EMERGENCE OF VANA AND VANB GENE AMONG VANCOMYCIN-RESISTANT ENTEROCOCCI IN FAECAL SAMPLES FROM ICU PATIENTS.

Background & objectives: Enterococci have emerged as important nosocomial pathogens and appearance of resistance to many of the antimicrobials used for Gram-positive organisms has made the management of infections due to Enterococcus species difficult. Resistance to glycopeptide antibiotics, especially vancomycin is of special concern. This study was undertaken to determine the prevalence of stool colonization with vancomycin resistant Enterococcus (VRE) and also evaluate the risk factors for colonization with vancomycin resistant Enterococcus among Hospitalized ICU patients isolates obtained from stool samples at MMIMSR, mullana Methods: Test was performed for VRE isolates collected over a period of one year (Feb2015- March2016).Total 50 Faecal samples were collected by using rectal swab for hospitalized ICUs patients then subjected to Cultures were done on MacConkey and Blood agar. After presumptive diagnosis as an enterococcus spp. using different biochemical tests. Again cultures on special VRE screen agar media to identify vancomycin resistant Enterococcus. The results were further supported by modified Kirby-bauer disk diffusion method with vancomycin (30µg) as per CLSI guideline. The VRE isolates were analyzed by PCR for vanA and vanB gene. Results: A total of 34 (68%) Enterococcus faecalis and 16 (32%) Enterococcus faecium were detected among the faecal isolates and 4 (8%) were VRE. The VRE isolates were multidrug resistant and linezolid resistance was also found to be seen. According to CLSI guideline isolates showing diameter of zone of inhibition ?16mm were considered among the VRE. The vanB gene was found in one of 4 VRE isolates and three vanA genes were found. All identified VRE patients were in age group within 21-40 years. Prolonged hospital stay (more than 15 days) was found to be significant risk factor for ICU patients. Interpretation & conclusions: In current practice, vancomycin resistance enterococci are emerging as nosocomial infection particularly in ICUs patients because of long time exposure in hospital. The following recommendations should be considered as hygiene maintains is the only way to prevent VRE. Prolonged use of vancomycin drug should not be recommended by the physician. We should take another major precaution including active surveillance cultures when patients admitted to hospital and after weekly culture for VRE till discharge. Future potential assembly studies are needed to comprehend better the epidemiology of VRE broadcast.