Surveillance for antimicrobial resistance in enterococci

Abstract

Aim: To describe antimicrobial resistance patterns of Enterococcus species in Auckland.

Background: Antimicrobial resistant enterococci have emerged as major nosocomial pathogens in overseas hospitals. It is recommended that hospitals perform periodic surveys to determine local enterococcal resistance patterns.

Methods: Enterococcal isolates from four patient groups were tested: group I were recovered from routine clinical specimens; group II were stool isolates from patients at risk of having vancomycin resistant enterococci, eg, intensive care unit patients, patients receiving vancomycin, and immunocompromised patients receiving antibiotics; group III were enterococci from stool specimens sent for Clostridium difficile toxin testing; group IV were isolates from stool specimens submitted to a community laboratory for enteric pathogen testing. All enterococci isolated were tested for the presence of beta-lactamase, susceptibility to amoxycillin, teicoplanin, vancomycin, and for high level gentamicin and streptomycin resistance.

Results: There were 121 group I enterococcal isolates. 628 stool specimens were cultured. Enterococci were isolated from: 76/148 (51%) group II specimens; 166/279 (60%) group III specimens; and 70/201 (35%) of group IV specimens. Antimicrobial susceptibility testing was performed on 433 isolates; 74% were E faecalis, 12% E faecium, 6% E gallinarum/casseliflavus group and 8% other enterococcal species. No isolate produced beta-lactamase. All E faecalis were susceptible to amoxycillin. Two E faecium and one enterococcus species were resistant to amoxycillin (MICs all 16 mg/L). All isolates were susceptible to teicoplanin. Fourteen E gallinarum/casseliflavus group isolates had intermediate susceptibility to vancomycin (MICs of 8 mg/L). One E faecium had intermediate susceptibility to vancomycin (MIC 8 mg/L). High level gentamicin and streptomycin resistance occurred in 64 (15%) and 50 (12%) isolates respectively.

Conclusion: Vancomycin resistance is rare and is essentially restricted to species that are rarely clinical pathogens, i.e., E casseliflavus and E gallinarum. Our results have established the local susceptibility profile for enterococcal isolates. This allows comparison with other locations and the detection of emerging trends of resistance.