Prevalence of Vancomycin and Gentamycin Resistance among Enterococci spp. in Iran during 2007-2019: A Systematic Review

Document Type : Systematic Review

Authors
M. Arfaatabar 1
T. Shahbazi 2
T. Ebrahimi 1
1 Department of Medical Laboratory Science, Kashan Branch, Islamic Azad University, Kashan, Iran
2 Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Iran,
10.52547/iem.8.1.77
Abstract
Backgrounds: Enterococci are Gram-positive bacteria that colonize the intestine of warm-blooded animals and humans as normal flora. Enterococci cause a variety of community-acquired and nosocomial infections. The emergence of vancomycin and gentamicin resistant enterococci has made a major challenge in the treatment of enterococcal infections worldwide. Therefore, the present study was conducted to evaluate the prevalence of vancomycin and gentamycin resistance among Enterococcus spp in Iran during 2007-2019.

Materials & Methods: In this study, 26 studies were reviewed to collect data on the frequency of vancomycin and gentamicin resistant enterococci in Iran. To find studies published during January 2007 to January 2019, a search strategy was performed by searching different Iranian and international databases, including SID, Google Scholar, Scopus, Medline, Pub Med, and Web of Science.

Findings: The prevalence of vancomycin- and gentamicin-resistant enterococci was very high in Iran (41 and 44%, respectively). Accordingly, Enterococcus faecalis was more prevalent in clinical samples compared to E. faecium (75.49% vs. 24.05%). However, resistance to vancomycin was higher in E. faecium strains compared to E. faecalis.

Conclusion: Due to the increasing vancomycin and gentamicin resistance among Enterococcus species in Iran, it is necessary to design strategies that lead to the rational prescription of antibiotics and limit the spread of resistant enterococci.

