Prevalence of Multidrug Resistant Enterococci in a Tertiary Care Hospital in India: A Growing Threat


Introduction: Enterococci are members of the healthy human intestinal flora, but are also leading causes of highly antibiotic-resistant infections. Serious enterococcal infections are often difficult to treat since the organisms have a tremendous capacity to acquire resistance to penicillin, high concentration of aminoglycoside & vancomycin. Careful review of in vitro susceptibility data is required to treat infections caused by MDR Enterococci. Therefore we conducted the study to find out prevalence of MDR Enterococci. Aims & Objectives: To study the prevalence of Vancomycin resistance, High Level Streptomycin Resistance (HLSR) & High Level Gentamicin Resistance (HLGR) in different enterococcal isolates. Materials & Methods: Total 180 enterococcal isolates were studied. Identification was done by conventional biochemical methods. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller–Hinton agar and results were interpreted as per CLSI guidelines. HLSR & HLGR was determined by disc diffusion method using high level Gentamicin disc (120 μg) & Streptomycin (300 μg) discs. Minimum inhibitory concentration (MIC) determination for Vancomycin was done by vancomycin E test strips. Results: Total 180 entetococcal isolates were studied. E. faecalis was 60%, E. faecium was 32.2%, E. durans and E. raffinosus were 4.4% & 3.3% respectively. Enterococcus fecium showed resistance in high percentage as compared to E. faecalis. 15 isolates were found to be vancomycin resistant. Conclusion: Resistance to aminoglycoside is of great concern. Regular screening of enterococcal isolates for vancomycin resistance detection should be implemented. It is very important to implement infection control measures, screening of health care workers, surveillance cultures in intensive care units which can control spread of multidrug resistant enterococci.

Share and Cite:

