Bacteriological and epidemiological profile of vancomycin-resistant Enterococcus faecium infections in Sahloul University Hospital

Abstract

Introduction: Antibiotics resistance is an emerging problem in isolates of Enterococcus faecium (E. faecium) which may develop resistance to vancomycin. The aims of this work were to establish the bacteriological profile of vancomycin resistant E. faecium (VRE) infections, to describe the clinical characteristics of the corresponding patients and the evolution of the consumption of antibiotics that can select VRE. Methods: It’s a retrospective study conducted in the Microbiology laboratory of the Sahloul Hospital in Sousse, Tunisia. It concerned all non-redundant isolates of VRE isolated from positive cultures of all types of clinical samples taken from patients hospitalized from 2016 to 2018. The epidemiological and clinical characteristics of patients with at least one culture-positive VRE specimen were collected. Data regarding antibiotic consumption and the occupancy from 2015 to 2018 were collected from the Pharmacy department and statistics office of the hospital, respectively. A chi-squared test was used to compare the number of VRE cases during the years of study. Results: There was a significant increase of VRE cases in 2017 (n=34) in comparison with 2016 (n=6) and 2018 (n=17). Most of VRE isolates had been isolated from urine samples and deep suppurations. They were multi-resistant to antibiotics. On the patient level, the main classes of antibiotics consumed during the same period were third generation cephalosporins and carbapenems in 20% of cases, teicoplanin and fluoroquinolones in 13% of cases. At the hospital level, excessive consumption of fluoroquinolones, of Amoxicillin–clavulanic acid and carbapenems was recorded during the study period. Conclusion: VRE infections occur mainly in patients with underlying diseases, a history of antibiotic consumption and long term hospitalization. The abusive consumption of antibiotics seems to be incriminated in the selection and the increase of number of VRE.