title: Emergence of unusual species of enterococci causing infections, South India.
abstract: BACKGROUND
  Enterococci tend to be one of the leading causes of nosocomial infections, with E. faecalis and E. faecium accounting up to 90% of the clinical isolates. Nevertheless, the incidence of other species of enterococci from clinical sources shows an alarming increase with the properties of intrinsic resistance to several antibiotics including beta-lactams and glycopeptides. Thus proper identification of enterococci to species level is quintessential for management and prevention of these bacteria in any healthcare facility. Hence this work was undertaken to study the prevalence of unusual species of enterococci causing human infections, in a tertiary care hospital in South India.
  
  
  METHODS
  The study was conducted in a tertiary care hospital in South India from July 2001 to June 2003. Isolates of enterococci were collected from various clinical specimens and speciated using extensive phenotypic and physiological tests. Antimicrobial susceptibility testing were performed and interpreted as per NCCLS guidelines. Whole cell protein (WCP) fingerprinting of enterococci were done for species validation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and analyzed computationally.
  
  
  RESULTS
  Our study showed the prevalence of unusual (non-faecalis and non-faecium enterococci) and atypical (biochemical variant) species of enterococci as 19% (46 isolates) and 5% (12 isolates) respectively. The 7 unusual species (46 isolates) isolated and confirmed by phenotypic characterization includes: 15 E. gallinarum (6.2%), 10 E. avium (4.1%), 6 E. raffinosus (2.5%), 6 E. hirae (2.5%), 4 E. mundtii (1.7%), 3 E. casseliflavus-including the two atypical isolates (1.2%) and 2 E. durans (0.8%). The 12 atypical enterococcal species (5%) that showed aberrant sugar reactions in conventional phenotyping were confirmed as E. faecalis, E. faecium and E. casseliflavus respectively by WCP fingerprinting. The antimicrobial susceptibility testing depicted the emergence of high-level aminoglycoside and beta-lactam resistance among different species apart from intrinsic vancomycin resistance by some species, while all the species tested were susceptible for linezolid and teicoplanin.
  
  
  CONCLUSIONS
  Our study reveals the emergence of multi-drug resistance among unusual species of enterococci posing a serious therapeutic challenge. Precise identification of enterococci to species level enables us to access the species-specific antimicrobial resistance characteristics, apart from knowing the epidemiological pattern and their clinical significance in human infections.
authors.affiliation: Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. vittalprakash@rediffmail.com
authors.forename: Vittal P
authors.initials: VP
authors.lastname: Prakash
authors.forename: Sambasiva R
authors.initials: SR
authors.lastname: Rao
authors.forename: Subash C
authors.initials: SC
authors.lastname: Parija
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D010641:Phenotype; D010802:Phylogeny; D013045:Species Specificity
chemical_list: D000900:Anti-Bacterial Agents