Is there any association between antibiotic resistance and virulence genes in Enterococcus isolates? Virulence genes in Enterococci
Article Sidebar
Main Article Content
Abstract
Objective: In this study, we aim to determine the frequency of antibiotic resistance and five virulence genes in Enterococcus species and the relationship between antibiotic resistance and virulence genes.
Material and Methods: A total of 86 Enterococcus strains isolated from inpatients between 2015 and 2016 were included. Identification and antibiotic susceptibilities of strains were determined using a BD Phoenix fully automated system. The presence of virulence-associated genes (esp, gel E, asa1, hyl, and cyl) were investigated by using PCR method.
Results: Of the 86 Enterococcus strains, 53 (61.6%) and 33 (38.4%) were Enterococcus faecium and Enterococcus faecalis, respectively. Vancomycin and high-level gentamicin resistance (HLGR) in E. faecalis strains were 0.6% and 60.6%, respectively. Furthermore, 52 of the 53 E. faecium strains were both vancomycin-resistant and HLGR. The frequency of esp, gel E, asa1, cyl, and hyl was 91.9%, 60.5%, 54.7%, 43%, and 26.7%, respectively. The asa 1, cyl, and gel E genes were detected at high frequencies in vancomycin-susceptible and non-HLGR strains, whereas hyl gene was detected at high frequencies in vancomycin-resistant and HLGR strains.
Conclusion: Virulence genes were more frequent in vancomycin-susceptible and non-HLGR Enterococcus strains than in the resistant strains. Although infections caused by multidrug-resistant strains are difficult to treat, it should be considered that susceptible strains have more virulence genes. This may reduce the in vivo efficacy of drugs and lead to treatment failures. Therefore, in addition to the in vitro susceptibilities of drugs, clinical efficacy should be monitored.
Downloads
Article Details
Accepted 2019-12-22
Published 2019-12-25
References
Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiology. 2009;155(6):1749–57.
Cesar AA, Murray BE. Enterococcus species, Streptococcus gallolyticus Group, and Leuconostoc Species. In: Bennet JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia (PA): Elsevier Inc.; 2015.p. 2328–39.
Baylan O.Virulence Factors And Immunopathogenesis In Enterococcal Infections. Nobel Med. 2019; 15(2):5–16.
Heidari H, Emaneini M, Dabiri H, Jabalameli F. Virulence factors, antimicrobial resistance pattern and molecular analysis of enterococcal strains isolated from burn patients. Microb Pathog. 2016; 90:93–97
Guzman Prieto AM, van Schaik W, Rogers MRC, et al. Global emergence and dissemination of enterococci as nosocomial pathogens: Attack of the clones? Front Microbiol. 2016;7(5):1–15.
Hollenbeck BL, Rice LB. Intrinsic and acquired resistance mechanisms in enterococcus. Virulence. 2012;3(5):421–33.
Cetinkaya Y, Falk P, Mayhall C. Vancomycin-Resistant Enterococci. Clin Microbiol Rev.2000;13(4):86–707.
Billström H,Lunda B, Sullivana A, Nord CE.Virulence and antimicrobial resistance in clinical Enterococcus faecium. Int J Antimicrob Agents. 2008; 32(5):374–77.
Fiore E, Van Tyne D, Gilmore M. Pathogenicity of Enterococci. Microbiol Spectr. 2019. 7(4):GPP3-0053-2018.
The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 5.1, 2015.
http://www.eucast.org. Accession date: 10 October 2019.
Vankerckhoven, V, Van Autgaerden T, Vael C, Lammens C, Chapelle S, Rossi R, et al. Development of a multiplex PCR for the detection of asa1, gelE, cylA, esp and hyl genes in enterococci and survey for virulence determinants among European hospital isolates of Enterococcus faecium. J. Clin. Microbiol. 2004. 42(10): 4473–79.
Soheili S, Ghafourian S, Sekawi Z, Neela V, Sadeghifard N, Ramli R et al. Wide distribution of virulence genes among Enterococcus faecium and Enterococcus faecalis clinical isolates. The Scientific World Journal, 2014. http://dx.doi.org/10.1155/2014/623174
Al-Talib, Zuraina N, Kamarudin B,Yean CY. Genotypic variations of virulent genes in Enterococcus faecium and Enterococcus faecalis isolated from three hospitals in Malaysia. Adv Clin Exp Med. 2015; 24(1):121–27.
O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015; 8:217–230.
