An Investigation of Vancomycin Resistant Enterococcus Grown in Rectal Screening Samples and Clinical Samples: Seven-Years Surveillance, A Retrospective Cross-Sectional Study

Vancomycin-resistant enterococci (VRE) are multidrug-resistant microorganisms that cause nosocomial infections, prolong hospital stay and cause mortality. Current recommendations are active surveillance, screening and contact isolation to prevent the spread of VRE positivity among patients. It has been observed that the failure of the systematic screening caused the spread of VRE and increased costs. It was aimed to determine vancomycin resistance rates in Enterococcus spp., which was grown from rectal swab samples and clinical samples sent for screening of hospitalized patients between January 2013 and May 2019, to investigate the distribution of resistant isolates to departments. A rectal swab sample for VRE screening was obtained from each patient admitted to intensive care units in our hospital, and subcultured onto VRE chromogenic medium (Gül Laboratories, Turkey). The susceptibility of the isolates to vancomycin (30 μg) was detected by Kirby-Bauer disk diffusion method in accordance with the Clinical and Laboratory Standards Institute (CLSI) criteria. The VITEK2 Compact automated system was used to determine the vancomycin susceptibility of enterococci isolated from clinical samples. VRE growth was detected in 316 (6 %) of the 5249 rectal swab samples sent to the laboratory, and vancomycin resistance was detected in 51 (3.9 %) of 1306 Enterococcus spp. from clinical specimens. Of the 51 isolates with vancomycin resistance, 80 % were isolated from urine, 14 % from blood, 4 % from wound, and 2% from joint fluid. While the VRE rate in rectal swab samples was 5.5 % in 2013, it increased to 11.6 % in 2019. Vancomycin resistance was 1.6 % in 2013 and peaked at 7.7 % in 2017 in Enterococcus spp. Twenty nine percent of the 51 clinical VRE isolates were grown from patients with VRE positive rectal swabs. The highest rate of VRE growth in rectal swab samples and culture samples was observed in the Anesthesia Intensive Care Unit. No relationship was found between VRE positivity decrease and increase rates of rectal swab and clinical samples over the years. In order to prevent the spread of VRE in the hospital environment, it is necessary to take surveillance cultures regularly in centers, to provide necessary training to hospital staff, to control the use of antimicrobials, and to ensure good cooperation between the microbiology laboratory and services.