Vancomycin-resistant enterococci (VRE) have emerged as
nosocomial pathogens over the last decade all over the world. Despite the use
of vancomycin in Gaza, there is no available data concerning resistance against
it. In order to determine the occurence of vancomycin-resistant enterococci
(VRE) in Gaza City, 100 hospitalized
patients from medical and surgical intensive care unit (ICU), pediatric ICU,
renal units and hemato-oncology wards at Al Shifa and Al Naser hospitals
were screened for VRE fecal colonization. In addition, 100
non-hospitalized individuals from all over Gaza city were screened. Specimens
were enriched and cultured on selective media for the isolation of enterococci.
All isolates were identified and
their minimum inhibitory concentration for vancomycin was determined. The
susceptibilities of the enterococci to vancomycin, ampicillin, penicillin,
tetracycline, ciprofloxacin, chloramphenicol, and gentamicin were determined by
the disk diffusion method.
A questionnaire was introduced to
100 patients
or their guardians to be filled. A
second questionnaire was introduced to 100 healthy subjects or their
guardians to be filled. Another questionnaire
was distributed to hospital
physicians to assess the extent of vancomycin use.
Enterococci were found in 94% of the hospitalized patients
and in 89% of non-hospitalized individuals. VRE were isolated from 69.1% and 43.8% hospitalized patients and non-hospitalized
individuals, respectively. High rates of resistance
to an important antimicrobials used in human medicine were observed.
E.
faecalis was observed to be
the predominant species recovered among non-hospitalized individuals (34%),
while among hospitalized patients, E. faecium was the predominant
identified species (37%). Among
hospitalized patients and non-hospitalized individuals, E. faecium has
the highest resistance rate to vancomycin.
In
conclusion, enterococci isolated from hospitalized and non hospitalized
subjects in Gaza city have high rates of antibiotic resistance including
vancomycin. Strategies to promptly identify
colonized patients should be designed and
implemented in hospitals. Prompt identification is based on targeted
surveillance, considering risk factors for VRE colonization.
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