Detection of virulence factors of Enterococcus faecalis isolated from the urinary system and evaluation of antibiotic resistance

Turan, Deniz; Gürler, Bülent; Turan, Deniz; Gürler, Bülent

Deniz Turan

Bülent Gürler

Abstract

Aims: Enterococci, which are among the leading causes of nosocomial infections, are opportunistic pathogens and cause urinary tract infections most frequently. The frequency of isolation increases especially in patients with urinary system anomalies or urological interventions. Although various virulence factors play a role in the pathogenesis of infections caused by enterococci, cytolysin, hemolysin and enterococcal surface protein (ESP) are among the frequently investigated virulence factors. In this study; It was aimed to investigate the relationship between the presence of virulence factors and antibiotic resistance in Enteroccus faecalis (E. faecalis) strains isolated from urine samples, as well as the effect of urinary catheter use on these factors.
Methods: 100 strains isolated from urine samples sent to İstanbul University İstanbul Faculty of Medicine Medical Microbiology Laboratory and identified as E. faecalis with the VITEK 2 (biomerioux-France) GP identification kit were included in the study. Hemolysin and gelatinase, virulence factors, were determined phenotypically. The presence of the ESP gene was investigated by PCR using ESP11 and ESP12 primers. Antibiotic sensitivities were studied by disk diffusion and gradient strip methods, and the results were evaluated in accordance with CLSI and EUCAST recommendations.
Results: Antibiotic resistance rates were found to be 2%, 31%, 1%, 22%, 37% for ampicillin, norfloxacin, nitrofurantoin, high-level gentamicin (HLG) and high-level streptomycin (HLS), respectively, while no strains resistant to vancomycin, linezolid and tigecycline were detected. When evaluated in terms of virulence factors; It was determined that 82% of the strains produced gelatinase, 67% produced ESP, and 35% produced hemolysin. No virulence factor was detected in eight strains.
Conclusion: In our study, no significant relationship was found between the presence of virulence factors and antibiotic resistance and catheter application. However, since the most detected gelatinase and ESP are virulence factors that have the ability to colonize and form biofilms on abiotic surfaces, it is thought that minimizing catheterization practices may contribute to the prevention of UTIs that may develop with enterococci.

Keywords : Enterococcus faecalis, urinary tract infection, antibiotic resistance, virulence factors

