Abstract

Enterococci are a common cause of nosocomial infection and prevalence of antibiotic resistance among them is increasing. This study aimed to identify the prevalence of high level aminoglycoside resistant enterococci at Alexandria Main University Hospital. A total of 133 enterococci strains isolated from clinical specimens were all subjected to Bauer Kirby disc diffusion to detect antibiotic susceptibility pattern. High level aminoglycoside resistance (HLAR) and vancomycin resistance were confirmed by minimum inhibitory concentration (MIC). The HLAR enterococci were further identified by API 20 STREP to species level and nitrocefin test was used to detect beta lactamase production. Furthermore, polymerase chain reaction (PCR) for detection of gentamycin resistance was done to all HLGR enterococcal strains and for detection of vancomycin resistance genes. Among the 133 enterococcal isolates, 47 (35.3%) were found to be HLAR (31 Enterococcus faecalis, 13 Enterococcus faecium and 3 Enterococcus avium). They were all negative for beta lactamase production, 78.7% were erythromycin resistant, 63.8% resistant to doxycyclines, 51.06% to chloramphenicol, 46.8% to penicillin, 42.5% to rifampicin, and 40.4% to ampicillin. All HLAR enterococcal isolates were sensitive to Teigycyciln and Linezolid except one strain was resistant to linezolid. Urinary enterococcal isolates were also found to be 88.4, 84.6, 80.7 and 15.3% resistant to ciprofloxacin, levofloxacin, norfloxacin, and nitrofurantoin, respectively. Regarding PCR, all HLGR strains had Aac 6^/)-Ie-aph (2^//)-Ia gene except for 2 strains. It was found also that 3 HLAR enterococcal strains were vancomycin resistant, all of  which were E. faecium with Van A genotype. HLAR enterococci constituted 35.3% from the total enterococci isolated during the period of study denoting the importance of these isolates as nosocomial pathogens. This situation obligates the clinical microbiologist to try to identify the most useful active antibiotic for treatment. On the other hand, physicians should use antibiotics appropriately and comply with the infection-control policies in an effort to prevent further spread of high level aminoglycoside resistant enterococci.

Key words: Alexandria Egypt, enterococci, high level aminoglycoside resistance, aminoglycosides, gentamycin, antibiotic resistance, vancomycin.