Gangurde, N. , Mane, M. and Phatale, S. (2014) Prevalence of Multidrug Resistant Enterococci in a Tertiary Care Hospital in India: A Growing Threat. Open Journal of Medical Microbiology, 4, 11-15. doi: 10.4236/ojmm.2014.41002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Shankar, N., Baghdayan, A.S. and Gilmore, M.S. (2002) Modulation of Virulence within a Pathogenicity Island in Vancomycin-Resistant Enterococcus faecalis. Nature, 417, 746-750.
[2] Sava, G., Heikens, E. and Huebner, J. (2010) Pathogenesis and Immunity in Enterococcal Infections. Clinical Microbiology and Infection, 16, 533-540.
[3] Mohanty, S., Dhawan, B., Gadepalli, R.S., Lodha, R. and Kapil, A. (2006) Case Report of Vancomycin Resistant Enterococcus Faecium VanA Phenotype: First Documented Isolation in India. The Southeast Asian Journal of Tropical Medicine and Public Health, 37, 335-337.
[4] Oberoi, L., et al. (2010) Multidrug Resistant Enterococci in a Rural Tertiary Care Hospital—A Cause of Concern. JK Science, 12, 157-158.
[5] Fraser, S.L. (2011) Enterococcal Infection. Medscape, Drugs, Diseases and Procedures.
[6] Bose, S., Ghosh, A. and Barapatre, R. (2012) Prevalence of Drug Resistance among Enterococcus Species Isolated from A Tertiary Care Hospital. International Journal of Medical Health Sciences, 1, 38-44.
[7] Karmarkar, M.G., Gershom, E.S. and Mehta, P.R. (2004) Enterococcal Infections with Special Reference to Phenotypic Characterization & Drug Resistance. Indian Journal of Medical Research, 119, 22-25.
[8] Forbes, A.B., Sahm, D.F. and Weissfeld, A.S. (2007) Chapter 13: Overview of Bacterial Identification Methods and Strategies. In: Baily & Scott’s Diagnostic Microbiology 12th Ed., Mosby Elsevier International Edition, 216-247.
[9] Collee, J.G., Fraser, A.G., Marmion, B.P. and Simmons, A. (2008) Chapter 7: Test for Identification of Bacteria. In: Collee, J.G., Miles, R.S. and Watt, B., Eds., Test for Identification of Bacteria, Mackie & McCartney’s Practical Medical Microbiology, 14th Edition, Indian Reprint, Churchil Livingstone, 131-149.
[10] Fernandes, S.C., Dhanashree, B., et al. (2013) Drug Resistance & Virulence Determinants in Clinical Isolates of Enterococcus Species. Indian Journal of Medical Research, 137, 981-985.
[11] Bauer, A.W., Kirby, W.M., Sherris, J.C. and Turck, M. (1966) Antibiotic Susceptibility Testing by a Standardized Single Disk Method. American Journal of Clinical Pathology, 45, 493-496.
[12] McNamara, E.B., King, E.M. and Smyth, E.G. (1995) A Survey of Antimicrobial Susceptibility of Clinical Isolates of Enterococcus Spp. from Irish Hospitals. Journal of Antimicrobial Chemotherapy, 35, 185-189.
[13] Wayne, P.A. (2010) Clinical & Laboratory Standard Institute, Performance Standard for Antimicrobial Susceptibility Testing. Twentieth Informational Supplement, 30, M100-M120.
[14] Telkar, A., et al. (2012) Change in the Prevalence and the Antibiotic Resistance of the Enterococcal Species Isolated from Blood Culture. Journal of Clinical and Diagnostic Research, 6, 405-407.
[15] Yemisen, M., Demirel, A., Mete, B., Kaygusuz, A., Mert, A., Tabak, F. and Ozturk, R. (2009) Comparative in Vitro Antimicrobial Activity of Tigecycline against Clinical Isolates of Vancomycin-Resistant Enterococcus. Indian Journal of Medical Microbiology, 27, 373-374.
[16] De, A., Bindlish, A., Kumar, S. and Mathur, M. (2009) Vancomycin Resistant Enterococci in a Tertiary Care Hospital in Mumbai. Indian Journal of Medical Microbiology, 27, 375-376.
[17] Mendiratta, D.K., Kaur, H., Deotale, V., Thamke, D.C., Narang, R. and Narang, P. (2008) Status of High Level Aminoglycoside Resistant Enterococcus Faecium and Enterococcus Faecalis in a Rural Hospital of Central India. Indian Journal of Medical Microbiology, 26, 369-371.
[18] Jain, S., Kumar, A., Kashyap, B. and Kaur, I.R. (2011) Clinico-Epidemiological Profile and High-Level Aminoglycoside Resistance in Enterococcal Septicemia from a Tertiary Care Hospital in East Delhi. International Journal of Applied and Basic Medical Research, 1, 80-83.
[19] Chaudhari, U., et al. (2007) Antimicrobial Susceptibility Pattern of Common and Unusual Enterococcus Species Isolated from Clinical Specimens. Journal of Infectious Diseases and Antimicrobial Agents, 24, 55-62.
[20] Shah, L., et al. (2012) Prevalence of Enterococci with Higher Resistance Level in a Tertiary Care Hospital: A Matter of Concern. National Journal of Medical Research, 2, 25-27.
[21] Mathur, P., Kapil, A., Chandra, R., Sharma, P. and Das, B. (2003) Antimicrobial Resistance in Enterococcus Faecalis at a Tertiary Care Centre of Northern India. Indian Journal of Medical Research, 118, 25-28.
[22] Kalyan, R., et al. (2013) Vancomycin Resistant Enterococci at a Tertiary Care Hospital in Northern India. International Journal of Pharma and Bio Sciences, 4, 1090-1094.
[23] Agarwal, J., Kalyan, R. and Singh, M. (2009) High-Level Aminoglycoside Resistance and Beta-Lactamase Production in Enterococci at a Tertiary Care Hospital in India. Japanese Journal of Infectious Diseases, 62, 158-159.
[24] Randhawa, V.S., Kapoor, L., Singh, V. and Mehta, G. (2004) Aminoglycoside Resistance in Enterococci Isolated from Paediatric Septicaemia in a Tertiary Care Hospital in North India. Indian Journal of Medical Research, 119, 77-79.
[25] Sekar, R., Srivani, R., Vignesh, R., Kownhar, H. and Shankar, E.M. (2008) Low Recovery Rates of High-Level Aminoglycoside-Resistant Enterococci Could be Attributable to Restricted Usage of Aminoglycosides in Indian Settings. Journal of Medical Microbiology, 57, 397-398.
[26] Kapoor, L., Randhawa, V.S. and Deb, M. (2005) Antimicrobial Resistance of Enterococcal Blood Isolates at a Pediatric Care Hospital in India. Japanese Journal of Infectious Diseases, 58, 101-103.
[27] Taneja, N., Rani, P., Emmanuel, R. and Sharma, M. (2004) Significance of Vancomycin Resistant Enterococci from Urinary Specimens at a Tertiary Care Centre in Northern India. Indian Journal of Medical Research, 119, 72-74.
[28] Gupta, V. and Singla, N. (2007) Antibiotic Susceptibility Pattern of Enterococcai. Journal of Clinical and Diagnostic Research, 5, 385-389.
[29] Huycke, M.M., Sahm, D.F. and Gilmore, M.S. (1998) Multiple-Drug Resistant Enterococci: The Nature of the Problem and an Agenda for the Future. Emerging Infectious Diseases, 4, 239-249.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.