Mete E, Kaleli I, Cevahir N, Demir M, Akkaya Y, Kiris Satilmis O. Evaluation of Virulence Factors in Enterococcus Species. Microbiol Bul. 2017; 51(2):101–14.
Say Coskun US. Investigation of the relationship between virulence factors and antibiotic resistance of Enterococci isolates. Cell Mol Biol. 2019, 65(2):114–17.
Baylan O, Nazik H, Bektöre B, Çitil BE, Turan D, Öngen B et al. The relationship between antibiotic resistance and virulence factors in urinary Enterococcus isolates. Mikrobiyol Bul. 2011; 45(3): 430–45.
Shankar V, Baghdayan AS, Huycke MM, Lindahl G, Gilmore MS. Infection-derived Enterococcus faecalis strains are enriched in esp, a gene encoding a novel surface protein. Infect. Immun. 1999;67(1): 93–200.
Udo EE, Al-Sweih N. Frequency of virulence-associated genes in Enterococcus faecalis isolated in Kuwait hospitals. Med Princ Pract. 2011; 20(3): 259–64.
Copur SS, Sahin F, Gocmen JS. Determination of virulence and multidrug resistance genes with polymerase chain reaction method in vancomycin-sensitive and -resistant enterococci isolated from clinical samples. Turk J Med Sci. 2016: 46(3): 877–91.
Gozalan A, Coskun-Ari FF, Ozdem B, Unaldi O, Celikbilek N, Kirca F et al. Molecular characterization of vancomycin-resistant Enterococcus faecium strains isolated from carriage and clinical samples in a tertiary hospital, Turkey. J Med Microbiol. 2015;64(7):759–66.
Cakirlar FK, Samasti M, Baris I, Kavakli H, Karakullukcu A, Sirekbasan S. et al. The epidemiological and molecular characterization of vancomycin-resistant enterococci isolated from rectal swab samples of hospitalized patient in Turkey. Clin Lab. 2014; 60(11):1807–12.
Virulence Determinants and Antimicrobial Resistance Patterns of Vancomycin-resistant Enterococcus faecium Isolated from Different Sources in Southwest Iran
Arshadi M, Mahmoudi M, Motahar MS, Saber Soltani S, Pourmand MR. Iran J Public Health. 2018;47(2):264–72.
Comerlato CB, Resende MC, Caierao J, d’Azevedo PA. Presence of virulence factors in Enterococcus faecalis and Enterococcus faecium susceptible and resistant to vancomycin. Mem Inst Oswaldo Cruz 2013; 108(5): 590–95.
Worth LJ, Slavin MA, Vankerckhoven V, Goossens H, Grabsch EA, Thursky KA. Virulence determinants in vancomycin-resistant Enterococcus faecium vanB: clonal distribution, prevalence and significance of esp and hyl in Australian patients with haematological disorders. J Hosp Infect 2008; 62(2):137–44.
Akpaka P, Kissoon S, Jayaratne P. Molecular Analysis of Vancomycin-Resistant Enterococci Isolated from Regional Hospitals in Trinidad and Tobago. Advances in Medicine. 2016, 1-8. http://dx.doi.org/10.1155/2016/876269.
Oancea C, Klare I, Witte W,Werner G. Conjugative transfer of the virulence gene, esp, among isolates of Enterococcus faecium and Enterococcus faecalis. J Antimicrob Chemother. 2004;45(1):232–35.
Hasani A, Sharifi Y, Ghotaslou R, Naghili B, Hasani A, Aghazadeh M, et al. Molecular screening of virulence genes in high-level gentamicin-resistant Enterococcus faecalis and Enterococcus faecium isolated from clinical specimens in Northwest Iran. Indian J Med Microbiol. 2012;30:175–81.
Hällgren A, Claesson C, Saeedi B, Monstein HJ, Hanberger H, Nilsson LE. Molecular detection of aggregation substance, enterococcal surface protein, and cytolysin genes and in vitro adhesion to urinary catheters of Enterococcus faecalis and Enterococcus faecium of clinical origin. Int J Med Microbiol. 2009;299(5): 323–32.
Yang JX, Li T, Ning YZ, Shao DH, Liu J, Wang S, Liang GW. Molecular characterization of resistance, virulence and clonality in vancomycin-resistant Enterococcus faecium and Enterococcus faecalis: A hospital-based study in Beijing, China. Infect Genet Evol. 2015;33:253–60.