Vancomycin Resistant Enterococcal Infections in Tertiary Care Hospitals of Islamabad and Rawalpindi, Pakistan

Vancomycin resistant enterococci (VRE) causes health-care related infections such as endocarditis, meningitis, bacteremia, Septicemia and gastrointestinal tract infections in immunocompromised patients. VRE are emerging therapeutic dilemma due to high resistance against commonly used antibiotics including vancomycin. The present study was conducted to investigate the prevalence of VRE in clinical samples isolated from three tertiary care hospitals in Islamabad and Rawalpindi. A total of 106 enterococci (Enterococcus faecalis, 52; Enterococcus faecium, 54) were isolated during April-September 2009. Out of 106, 54 (50.94%) isolates were resistant to vancomycin as determined by disc diffusion test and culturing on ChromID VRE agar. Maximum and minimum resistance was found against cefotaxime (100%) and teicoplanin (18.86%), respectively. The results showed that teicoplanin is the drug of choice as lowest resistance was observed against this antibiotic as compared to other antibiotics. The MIC of VRE isolates ranged between >4mg/L and ≥512 mg/L for cefotaxime, ciprofloxacin, erythromycin, doxycycline and vancomycin. The high rate of VRE isolation from clinical samples and their resistance to multiple antibiotics suggests a rapid spread of resistance among Enterococci alongwith an emerging shift in VRE distribution.