Indian journal of medical microbiology · 2026
Emergence of vancomycin-variable enterococci in urinary tract infections in north India: A cross-sectional molecular study.
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Singh Riya, Verma Sheetal, Venkatesh Vimala, Kalyan R K, Singh Upma, Rashmi
Аннотация
BACKGROUND: Vancomycin-resistant enterococci (VRE) and Vancomycin-variable enterococci (VVE) pose significant challenges in urinary tract infections (UTIs) due to limited treatment options and silent resistance genes.
OBJECTIVE: To determine the prevalence, resistance profiles, and clinical outcomes of VRE and VVE in UTIs at a Regional AMR Surveillance Centre in North India.
METHODS: A cross-sectional study was conducted among hospitalised UTI patients (≥18 years) at a tertiary care hospital. Enterococcus isolates were identified by MALDI-TOF MS and tested for antimicrobial susceptibility (CLSI 2023). PCR was used to detect vanA, vanB, and vanC genes. All vanA-positive but phenotypically susceptible isolates were subjected to reversion assays on vancomycin-supplemented agar to confirm VVE status. Clinical data were analyzed for risk factors and outcomes.
RESULTS: Of 130 Enterococcus isolates, 88.5% were E. faecalis and 11.5% E. faecium. VRE prevalence was 16.2% (21/130), with 90.5% harboring vanA. VVE comprised 8.5% (11/130). All 11 vanA-positive but phenotypically susceptible isolates reverted to resistance on vancomycin-supplemented agar, confirming true VVE. VRE showed 100% resistance to ampicillin, with high resistance to nitrofurantoin (85.7%), while VVE exhibited 63.6% ampicillin resistance and 9.1% nitrofurantoin resistance. Both groups retained 100% susceptibility to linezolid and fosfomycin. Clinical risk factors associated with VRE/VVE included urinary catheterization, ICU admission, and prolonged hospitalization (>30 days). Mortality was higher in VRE (25%) and VVE (18.2%) compared to VSE (6.3%) (p = 0.023).
CONCLUSION: This study confirms the presence of VVE in India by demonstrating reversion of all vanA-positive, vancomycin-susceptible isolates to resistant phenotypes. The high prevalence of VRE/VVE, driven by vanA, highlights the inadequacy of phenotypic AST alone. Targeted molecular screening of high-risk isolates may be considered to prevent therapeutic failure. Linezolid and fosfomycin remain effective options, but urgent strengthening of stewardship and infection control measures is warranted.
OBJECTIVE: To determine the prevalence, resistance profiles, and clinical outcomes of VRE and VVE in UTIs at a Regional AMR Surveillance Centre in North India.
METHODS: A cross-sectional study was conducted among hospitalised UTI patients (≥18 years) at a tertiary care hospital. Enterococcus isolates were identified by MALDI-TOF MS and tested for antimicrobial susceptibility (CLSI 2023). PCR was used to detect vanA, vanB, and vanC genes. All vanA-positive but phenotypically susceptible isolates were subjected to reversion assays on vancomycin-supplemented agar to confirm VVE status. Clinical data were analyzed for risk factors and outcomes.
RESULTS: Of 130 Enterococcus isolates, 88.5% were E. faecalis and 11.5% E. faecium. VRE prevalence was 16.2% (21/130), with 90.5% harboring vanA. VVE comprised 8.5% (11/130). All 11 vanA-positive but phenotypically susceptible isolates reverted to resistance on vancomycin-supplemented agar, confirming true VVE. VRE showed 100% resistance to ampicillin, with high resistance to nitrofurantoin (85.7%), while VVE exhibited 63.6% ampicillin resistance and 9.1% nitrofurantoin resistance. Both groups retained 100% susceptibility to linezolid and fosfomycin. Clinical risk factors associated with VRE/VVE included urinary catheterization, ICU admission, and prolonged hospitalization (>30 days). Mortality was higher in VRE (25%) and VVE (18.2%) compared to VSE (6.3%) (p = 0.023).
CONCLUSION: This study confirms the presence of VVE in India by demonstrating reversion of all vanA-positive, vancomycin-susceptible isolates to resistant phenotypes. The high prevalence of VRE/VVE, driven by vanA, highlights the inadequacy of phenotypic AST alone. Targeted molecular screening of high-risk isolates may be considered to prevent therapeutic failure. Linezolid and fosfomycin remain effective options, but urgent strengthening of stewardship and infection control measures is warranted.
Предметные рубрики MeSH
HumansIndiaCross-Sectional StudiesUrinary Tract InfectionsAnti-Bacterial AgentsMicrobial Sensitivity TestsGram-Positive Bacterial InfectionsPrevalenceVancomycinVancomycin-Resistant EnterococciEnterococcus faecalisMaleFemaleEnterococcus faeciumBacterial ProteinsVancomycin ResistanceCarbon-Oxygen Ligases