Vancomycin-Resistant Enterococci in Fecal Samples from Hospitalized Patients and Non- Hospitalized Individuals in Gaza City

Abstract

Vancomycin-resistant enterococci (VRE) have emerged as nosocomial pathogens over the last decade all over the world. Despite the use of vancomycin inGaza, there is no available data concerning resistance against it. In order to determine the occurence of vancomycin-resistant enterococci (VRE) in Gaza City, 100 hospitalized patients from medical and surgical intensive care unit (ICU), pediatric ICU, renal units and hemato-oncology wards at Al Shifa and Al Naser hospitals were screened for VRE fecal colonization. In addition, 100 non-hospitalized individuals from all overGazacity were screened. Specimens were enriched and cultured on selective media for the isolation of enterococci. All isolates were identified and their minimum inhibitory concentration for vancomycin was determined. The susceptibilities of the enterococci to vancomycin, ampicillin, penicillin, tetracycline, ciprofloxacin, chloramphenicol, and gentamicin were determined by the disk diffusion method. A questionnaire was introduced to 100patients or their guardians to be filled. A second questionnaire was introduced to 100 healthy subjects or their guardians to be filled. Another questionnaire was distributed to hospital physicians to assess the extent of vancomycin use. Enterococci were found in 94% of the hospitalized patients and in 89% of non-hospitalized individuals. VRE were isolated from 69.1% and 43.8% hospitalized patients and non-hospitalized individuals, respectively. High rates of resistance to an important antimicrobials used in human medicine were observed. E. faecalis was observed to be the predominant species recovered among non-hospitalized individuals (34%), while among hospitalized patients, E. faecium was the predominant identified species (37%). Among hospitalized patients and non-hospitalized individuals, E. faecium has the highest resistance rate to vancomycin. In conclusion, enterococci isolated from hospitalized and non hospitalized subjects in Gaza city have high rates of antibiotic resistance including vancomycin. Strategies to promptly identify colonized patients should be designed and implemented in hospitals. Prompt identification is based on targeted surveillance, considering risk factors for VRE colonization.