Investig Clin Urol.  2016 Mar;57(2):129-134. 10.4111/icu.2016.57.2.129.

Vancomycin resistant enterococci in urine cultures: Antibiotic susceptibility trends over a decade at a tertiary hospital in the United Kingdom

• Toner L
• Papa N
• Aliyu SH
• Dev H
• Lawrentschuk N
• Al-Hayek S

• KMID: 2363135
• DOI: http://doi.org/10.4111/icu.2016.57.2.129

Abstract

PURPOSE
Enterococci are a common cause of urinary tract infection and vancomycin-resistant strains are more difficult to treat. The purpose of this surveillance program was to assess the prevalence of and determine the risk factors for vancomycin resistance in adults among urinary isolates of Enterococcus sp. and to detail the antibiotic susceptibility profile, which can be used to guide empirical treatment.
MATERIALS AND METHODS
From 2005 to 2014 we retrospectively reviewed 5,528 positive Enterococcus sp. urine cultures recorded in a computerized laboratory results database at a tertiary teaching hospital in Cambridge, United Kingdom.
RESULTS
Of these cultures, 542 (9.8%) were vancomycin resistant. No longitudinal trend was observed in the proportion of vancomycin-resistant strains over the course of the study. We observed emerging resistance to nitrofurantoin with rates climbing from near zero to 40%. Ampicillin resistance fluctuated between 50% and 90%. Low resistance was observed for linezolid and quinupristin/dalfopristin. Female sex and inpatient status were identified as risk factors for vancomycin resistance.
CONCLUSIONS
The incidence of vancomycin resistance among urinary isolates was stable over the last decade. Although resistance to nitrofurantoin has increased, it still serves as an appropriate first choice in uncomplicated urinary tract infection caused by vancomycin-resistant Enterococcus sp.

Keyword

Antibiotic prophylaxis; Enterococcus; Microbial drug resistance; Urinary tract infection; Vancomycin-resistant enterococci

MeSH Terms

Aged
Drug Resistance, Bacterial
England
Female
Gram-Positive Bacterial Infections/drug therapy/*microbiology
Hospitalization/statistics & numerical data
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Retrospective Studies
Risk Factors
Tertiary Care Centers
Urinalysis
Urinary Tract Infections/drug therapy/*microbiology
*Vancomycin Resistance
Vancomycin-Resistant Enterococci/drug effects/*isolation & purification

Figure

• 

  Fig. 1 Number of urine cultures positive for Enterococcus sp. each year. The proportion that demonstrated vancomycin resistance is shaded in red and the percentage is shown above the bars. The proportion that was vancomycin susceptible is shaded in blue. No statistically significant trend in VRE percentage over the years was observed (p>0.35). VRE, vancomycin-resistant Enterococcus sp.

• 

  Fig. 2 Antibiotic resistance of VRE urinary isolates across time. The blue, red, orange, and green lines represent ampicillin, nitrofurantoin, tigecycline, and linezolid, respectively. VRE, vancomycin-resistant Enterococcus sp.

• 

  Fig. 3 Antibiotic susceptibility profile of vancomycin-resistant Enterococcus faecalis (n=15), shaded in blue, and E. faecium (n=107), shaded in red, from 2012 onward. *p<0.05. **p<0.01.

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