYear W187399952019 @default.
• W18739995 crossrefType "journal-article" @default.
• W18739995 hasAuthorship W18739995A5036517573 @default.
• W18739995 hasAuthorship W18739995A5090975264 @default.
• W18739995 hasConcept C126322002 @default.
• W18739995 hasConcept C177713679 @default.
• W18739995 hasConcept C2777234453 @default.
• W18739995 hasConcept C2778980435 @default.
• W18739995 hasConcept C2779489039 @default.
• W18739995 hasConcept C2780585763 @default.
• W18739995 hasConcept C2910137292 @default.
• W18739995 hasConcept C2991842025 @default.
• W18739995 hasConcept C501593827 @default.
• W18739995 hasConcept C523546767 @default.
• W18739995 hasConcept C54355233 @default.
• W18739995 hasConcept C71924100 @default.
• W18739995 hasConcept C86803240 @default.
• W18739995 hasConcept C89423630 @default.
• W18739995 hasConceptScore W18739995C126322002 @default.
• W18739995 hasConceptScore W18739995C177713679 @default.
• W18739995 hasConceptScore W18739995C2777234453 @default.
• W18739995 hasConceptScore W18739995C2778980435 @default.
• W18739995 hasConceptScore W18739995C2779489039 @default.
• W18739995 hasConceptScore W18739995C2780585763 @default.
• W18739995 hasConceptScore W18739995C2910137292 @default.
• W18739995 hasConceptScore W18739995C2991842025 @default.
• W18739995 hasConceptScore W18739995C501593827 @default.
• W18739995 hasConceptScore W18739995C523546767 @default.
• W18739995 hasConceptScore W18739995C54355233 @default.
• W18739995 hasConceptScore W18739995C71924100 @default.
• W18739995 hasConceptScore W18739995C86803240 @default.
• W18739995 hasConceptScore W18739995C89423630 @default.
• W18739995 hasIssue "6" @default.
• W18739995 hasLocation W187399951 @default.
• W18739995 hasLocation W187399952 @default.
• W18739995 hasOpenAccess W18739995 @default.
• W18739995 hasPrimaryLocation W187399951 @default.
• W18739995 hasRelatedWork W1972298183 @default.
• W18739995 hasRelatedWork W2005817618 @default.
• W18739995 hasRelatedWork W2086351130 @default.
• W18739995 hasRelatedWork W2140760349 @default.
• W18739995 hasRelatedWork W2474783783 @default.
• W18739995 hasRelatedWork W2593414419 @default.
• W18739995 hasRelatedWork W2756630929 @default.
• W18739995 hasRelatedWork W3082561586 @default.
• W18739995 hasRelatedWork W4282559812 @default.
• W18739995 hasRelatedWork W3118643602 @default.
• W18739995 hasVolume "16" @default.
• W18739995 isParatext "false" @default.
• W18739995 isRetracted "false" @default.
• W18739995 magId "18739995" @default.
• W18739995 workType "article" @default.