Efficacy of oritavancin and nisin alone and their combination against vancomycin resistant enterococci strains in hospitalized patients in Turkiye

Abstract

Purpose: Vancomycin-Resistant Enterococci (VREs) have emerged and become a problem that threatens the health of hospitalized patients. VRE can cause different serious infections of the urinary tract, the bloodstream, wound and other body sites. VREs are resistant to multiple antibiotics and treatment options are very limited. We aimed to investigate the efficacy of oritavancin and nisin alone and their combination against VRE strains.

Methods: VRE isolates from rectal swabs of hospitalized patients were identified by conventional and commercial methods. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of oritavancin and nisin against VRE strains were determined. The synergistic effect of both agent combinations was examined by the Checkerboard test.

Results: All VRE strains were identifined as Enterococcus faecium. The MIC value of oritavancin was found in the range of 0.015-0.24 ​μg/mL; in which 48 strains were susceptible (≤0.12 ​μg/mL) and two strains were resistant (>0.12 ​μg/mL). The MBC of oritavancin was determined in the range of 0.06-3.84 ​μg/mL. The MIC of nisin was found in the range of 12.5-100 ​μg/mL; in which 32 strains were susceptible (≤50 ​μg/mL) and 18 strains were resistant (>50 ​μg/mL). MBC of nisin was determined in the range of 25-800 ​μg/mL. Two oritavancin resistant strains were displayed indifference effect, whereas from 18 nisin resistant strains, 11 showed indifference, and seven displayed synergistic effect. Thirty-eight out of 48 strains which were sensitive to oritavancin showed indifference and 10 revealed synergistic effect, whereas 29 of 32 strains which were sensitive to nisin showed indifference and three had synergistic effect.

Conclusions: A synergistic combination of oritavansin and nisin was detected in 20 strains (40%), Our study is the first study in Turkiye.

Keywords: Checkerboard method; Nisin; Oritavancin; Vancomycin-resistant enterococci.