Vancomycin Resistant Enterococci and Trend of Antimicrobial Susceptibility in Urine Cultures

Jitu Mani Kalita; Kavita Yedale; Vibhor Tak; Vijaya Lakshmi Nag; Alisha Aggarwal; Gautam Ram Choudhary

doi:10.18502/jmb.v12i3.16596

Jitu Mani Kalita Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Kavita Yedale Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Vibhor Tak Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Vijaya Lakshmi Nag Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Alisha Aggarwal Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Gautam Ram Choudhary Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.

DOI: https://doi.org/10.18502/jmb.v12i3.16596

Keywords: HiChrome UTI agar, Multidrug resistant, Urinary tract infection, Vancomycin resistant enterococci.

Abstract

Background: Enterococci are emerging nosocomial pathogen showing resistance to broad spectrum antibiotics. As reported by the center for disease control and prevention, enterococci (13.9%) are the second leading cause of urinary tract infection, after Escherichia coli. After the first report of vancomycin-resistant enterococci in England (1988), India reported its first vancomycin resistant enterococci isolate from New Delhi (1999). The prevalence of vancomycin resistant enterococci ranges from 1-9%, in India. To evaluate the prevalence of vancomycin resistant enterococci among urinary isolates and to check their antimicrobial resistance pattern.

Methods: A retrospective observational study conducted at a tertiary care hospital. Data were analysed from November, 2017 to October, 2018. A total of 12,129 urine samples were received and subjected to culture on HiCrome UTI agar (Hi-Media laboratories, Mumbai) and incubated at 37 °C for a period of 18-24 hours. Antimicrobial susceptibility was performed using Kirby–Bauer disc diffusion method. Identification was done on the basis of colony colour and species identification was done by using biochemical test as per standard laboratory protocol. In one case automated siemens microscan walkaway identification system was used for confirmation.

Results: Enterococci were isolated in 4.06% from urine cultures out of which 7.52% were vancomycin resistant. Most of the vancomycin resistant enterococci isolate (86.49%) were multi drug resistant.

Conclusion: In vancomycin resistant enterococci related urinary tract infection, nitrofurantoin can be used as an appropriate first choice in uncomplicated cases and linezolid should be reserved for serious and complicated urinary tract infections.