title: Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia.
abstract: BACKGROUND
  Multi-drug-resistant Enterococci colonizing the intestinal tract of hospitalized patients are the major source of infection as well as nosocomial spread. Despite worldwide increasing rate of multidrug resistant Enterococci colonization and infection among hospitalized patients, there is scarcity of data from resource limited setting. The present study aimed at determining the antimicrobial resistance profile of Enterococcus species from intestinal tracts of hospitalized patients in Jimma, Ethiopia.
  
  
  METHODS
  The study was conducted among hospitalized patients at Jimma University Specialized Hospital, from January to July 2013. Fecal samples were collected and processed for bacterial isolation and susceptibility testing to antimicrobial agents. Stool samples were inoculated onto enterococcus selective media (Bile Esculin azide agar plate) with and without 6 µg/ml of vancomycin. The isolates were identified to genus and species level by cultural characteristics, Gram's stain, catalase test, growth in 6.5% NaCl broth, growth at 45°C, motility test and by using API 20 Streptococcus system. Sensitivity testing was done using Kirby-Bauer disk diffusion method. Minimum inhibitory concentrations for vancomycin were determined using E-test strips.
  
  
  RESULTS
  Overall, Enterococci were isolated from 114 (76%) of the study subjects. The isolates were Enterococcus faecium (35.1%) followed by Enterococcus faecalis (29.8%), Enterococcus gallinarum (17.5%), Enterococcus casseliflavus (8.8%) and Enterococcus durans (8.8%). Among 114 tested Enterococci isolates, 41 (36%) were resistant to ampicillin, 62 (54.4%) to streptomycin and 39 (34.2%) to gentamycin. Other alternative antibiotics to treat mixed nosocomial infection caused by Enterococci also showed high rate of resistance in vitro: ciprofloxacin (50% of resistance), norfloxacin (49.1%), erythromycin (63.2%), tetracycline (64.9%), chloramphenicol (34.2%), and nitrofrantoin (32.4%). Multiple drug resistance was observed among 89.5% of E. faecium and E. faecalis. Vancomycin resistant Enterococci were observed in 5% of E. faecium isolates.
  
  
  CONCLUSIONS
  This study reveals high rate of fecal colonization by multidrug-resistant Enterococci and prevalence of vancomycin resistance strains. Thus periodic surveillance of antibacterial susceptibilities is recommended to detect emerging resistance and to prevent the spread of antibacterial-resistant strains.
authors.affiliation: Department of Biomedical Sciences, Faculty of Public Health and Medical Sciences, Mettu University, P. O. Box: 318, Mettu, Ethiopia. abdulhakimabamecha@gmail.com.
authors.forename: Abdulhakim
authors.initials: A
authors.lastname: Abamecha
authors.affiliation: Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia. beyenewondafrash@googlemail.com.
authors.forename: Beyene
authors.initials: B
authors.lastname: Wondafrash
authors.affiliation: Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia. alemsaged.abdissa@ju.edu.et.
authors.forename: Alemseged
authors.initials: A
authors.lastname: Abdissa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D013293:Enterococcus faecalis / Q000187:drug effects / Q000302:isolation & purification; D016984:Enterococcus faecium / Q000187:drug effects / Q000302:isolation & purification; D005002:Ethiopia; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D020713:Vancomycin Resistance; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents