A PROSPECTIVE STUDY OF ANTIBIOTIC RESISTANCE AND VIRULENCE FACTORS IN ENTEROCOCCI ISOLATED FROM PATIENTS WITH END STAGE RENAL DISEASE

Introduction and objectives: Patients with end stage renal disease (ESRD) are at risk for colonization and infections with multidrug resistant (MDR) enterococci, which are a formidable challenge to treat. This study aims to speciate enterococci isolated from ESRD patients; determine their antibiogram and virulence factors. Methods: 50 isolates of enterococci obtained from ESRD patients were studied. Rectal swabs were screened for gastrointestinal VRE colonisation. Sample collection, processing and antibiotic susceptibility testing were performed according to standard guidelines. Vancomycin resistant enterococci (VRE) were characterized based on vancomycin MIC as VanA, VanB and VanC phenotypes. Presence of vanA and vanB genes was confirmed by polymerase chain reaction. Haemolysin, gelatinase, beta-lactamase and biofilm production were detected using standard methods. Results: out of the 50 isolates of enterococci 28(56%) were E.faecalis, 21(42%) E.faecium and 1(2%) was E.gallinarum. 12 isolates (E.faecium 33.33% and E.faecalis 17.85%) showed vancomycin resistance, of which 9 were VanA, 2 VanB and 1 VanD phenotype. 22(44%) isolates produced haemolysin, 16(32%) gelatinase, 19(38%) beta-lactamase and 12(24%) produced biofilms. 10/12(83.3%) patients with VRE infection showed gastrointestinal colonization with the same. Interpretation & conclusion: Colonization and infection caused by MDR enterococci and VRE are a significant clinical problem in patients with ESRD. Judicious use of vancomycin, careful screening and infection control precautions should be practiced to limit the transmission of VRE.