Anti-microbial resistance of Enterococci isolated from urinary tract infections in Iran.

BACKGROUND During the last decade, enterococci have become important nosocomial pathogens, representing the second leading cause of urinary tract infections. This increasing prevalence has been paralleled by the occurrence of multi-drug resistant (MDR) and high-level gentamicin resistant (HLGR) strains. METHODS From September 2005 to 2006, a total of 638 enterococcal isolates were collected from urine samples among 9 medical centers in Tehran (Iran). Confirmation of species and detection of gentamicin resistance genes were done by PCR method. Anti-microbial susceptibility test was determined with disk diffusion and minimal inhibitory concentration of gentamicin among HLGR isolates assayed by microdilution methods. RESULTS The isolates were found to consist of Enterococcus faecalis (77.8%) and Enterococcus faecium (22.2%). The results obtained from PCR showed a high rate of agreement with phenotypic assays for both species. MDR to most prevalent anti-microbials was present in 29% and 72% of the E. faecalis and E. faecium isolates, respectively. HLGR phenotype was detected in 64% of E. faecalis and 92% of E. faecium isolates. The aac(6')-Ie-aph(2'')-Ia gene were identified in 83% of E. faecalis and 100% of E. faecium HLGR isolates. E. faecalis and E. faecium isolates differed in their susceptibilities to different antibiotics. CONCLUSION Emergence of multi-resistant enterococci and high level resistance to gentamicin shown by enterococcal strains is of concern because of the decrease in the therapeutic options for treatment of infections caused by enterococci.