title: Community Acquired Enterococcal Urinary Tract Infections and Antibiotic Resistance Profile in North India.
abstract: BACKGROUND
  Urinary tract infections (UTIs) remain a major problem both in hospitalized and outdoor patients. Multidrug-resistant enterococci are emerging as a major nosocomial pathogen with increasing frequency. However, the incidence of community-acquired enterococcal infections and species prevalent in India is not thoroughly investigated.
  
  
  OBJECTIVE
  This study aims to estimate the burden of community-acquired UTIs seen at a tertiary care hospital and to identify the Enterococcus species isolated from these patients. The study also aims to determine the antibiotic susceptibility pattern with reference to high-level aminoglycosides and vancomycin.
  
  
  METHODS
  Semi-quantitative cultures from a total of 22,810 urine samples obtained from patients seen at various Outpatient Departments were analyzed. From them 115 nonduplicate isolates of enterococci were obtained as significant pure growth (>10(5) cfu/ml) and speciated. Antibiotic susceptibility was performed by Kirby-Bauer disc diffusion method. Vancomycin resistance screening was performed by the vancomycin screen agar method recommended by Clinical and Laboratory Standards Institute and confirmed by determination of minimum inhibitory concentration by agar dilution method.
  
  
  RESULTS
  Of 115 enterococcal isolates, 61 were identified as Enterococcus faecalis, 42 as Enterococcus faecium, 3 each as Enterococcus dispar, and Enterococcus pseudoavium. High-level gentamicin resistance (HLGR) was higher in E. faecium (47.6%) than E. faecalis (32.7%) and HLSR also showed the same pattern with 47.6% and 27.9% resistance, respectively. Vancomycin resistant enterococci accounted for 11.3% of the isolates, and out of them 53.8% were E. faecium by agar dilution method.
  
  
  CONCLUSIONS
  High rate of resistance to antibiotics of penicillin group and aminoglycosides was observed in our tertiary care hospital even in community acquired UTIs. Hence, there is an urgent need for more rational and restricted use of antimicrobials.
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Varun
authors.initials: V
authors.lastname: Goel
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Purva
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sarman
authors.initials: S
authors.lastname: Singh
keywords: Enterococcus faecalis; Enterococcus faecium; urinary tract infection; vancomycin resistant enterococci