Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 27:11:1275778.
doi: 10.3389/fpubh.2023.1275778. eCollection 2023.

Epidemiology of vancomycin-resistant enterococci in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data

Jens Thomsen  1   2 , Najiba M Abdulrazzak  3 , Hussain AlRand  4 ; UAE AMR Surveillance Consortium; Godfred Antony Menezes  5 , Carole A Moubareck  6 , Dean B Everett  2   7   8 , Abiola Senok  9   10 , Andreas Podbielski  11
Affiliations

Epidemiology of vancomycin-resistant enterococci in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data

Jens Thomsen et al. Front Public Health. .

Abstract

Introduction: Enterococci are usually low pathogenic, but can cause invasive disease under certain circumstances, including urinary tract infections, bacteremia, endocarditis, and meningitis, and are associated with peritonitis and intra-abdominal abscesses. Increasing resistance of enterococci to glycopeptides and fluoroquinolones, and high-level resistance to aminoglycosides is a concern. National antimicrobial resistance (AMR) surveillance data for enterococci from the Middle East and North Africa (MENA) and the Gulf region is scarce.

Methods: A retrospective 12-year analysis of N = 37,909 non-duplicate diagnostic Enterococcus spp. isolates from the United Arab Emirates (UAE) was conducted. Data was generated by routine patient care during 2010-2021, collected by trained personnel and reported by participating surveillance sites to the UAE National AMR Surveillance program. Data analysis was conducted with WHONET.

Results: Enterococcus faecalis was the most commonly reported species (81.5%), followed by Enterococcus faecium (8.5%), and other enterococci species (4.8%). Phenotypically vancomycin-resistant enterococci (VRE) were found in 1.8% of Enterococcus spp. isolates. Prevalence of VRE (%VRE) was highest for E. faecium (8.1%), followed by E. faecalis (0.9%). A significant level of resistance to glycopeptides (%VRE) for these two species has been observed in the majority of observed years [E. faecalis (0-2.2%), 2010: 0%, 2021: 0.6%] and E. faecium (0-14.2%, 2010: 0%, 2021: 5.8%). Resistance to fluoroquinolones was between 17 and 29% (E. faecalis) and was higher for E. faecium (between 42 and 83%). VRE were associated with higher patient mortality (RR: 2.97), admission to intensive care units (RR: 2.25), and increased length of stay (six excess inpatient days per VRE case), as compared to vancomycin-susceptible Enterococcus spp.

Discussion: Published data on Enterococcus infections, in particular VRE-infections, in the UAE and MENA region is scarce. Our data demonstrates that VRE-enterococci are relatively rare in the UAE, however showing an increasing resistance trend for several clinically important antibiotic classes, causing a concern for the treatment of serious infections caused by enterococci. This study also demonstrates that VRE were associated with higher mortality, increased intensive care unit admission rates, and longer hospitalization, thus poorer clinical outcome and higher associated costs in the UAE. We recommend the expansion of current surveillance techniques (e.g., local VRE screening), stricter infection prevention and control strategies, and better stewardship interventions. Further studies on the molecular epidemiology of enterococci are needed.

Keywords: United Arab Emirates (UAE); antimicrobial resistance (AMR); surveillance; vancomycin; vancomycin-resistant enterococci (VRE).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Number of surveillance sites participating in National AMR surveillance over the surveillance period (2010–2021), by year and Emirate.
Figure 2
Figure 2
Numbers of non-repetitive Enterococcus spp. isolated per year over the surveillance period (2010–2021), by year.
Figure 3
Figure 3
Species distribution of Enterococcus spp. over the surveillance period (2010–2021), by year and species.
Figure 4
Figure 4
Age distribution of Enterococcus spp. patients over the surveillance period (2010–2021), by year and age category. Newborn: 0–30 days, Pediatric: 1 month to 18 years, Adult: 19+ years.
Figure 5
Figure 5
Gender and age distribution of Enterococcus spp. patients over the surveillance period (2010–2021), by male (A) and female (B) gender and age group.
Figure 6
Figure 6
Distribution of Enterococcus spp. non-duplicate isolates/patients over the surveillance period (2010–2021), by sample type group.
Figure 7
Figure 7
Resistance trends of Enterococcus faecalis (A) and Enterococcus faecium (B) to 10 antibiotics over the period of the study (2010–2021), by year and antibiotic.
Figure 8
Figure 8
Enterococcus species: trend of percent MDR (% MDR) (A), % possible XDR (B), and % possible PDR (C) over the study period (2010–2021), by year.
See this image and copyright information in PMC

References

    1. Kåhrström CT, Pariente N, Weiss U. Intestinal microbiota in health and disease. Nature. (2016) 535:7610. 10.1038/535047a - DOI - PubMed
    1. García-Solache M, Rice LB. The enterococcus: a model of adaptability to its environment. Clin Microbiol Rev. (2019) 32:e00058-18. 10.1128/CMR.00058-18 - DOI - PMC - PubMed
    1. Marutescu LG, Popa M, Gheorghe-Barbu I, Barbu IC, Rodríguez-Molina D, Berglund F, et al. Wastewater treatment plants, an “escape gate” for ESCAPE pathogens. Front Microbiol. (2023) 14:1193907. 10.3389/fmicb.2023.1193907 - DOI - PMC - PubMed
    1. Werner G, Abu Sin M, Bahrs C, Brogden S, Feßler AT, Hagel S, et al. Therapierelevante Antibiotikaresistenzen im One-Health-Kontext [Therapy-relevant antibiotic resistances in a One Health context]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. (2023) 66:628–43. 10.1007/s00103-023-03713-4 - DOI - PMC - PubMed
    1. Munk P, Brinch C, Møller FD, Petersen TN, Hendriksen RS, Seyfarth AM, et al. Genomic analysis of sewage from 101 countries reveals global landscape of antimicrobial resistance. Nat Commun. (2022) 13:7251. 10.1038/s41467-022-34312-7 - DOI - PMC - PubMed

Publication types

MeSH terms