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Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium bacteremia from an Indian tertiary hospital

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Abstract

We determined the clinical and molecular epidemiology of emerging nosocomial vancomycin-resistant Enterococcus faecium (VREfm)–causing serious bloodstream infections (BSIs) and the correlations between antibiotic resistance and virulence determinants among isolates. All isolates were confirmed by molecular methods (16SrRNA and E. faecium ddl genes) and tested for disk diffusion. PCR was used to detect aac(6′)-aph(2″), vanA and vanB resistance genes, and asa1, cylA, ace, esp, gelE and hyl virulence genes. VREfm and high-level gentamicin-resistant (HLGR) representative isolates were selected to characterize by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Of 173 isolates, 73 (42.2%), 146 (84.4%), and 0 (0.0%) were vanA-containing VREfm, aac(6′)-aph(2″)–positive HLGR, and vanB-positive. Independent predictors of VREfm infection were hematological malignancies (P = 0.001) and previous hospitalizations (P = 0.007). Observed mortality rate was 34.7%. Independent predictors of BSI-related mortality were endotracheal intubations (P < 0.001), gastrointestinal diseases (P = 0.002), and pulmonary disease (P < 0.001). All VREfm were resistant to vancomycin, teicoplanin, ciprofloxacin, and erythromycin. The esp, hyl, ace, asa1, cylA, and gelE genes were detected at 55.9, 22.5, 2.9, 2.3, 1.7, and 1.2%, respectively. The esp gene was significantly associated with VREfm compared to VSEfm (P = 0.001). PFGE analysis revealed 23 clones, with 7 major clones. The MLST analysis revealed the following five sequence types: ST80, ST17, ST117, ST132, and ST280, all belonging to CC17. The emergence and expansion of VREfm CC17 with limited antibiotic options in our hospital present a serious public health menace and represent challenges to infection control.

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Acknowledgments

We thank H. Billstrom, V. Vankerckhoven, M. Ravichandran, C. Y. Yean, Claverie-Martín, and E. E. Udo for the gift reference strains. This work was completed as part of Dr. Chandranhan Rao’s Ph.D. thesis.

Funding

This work was supported by the Indian Council of Medical Research (ICMR), New Delhi, India (Project File No.: 5/3/3/10/2011-ECD-I).

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Authors and Affiliations

  1. Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Chandrabhan Rao, Benu Dhawan, Arti Kapil, Bimal Das & Seema Sood

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Sreenivas Vishnubhatla

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  1. Chandrabhan Rao
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  2. Benu Dhawan
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  4. Arti Kapil
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  5. Bimal Das
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Correspondence to Benu Dhawan.

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The authors declare that they have no conflict of interest.

Ethical approval and informed consent

This study was approved by the Ethics Committee of the AIIMS, New Delhi, India (Ref. No.: IEST/T-151/2010). The informed consent of each patient included in this study was obtained.

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Rao, C., Dhawan, B., Vishnubhatla, S. et al. Clinical and molecular epidemiology of vancomycin-resistant Enterococcus faecium bacteremia from an Indian tertiary hospital. Eur J Clin Microbiol Infect Dis 40, 303–314 (2021). https://doi.org/10.1007/s10096-020-04030-3

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