Download Article

1. Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of enterococci. Microbiol Spectrum. 2019;7(4):3-53.
2. Rice LB. Enterococcal physiology and antimicrobial resistance: the streetlight just got a little brighter. mBio. 2021;12(1): e03511-e03520. doi:10.1128/mBio .03511-20
3. Aung MS, Urushibara N, Kawaguchiya M, et al. Antimicrobial resistance, virulence factors, and genotypes of Enterococcus faecalis and Enterococcus faecium clinical ısolates in Northern Japan: identification of optrA in ST480 E. faecalis. Antibiotics. 2023;12(1):108. doi:10.3390/antibiotics12010108
4. Ghalavand Z, Alebouyeh M, Ghanati K, et al. Genetic relatedness of the Enterococcus faecalis isolates in stool and urine samples of patients with community-acquired urinary tract infection. Gut Pathog. 2020;12:42. doi:10.1186/s13099-020-00380-7
5. Baylan O. Enterokok enfeksiyonlarında immünopatogenez ve virülans faktörleri. Nobel Med. 2019;15(2):5-16.
6. Moussa AA, Nordin AF, Hamat RA, Jasni AS. High level aminoglycoside resistance and distribution of the resistance genes ın Enterococcus faecalis and Enterococcus faecium from teaching hospital ın Malaysia. Infect Drug Resist. 2019;12:3269-3274.
7. Zheng J-X, Wu Y, Lin Z-W, et al. Characteristics of and virulence factors associated with biofilm formation in clinical Enterococcus faecalis isolates in China. Front. Microbiol. 2017;8:2338. doi: 10.3389/fmicb.2017.02338
8. Ramos BA, Manta MM, da Silva, SM, et al. Virulence factors and biofilm formation in vancomycin resistant Enterococcus faecalis and Enterococcus faecium isolates in Brazil. Advanc Microbiol. 2023;13(6):299-314. doi:10.4236/aim.2023.136019
9. Guzman Prieto AM, Schaik WV, Rogers MRC, et al. Global emergence and dissemination of Enterococci as nosocomial pathogens: attack of the clones? Front Microbiol. 2016;7:1-15.
10. Vergis EN, Shankar N, Chow JW, et al. Association between the presence of Enterococcal virulence factors gelatinase, hemolysin and Enterococcal surface protein and mortality among patients with bacteremia due to Enterococcus faecalis. Clin Infect Dis. 2002;35(5):570-575.
11. Creti R, Imperi M, Bertuccini L, et al. Survey for virulence determinants among Enterococcus faecalis isolated from different sources. J Med Microbiol. 2004;53(Pt 1):13-20.
12. Samani RJ, Tajbakhsh E, Momtaz H, Samani.; Prevalence of virulence genes and antibiotic resistance pattern in Enterococcus faecalis isolated from urinary tract infection in Shahrekord, Iran. Rep Biochemistr Mol Biol. 2021;10(1):50-59.
13. Hallgren A, Claesson C, Saeedi B, et al. Molecular detection of aggregation substance, enterococcal surface protein, and cytolysin genes and in vitro adhesion to urinary catheters of Enterococcus faecalis and E. faecium of clinical origin. Int J Med Microbiol. 2009;299(5):323-332.
14. Clinical and laboratory standart institue performance standarts for antimicrobial susceptibility testing. Nighteen International Supplement. 2009. M100-S19. CLSI, Wayne, PA.
15. European centre for disease prevention and control. antimicrobial resistance surveillance in Europe 2014. Annual Report of the European antimicrobial resistance surveillance network (EARS-Net). Stockholm: ECDC; 2015:1-85.
16. European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report 2019. Stockholm: ECDC; 2020:1-28.
17. European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report 2021. Stockholm: ECDC; 2022.
18. Horner C, Mushtag S, Hope R, et al. Replacement of Enterococcus faecalis by Enterococcus faecium as the predominant Enterococcus in UK bacteraemias. JAC Antimicrob Resist. 2021. doi:10.1093/jacamr/dlab185
19. Gupta S, Srivastava P, Yadav S, et al. Vancomycin-Resistant Enterococci causing bacteriuria in hospitalized patients from Northwest India. Website: www.journaldmims.com 2020. doi: 10.4103/jdmimsu.jdmimsu_69_20
20. Das A, Banerjee T, Anupurba S. Susceptibility of nitrofurantoin and fosfomycin against outpatient urinary isolates of multidrug-resistant Enterococci over a period of 10 years from India. Microbial Drug Resistance. 2019;26(12):1-7. doi:10.1089/mdr. 2019.0044
21. Kafil HS, Mobarez AM. Spread of Enterococcal surface protein in antibiotic resistant Enterococcus faecium and Enterococcus faecalis isolates from urinary tract infections. Open Microbiol J. 2015;9:14-17.
22. Kutlu o, Arabacı Ç. Antibiotic susceptibility pattern of Enterococcus isolates in a five year period at a tertiary care hospital. J Surg Med. 2019;3(9):644-647.
23. Savcı Ü, Şahin M, Eser B. Klinik örneklerden izole edilen Enterococcus faecalis ve Enterococcus faecium suşlarında antibiyotik dirençlerinin değerlendirilmesi. J Health Sci Med. 2018;1(1):4-8.
24. Şimşek M. İdrar kültürlerinden izole edilen enterokok suşlarının tür dağılımları ve antibiyotik duyarlılıkları. Kocatepe Med J. 2019;20(1):177-182.
25. Baylan O, Nazik H, Bektöre B, ve ark. Üriner enterokok izolatlarının antibiyotik direnci ile virülans faktörleri arasındaki ilişki. Mikrobiyol Bul. 2011;45(3):430-445.
26. Zheng J, Bai B, Lin Z, et al. Characterization of biofilm formation by Enterococcus faecalis isolates derived from urinary tract infections in China. J Med Microbiol. 2018;67(1):60-67.
27. Zheng JX, Wu Y, Lin Z, et al. Characteristics of and virulence factors associated with biofilm formation in clinical Enterococcus faecalis isolates in China. Front Microbiol. 2017;8:1-9.
28. Hashem Y, Abdelrahman KA, Aziz R. Phenotype-genotype correlations and distribution of key virulence factors in Enterococcus faecalis isolated from patients with urinary tract infections. Infect Drug Resist. 2021:14;1713-1723.
29. Gök ŞM, Dağı HT, Kara F. Klinik örneklerden izole edilen Enterococcus faecium ve Enterococcus faecalis izolatlarının antibiyotik direnci ve virülans faktörlerinin aras¸tırılması. Mikrobiyol Bul. 2020;54(1):26-39.
30. Mete E, Kaleli İ, Cevahir N ve ark. Enterokok türlerinin virulans faktörlerinin aras¸tırılması. Mikrobiyol Bul. 2017;51(2):101-114.

Article available in :

Volume 7, Issue 5, 2024
Page : 543-548

https://doi.org/10.32322/jhsm.1511125

Article Information

Received : 05 Tem 2024
Accepted : 31 Ağu 2024
Published : 27 Eyl 2024

Corresponding Author :

Deniz Turan: Department of Medical Microbiology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkiye

[email protected]

Citation : Turan D, Gürler B. Detection of virulence factors of Enterococcus faecalis isolated from the urinary system and evaluation of antibiotic resistance. J Health Sci Med. 2024;7(5):543-548.

Read: 16
Cited: 0
Download : 11

Journal of Health Sciences and Medicine

ISSN: Active

eISSN: 2636-8579

Creative Commons CC BY-NC-ND 4.0 International License.

EndNote Style

Abstract

Journal of Health Sciences and Medicine

ISSN: Active

eISSN: 2636-8579

Creative Commons CC BY-NC-ND 4.0 International License.

EndNote Style

Abstract

References