Keywords

Subjects

1. Mohammadi F, Tabaraie B, Davudian E, Maleki A, Maleknia S, Nejati M, et al. Evaluation of drug resistance frequency among Entrococcus faecium and Entrococcus faecalis strains and detection of vanA/B genes in vancomycin resistance isolated by PCR method in Ilam and Kermanshah hospitals. Iran J Med Microbiol 2011;5(1):14-8.
2. Peyvasti VS, Mobarez AM, Shahcheraghi F, Khoramabadi N, Rahmati NR, Doust RH. High-level aminoglycoside resistance and distribution of aminoglycoside resistance genes among Enterococcus spp. clinical isolates in Tehran, Iran. J Glob Antimicrob Resist. 2020;20:318-23.
3. Ayobami O, Willrich N, Reuss A, Eckmanns T, Markwart R. The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections. Emerging Microbes & Infections. 2020;9(1):1180-93.
4. Miller WR, Munita JM, Arias CA. Mechanisms of antibiotic resistance in enterococci. Expert Rev Anti Infect Ther. 2014;12(10):1221-36.
5. Eliopoulos GM, Gold H. Vancomycin-resistant enterococci: mechanisms and clinical observations. Clinical Infectious Diseases. 2001;33(2):210-9.
6. O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015;8:217.
7. Shiadeh SMJ, Pormohammad A, Hashemi A, Lak P. Global prevalence of antibiotic resistance in blood-isolated Enterococcus faecalis and Enterococcus faecium: a systematic review and meta-analysis. Infect Drug Resist. 2019;12:2713.
8. Donabedian S, Thal L, Hershberger E, Perri M, Chow J, Bartlett P, et al. Molecular characterization of gentamicin-resistant enterococci in the United States: evidence of spread from animals to humans through food. Journal of Clinical Microbiology. 2003;41(3):1109-13.
9. Shete V, Grover N, Kumar M. Analysis of aminoglycoside modifying enzyme genes responsible for high-level aminoglycoside resistance among enterococcal isolates. J Pathog. 2017;2017.
10. Jabbari-Shiade SM, Moniri R, Khorshidi A, Saba MA, Mousavi SGA, Salehi M. Prevalence of vancomycin-resistant enterococcus strains in fecal samples isolated from ICU patients in Kashan Shahid-Beheshti hospital during 2011-2012. KAUMS Journal (FEYZ). 2013;17(5):482-7.
11. Sattari-Maraji A, Jabalameli F, Farahani NN, Beigverdi R, Emaneini M. Antimicrobial resistance pattern, virulence determinants and molecular analysis of Enterococcus faecium isolated from children infections in Iran. BMC Microbiol. 2019;19(1):156.
12. Khanmohammadi S, Nahaei M, Ahangarzadeh Rezaee M, Sadeghi J. Frequency of Vancomycin, Gentamicin, Erythromycin and Tetracycline Resistance in Enterococci Isolated from Children’s Hospital of Tabriz in 2017: A Short Report. J Rafsanjan Univ Med Sci. 2018;17(4):385-92.
13. Goudarzi M, Mohabati Mobarez A, Najar-Peerayeh S, Mirzaei M. Prevalence of Multidrug Resistance in Enterococcus faecium Isolated from Patients and Environment of Hospitals in Lorestan Province,(Iran). Qom University of Medical Sciences Journal. 2018;12(5):71-8.
14. Sabouni F, Movahedi Z, Mahmoudi S, Pourakbari B, Valian SK, Mamishi S. High frequency of vancomycin resistant Enterococcus faecalis in children: an alarming concern. Int J Prev Med 2016;57(4):E201.
15. Labibzadeh M, Kaydani GA, Savari M, Ekrami A. Emergence of high-level gentamicin resistance among Enterococci clinical isolates from burn patients in south-west of Iran: vancomycin still working. Pol J Microbiol. 2018;67(4):401.
16. Moosavian M, Ghadri H, Samli Z. Molecular detection of vanA and vanB genes among vancomycin-resistant enterococci in ICU-hospitalized patients in Ahvaz in southwest of Iran. Infect Drug Resist. 2018;11:2269.
17. Gajan EB, Shirmohammadi A, Aghazadeh M, Alizadeh M, Deljavan AS, Ahmadpour F. Antibiotic resistance in Enterococcus faecalis isolated from hospitalized patients. Journal of dental research, dental clinics, dental prospects. 2013;7(2):102.
18. Ghasemi A, Moniri R, Musavi GA. The survey of multi drug resistant of Enterococcus faeciumisolated from clinical samples in shahid Beheshti and Shabeeh khani hospitals. Iranian Journal of Medical Microbiology. 2009;3(2):21-6.
19. Haghi F, Lohrasbi V, Zeighami H. High incidence of virulence determinants, aminoglycoside and vancomycin resistance in enterococci isolated from hospitalized patients in Northwest Iran. BMC infectious diseases. 2019;19(1):744.
