Vancomycin Resistant Enterococcus (VRE): Prevalence and Characteristics in a Tertiary Hospital In Malaysia

NA MOHAMED ¹, H HUSSIN ², KM CHANG ³, R HASHIM ⁴, N AHMAD ⁴

¹ Department of Basic Medical Science, Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, ² Microbiology Unit, Department of Pathology, Hospital Ampang, Selangor, Malaysia, ³ Department of Haematology, Hospital Ampang, Selangor, Malaysia and ⁴ Institute of Medical Research, Kuala Lumpur, Malaysia

ABSTRACT

Introduction: Vancomycin-resistant Enterococcus (VRE) are undoubtedly less virulent as compared to other common pathogenic bacteria such as Staphylococcus aureus. However the presence of VRE is a matter of concern, as VRE infections are associated with high mortality, particularly in immunocompromised patients. The resistant gene is transferable to Methicillin-Resistant Staphylococcus aureus (MRSA). Materials and Methods: VRE cases from clinical samples in a tertiary government hospital were identified retrospectively over a period of 12 months. VRE genotype was confirmed by molecular method. Patients’ clinical data were obtained from the hospital information system. Results: 2.88% (n=7/243) of all Enterococcal spp isolated from clinical samples were resistant to vancomycin (VRE). All were from haematological patients, six were diagnosed with neutropaenic sepsis. All VRE were isolated within eight to 37 days after chemotherapy. Six out of seven cases where VRE were isolated had received carbapenem in their therapy. There were four samples from central venous catheter, one from peripheral blood, one from pus and one from urine sample. Only three patients were treated with Linezolid. However, all patients recovered well. All isolates carry vanA gene with vancomycin MIC of >256 ug/mL. Conclusions: The prevalence of VRE in this current study is higher than an earlier study done in Malaysia. This finding showed that patients from haematological ward had higher risk of VRE colonization or infection. Periodic screening is necessary to monitor the prevalence of multidrug resistant organism in order to encourage healthcare workers towards practicing proper infection control measures.

Keywords: Prevalence, Vancomycin-resistant Enterococcus, microbial resistance, sepsis, haematology

Correspondence author: Nurul A MOHAMED. Department of Basic Medical Science, Faculty of Medicine and Health Science, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia. Tel: +603 4289 2400, Fax: +603 4289 2477  E mail: drnurul@usim.edu.my

Brunei Int Med J. 2015; 11 (5): 241-246