Transcript (VRE) among Non–Hospitalized Individuals in Gaza City, Palestine

Vancomycin Resistant Enterococci
(VRE) among Non–Hospitalized
Individuals in Gaza City, Palestine
Dr. Abdelraouf A. Elmanama
(Ph. D microbiology)
Rasha R. Rashed (B. Sc Medical Technology)
Baha' Sh. Mosabbih (B. Sc Medical Technology)
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Introduction
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Enterococci are gram-positive cocci which often
occur in pairs (diplococci)
Two species are common commensal organisms
in the intestines of humans: E. faecalis and E.
faecium
Enterococci occur almost everywhere, including
soil, food, water, plants, animals, birds, and
insects they inhabit in humans and other animal's
gastrointestinal tract and the female genital tract
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Intro (cont.)
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Enterococci are amongst the most antibiotic resistant
bacteria isolated from humans.
Minor infections can usually be treated by antibiotics such
as penicillins, macrolides or tetracyclines,
However, only penicillins, or teicoplanin and vancomycin
are reliably effective against serious enterococcal
infections such as endocarditis or meningitis.
Serious infections often need prolonged treatment, usually
with several antibiotics being given together by injection.
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Intro. (cont.)
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Enterococcus spp. is now the third most common pathogen
among hospitalized patients, accounting for nearly 12% of
nosocomial infections
in 1986 the first vancomycin-resistant enterococcus (VRE)
was found in France and a year later the first strain was
isolated in the UK .
Infection with vancomycin-resistant enterococci (VRE) is a
growing problem in health care systems. The Centers for
Disease Control and Prevention (CDC) reported that 28.5%
of enterococcal isolates from patients in intensive care units
(ICUs) from January through December 2003 in the United
States (NNIS System) were vancomycin-resistant, with an
increase of 12% comparing with 1998 through 2002.1
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Objectives
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This study is considered as the first study in Gaza strip to
investigate the occurrence of VRE among non– hospitalized
individuals. We also attempted to assess the public
awareness on antibiotic resistance issue and to examine the
possible risk factors of acquiring VRE.
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Materials & Methods
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Test subjects
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One hundred, randomly selected healthy subjected (36
females and 64 males) were interviewed and either a stool
or rectal swab samples were collected.
They were asked to fill out a brief questionnaire and
submit a rectal swab, which was either performed by the
participants themselves or by one of the investigators.
The questionnaire consisted of both open and close ended
questions dealing with personal, socioeconomic data, and
attitude toward diagnosis and treatment of illness with
antibiotics.
The study started Jan 15- 1 and lasted to June 6, 2006.
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Microbiological examination
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Rectal swabs or 1 g of stool specimen were placed in tubes
containing 5 ml of Brain Heart Infusion Both (BHIB) and
transported to the laboratory.
Subcultures were made onto the surface of freshly prepared
Slanetz & Bartley Agar (oxoid) and Bile Esculine Agar
(HiMedia) with no antibiotics. Plates were incubated at 37
oC for 48-72 hours.
Colonies growing on agar with morphologically resembling
Enterococci were primarily identified by Gram staining,
catalse test and by growth in 6.5% NaCl broth.
Species identification was performed with the API 20 STREP
system (bioMe´rieux, Marcy l’Etoile, France).
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Susceptibility testing
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Resistance to vancomycin was screened by the
modified Kirby-Bauer disk diffusion assay. An
inoculum with a turbidity equivalent to that of a no. 1
McFarland standard and Mueller-Hinton agar were
used.
Vancomycin disks (30 µg) were placed on the surface
of the plate.
The plates were read after incubation at 37°C for 24 h.
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Data analysis
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Data obtained from microbiological investigation &
from the questionnaire survey were uploaded to
(spss version 11) software and analyzed using cross
tabulating & chi square test.
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Results
Distribution of Enterococcus positive stool culture
according to age and sex
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Distribution of VRE according to sex
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Distribution of Enterococcus positive
stool culture according to age
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Distribution of VRE according to age
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Public awareness
Age and having info about Antibiotic resistance
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Gender and having info about
Antibiotic resistance
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