20. Udo EE, Al-Sweih N, Phillips OA, Chugh TD. Species prevalence and antibacterial resistance of enterococci isolated in Kuwait hospitals. J Med Microbiol. 2003;52(2):163-8.
21. Titze-de-Almeida R, Rollo Filho M, Nogueira CA, Rodrigues IP, Eudes Filho J, Nascimento RSd, et al. Molecular epidemiology and antimicrobial susceptibility of Enterococci recovered from Brazilian intensive care units. Braz j infect dis. 2004;8(3):197-205.
22. Jia W, Li G, Wang W. Prevalence and antimicrobial resistance of Enterococcus species: a hospital-based study in China. Int J Environ Res Public Health. 2014;11(3):3424-42.
23. Emaneini M, Aligholi M, Aminshahi M. Characterization of glycopeptides, aminoglycosides and macrolide resistance among Enterococcus faecalis and Enterococcus faecium isolates from hospitals in Tehran. Pol J Microbiol. 2008;57(2):173-8.
24. Wagenlehner F, Naber K. New drugs for Gram-positive uropathogens. Int J Antimicrob Agents. 2004;24:39-43.
25. Shokoohizadeh L, MohabatiMobarez A, Zali M, Ranjbar R, Alebouyeh M. Frequency of vancomycin-resistant Enterococcus Faecium Strains Isolated from Urinary Tract infections (UTI) in 4 hospitals of tehran. J Adv Med Biomed Res. 2014;22(91):121-30.
26. Chakraborty A, Pal NK, Sarkar S, Gupta MS. Antibiotic resistance pattern of Enterococci isolates from nosocomial infections in a tertiary care hospital in Eastern India. Journal of natural science, biology, and medicine. 2015;6(2):394.
27. Salem-Bekhit M, Moussa I, Muharram M, Alanazy F, Hefni H. Prevalence and antimicrobial resistance pattern of multidrug-resistant enterococci isolated from clinical specimens. Indian J Med Microbiol. 2012;30(1):44.
28. Jumah MTB, Vasoo S, Menon SR, De PP, Neely M, Teng CB. Pharmacokinetic/pharmacodynamic determinants of vancomycin efficacy in enterococcal bacteremia. Antimicrob Agents Chemother. 2018;62(3).
29. Moghimbeigi A, Moghimbeygi M, Dousti M, Kiani F, Sayehmiri F, Sadeghifard N, et al. Prevalence of vancomycin resistance among isolates of enterococci in Iran: a systematic review and meta-analysis. Adolesc Health Med Ther. 2018;9:177.
30. Gupta V, Singla N, Behl P, Sahoo T, Chander J. Antimicrobial susceptibility pattern of vancomycin resistant enterococci to newer antimicrobial agents. The Indian journal of medical research. 2015;141(4):483.
31. Sun H, Wang H, Xu Y, Jones RN, Costello AJ, Liu Y, et al. Molecular characterization of vancomycin-resistant Enterococcus spp. clinical isolates recovered from hospitalized patients among several medical institutions in China. Diagn Microbiol Infect Dis. 2012;74(4):399-403.
32. Özsoy S, İlki A. Detection of vancomycin-resistant enterococci (VRE) in stool specimens submitted for Clostridium difficile toxin testing. Braz J Microbiol 2017;48(3):489-92.
33. Biswas PP, Dey S, Adhikari L, Sen A. Detection of vancomycin resistance in enterococcus species isolated from clinical samples and feces of colonized patients by phenotypic and genotypic methods. Indian Journal of Pathology and Microbiology. 2016;59(2):188.
34. Moussa AA, Nordin AFM, Hamat RA, Jasni AS. High Level Aminoglycoside Resistance And Distribution Of The Resistance Genes In Enterococcus faecalis And Enterococcus faecium From Teaching Hospital In Malaysia. Infect Drug Resist. 2019;12:3269.
35. El-Mahdy R, Mostafa A, El-Kannishy G. High level aminoglycoside resistant enterococci in hospital-acquired urinary tract infections in Mansoura, Egypt. Germs. 2018;8(4):186.
36. Jannati E, Amirmozaffari N, Saadatmand S, Arzanlou M. Faecal carriage of high-level aminoglycoside-resistant and ampicillin-resistant Enterococcus species in healthy Iranian children. J Glob Antimicrob Resist. 2020;20:135-44.
37. Dadfarma N, Fooladi AAI, Oskoui M, Hosseini HM. High level of gentamicin resistance (HLGR) among enterococcus strains isolated from clinical specimens. Journal of infection and public health. 2013;6(3):202-8.
38. Padmasini E, Padmaraj R, Ramesh SS. High level aminoglycoside resistance and distribution of aminoglycoside resistant genes among clinical isolates of Enterococcus species in Chennai, India. Sci World J. 2014;2014.
39. Feizabadi M, Sayady S, Shokrzadeh L, Khatibi S, Gharavi S. Aminoglycosides modifying enzymes genes among the population of enterococci in Tehran. Iranian Journal of Medical Microbiology. 2007;1(1):11-6.
40. Sharifi Y, Hasani A, Ghotaslou R, Varshochi M, Hasani A, Soroush MH, et al. Vancomycin-resistant enterococci among clinical isolates from north-west Iran: identification of therapeutic surrogates. J Med Microbiol. 2012;61(4):600-2.
41. Taji A, Heidari H, Ebrahim-Saraie HS, Sarvari J, Motamedifar M. High prevalence of vancomycin and high-level gentamicin resistance in Enterococcus faecalis isolates. ACTA MICROBIOL IMM H. 2019;66(2):203-17.
42. Mittal S, Singla P, Deep A, Bala K, Sikka R, Garg M, et al. Vancomycin and high level aminoglycoside resistance in Enterococcus spp. in a tertiary health care centre: a therapeutic concern. J Pathog. 2016;2016.
43. Vigani A, Macedo de Oliveira A, Bratfich O, Stucchi R, Moretti M. Clinical, epidemiological, and microbiological characteristics of bacteremia caused by high-level gentamicin-resistant Enterococcus faecalis. Braz J Med Biol Res. 2008;41(10):890-5.
44. Tian Y, Yu H, Wang Z. Distribution of acquired antibiotic resistance genes among Enterococcus spp. isolated from a hospital in Baotou, China. BioMed Central. 2019;12(1):27.
45. Diab M, Salem D, El-Shenawy A, El-Far A, Abdelghany A, Awad AR, et al. Detection of high level aminoglycoside resistance genes among clinical isolates of Enterococcus species. Egyptian Journal of Medical Human Genetics. 2019;20(1):28.
46. JABBARI SSM, MONIRI R, KHORSHIDI A, SABA MA, MOUSAVI SGA, SALEHI M. Evaluation of the prevalence of Vancomycin-resistant Enterococci strains isolated from patients in the ICU in Kashan. 2012.
47. MASOUMI ZS, MIRNEJAD R, ZARE KS, PIRANFAR V, BAGHERI BO. IDENTIFICATION OF ENTEROCOCCI FAECALIS AND E. FAEACIUM PATHOGENS VIA TEHRAN HOSPITALS CLINICAL SAMPLES BY PHENOTYPIC AND GENOTYPIC METHODS AND EVALUATION OF ANTIMICROBIAL SUSCEPTIBILITY IN 2015. 2016.
48. Moosavi SM, Sepahi AA, Nikbin VS, Fazlollah S. Molecular Appraisement of Isolated Antibiotic Resistant Enterococci from Vaginal Specimen in Spontaneously Abortion Women’s. 2017.
49. Samadi H, Pirhajati Mahabadi R, Pournajaf A, Omidi S, Moghimyan S, Alyasin N. An Investigation of the vanA and vanB Genes in Enterococcus faecalis and Enterococcus faecium Strains Isolated from the Hospitalized Patients in Shariati Hospital and Evaluation of Their Antibiotic Susceptibility. Qom Univ Med Sci J. 2015;9(3):32-8.
50. Moaddab SR, B. Kazemi Haki and N. Ebrahimi AtashKhosroo,. Investigation of genes responsible for vancomycin resistance by Multiplex-PCR among enterococci isolated strains from inpatients and outpatients. J Med Sci. 2015;24(4):227-34.
51. Kaveh M, Bazargani A, Ramzi M, Ebrahim-Saraie HS, Heidari H. Colonization rate and risk factors of vancomycin-resistant enterococci among patients received hematopoietic stem cell transplantation in Shiraz, southern Iran. Int J Organ Transplant Med 2016;7(4):197.
52. Arshadi M, Shokoohizadeh L, Douraghi M, Owlia P, Mashhadi R, Soltani S, et al. Epidemiological linkage of vancomycin-resistant Enterococcus faecium from different sources in Ahwaz, Iran. FEMS microbiology letters. 2019;366(6):fnz062.
53. Mohamadi M, M. Jafari, M. Heidari, H. Eshaghi, A. Pournajaf, R. Kafshgari, gholami. A survey of high-level resistance to gentamicin and aminoglycoside-modifying enzyme-encoding genes in Enterococcus faecalis and Enterococcus faecium isolated from infected burn wounds. Cell Mol Biol. 2018;9(33):39-48.
54. Esmailzadeh M, Safari M, Moniri R, Gilasi HR, Jabbary M. Distribution of gentamicin resistant genes of nosocomial Enterococcus spp from intensive care unit of Shahid Beheshty Hospital in Kashan, Iran. Journal of Pure and Applied Microbiology. 2016;10(3):1919-27.
55. Ghaffarpasand I, Moniri R. The prevalence of fecal carriage of antibiotic resistant enterococci among hospitalized patients in Shahid beheshti hospital, Kashan, Iran at 2007. KAUMS Journal (FEYZ). 2010;14(1):70-5.
Infection Epidemiology and Microbiology
Volume 8, Issue 1
February 2022
Pages 77-86