American Journal of Epidemiology and Infectious Disease
ISSN (Print): 2333-116X ISSN (Online): 2333-1275 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Epidemiology and Infectious Disease. 2016, 4(4), 72-77
DOI: 10.12691/ajeid-4-4-2
Open AccessArticle

Prevalence of Various Genotypes of Vancomycin Resistant Enterococci in Neonatal Intensive Care

Mohammed A Garout1, Hani A Jokhdar1, Magda R. Abdelwadood2, and Nagwa Ramadan3

1Department of Community Medicine and Pilgrims Health, Faculty of Medicine UQU, Makkah KSA

2Microbiology &Immunology Ain Shams University, Faculty of Medicine

3MD of Clinical Pathology, Matarya teaching hospital

Pub. Date: September 18, 2016

Cite this paper:
Mohammed A Garout, Hani A Jokhdar, Magda R. Abdelwadood and Nagwa Ramadan. Prevalence of Various Genotypes of Vancomycin Resistant Enterococci in Neonatal Intensive Care. American Journal of Epidemiology and Infectious Disease. 2016; 4(4):72-77. doi: 10.12691/ajeid-4-4-2


After they were first identified in the mid-1980s, vancomycin-resistant enterococci (VRE) spread rapidly and became a major problem in many institutions both in Europe and the United States. Since VRE have intrinsic resistance to most of the commonly used antibiotics and the ability to acquire resistance to most of the current available antibiotics, either by mutation or by receipt of foreign genetic material, they have a selective advantage over other microorganisms in the intestinal flora and pose a major therapeutic challenge. The possibility of transfer of vancomycin resistance genes to other gram-positive organisms raises significant concerns about the emergence of vancomycin-resistant Staphylococcus aureus. Multiple drug–resistant organisms such as vancomycin –resistant enterococci (VRE),cause serious infections especially among high –risk patients in NICU, we started active surveillance cultures to determine their efficacy in detecting and controlling the speed of VRE among high risk infants active surveillance cultures other infection control measures, and mandatory in service education is the module for preventing multiple drug resistance organisms transmission which were performed on NICU on admission and then weekly during their stay, molecular DNA extraction from rectal swab specimen of VRE isolates then amplification and genotyping by PCR using 3 primers Van A, Van b,VanC1. Results: active surveillance cultures identified forty nine patients with VRE colonization or infection among 500 admitted to the NICU. PCR was done on this 49 identified plus 16 detected from reculture after 1 week. Two genes clusters appeared 36 were identified biochemical as E.faecium and were shown to contain Van A. 10 were identified as E. gallinum and contained Van C.1 specimens contained both E. faecium and E.gallinurm and 2 specimens were shown to contain Van B and identified as E.faecium. 16 VER isolates were identified from patients examined after 1 week 9 of them was contained Van A and identified as E.faecium 5 was contained Van C1 and identified asE.gallinurm.2 was contained Van B. Conclusions: VRE is often passed from person to person by the contaminated hands of caregivers. VRE can get onto a caregiver's hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not spread through the air by coughing or sneezing, Control transmission of multi colonel VRE stains can be achieved by active surveillance cultures together with complementation of other infection control measures. The risk of VRE infection can be reduced by minimizing the use of indwelling devices such as intravenous lines and urinary catheters. The risk is also reduced by eliminating inappropriate use of antibiotics control of transmission of multiple drug resistance colonel VER strains active surveillance cultures together with implementation of other infection control measures, were instrumental in controlling VER transmission in NICU.

enterococci vancomycin neonatal prevalence

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Achillaes.G, Athanasia Christidou, Efstathia Scouilica, Paulos Nikolaidis and Yannis Tselentis (2005): Epidemiological and molecular analysis of intestinal colonization by Vancomycin resistant enterococci in Greek hospitals.
[2]  Clark, N.C.R.C. Cooksey, B.C. Hill, J.M. Swenson and F.C.Tenover.1993.characteriszation of glycopeptides resistant enterococci from US hospitals. Antimicrob. Agents Chemother. 37. 2311-2317.
[3]  Centinkaya, y.,Kalk,P.& Mayhall, c.g.(2000). Vancomycin-resistant enterococci. Clin Microbiol Rev 13, 686-707.
[4]  Charnow J.A.Studies expand found of epidemiology data on VRE, Inf.Dis.Nawes.1994.10.1-5.
[5]  Edet E.Udo, Noura Al sweih, Oludotun A.Phillins and Tulsi D.2003: Speices prevalence and antibacterial resistance of enterococci isolated in Kuwait hospitals 1.J.Med.Microbiol. 52. (2003) 163-168.
[6]  Jone, R.N., Marshall, S.A., Pfaller M.A., Wilke, W.W., Hollis, R.J., Erwin, M.E., Edmoned., M.B & Wenzel R.P. (1997): Nosocomial enterococcal blood stream infections in the scope program: antimicrobial resistance, species occurrence, molecular testing results and laboratory testing accurately. Diag. Microbiol. Infec.Dis.29, 95-102 (Medline).
[7]  Huycke, Mark, Sahm DF, Gilmore M.S; Multiple drug resistant Enterococci the nature of problem and an agenda for the future. Emerging infectious diseases 1998., 4(2); 239-49.
[8]  Low, D.E., N.Keller, Barth and R.N.Jone. 2001. Clinical prevalence antimicrobial susceptibility, and geographic resistance patterns of enterococci:resultes from the antimicrobial surveillance program 1997.
[9]  Lavan, M., Vercauteren. E. Descheemaeker. P. VanLaer and Goossens H., (1999): Comparison of direct plating and broth enrichment culture for the detection of intestinal colonization by glycopeptide- resistant enterococci among hospitalized patients. j. Clin. Microbiol. 37: 1436-1440.
[10]  MMWR 2002 morb mortal wkil rep. 2002. 51: 565-7: Staphylococcus aureus resistant to vancomycin –United States.
[11]  Millar B, Moore J, Mallon al., Molecular diagnosis of infective endocarditis anew Duke's criterion Scand J Infect 2001. 26; 163-71., 26; 163-71.
[12]  Morris J.G Shay J.Hebden, Mc Carter, c. Dowling and R.S. Shwallbe 1995: enterococci resistant to multiple antimicrobial agents including Vancomycin
[13]  Nelson R.R.S., Mcgrrogor, k.f. Brown, A.R., Amyes. S.G.B & Young, H-K (2000). Isolation and characterization of glycopeptides –resistant enterococci from hospitalized patients over a 30 month period J.Clin Micrbiol 38, 2112-2116.
[14]  NNIS National Nosocomial Infection Surveillance system Report data summary from JAN 1992 through June 2004, issued October 2004 Am, J, Infec. Control 2004, 32., 470-85.
[15]  Mundy L.M., Sham.D.F and Gilmore M200: Relationships between enterococcal virulence and antimicrobial Resistance. clin. Micrbiol. Rev. 13; 513-522.
[16]  Reinert, R.R., Conrad, G., Schaeger, J.J., Werner, G., Witte, W., & Klare, I. (1999). Survey of antibiotic resistance among enterococci in North Rhine –Westphalia Germany. J. Clin Microbiol.37, 1638-1641.
[17]  Rebecca C, Bruce M, Sprague, Joseph M, Sumathi Nambiar, and Nalini Singh (2005): characterizing vancomycin resistant enterococci in neonatal intensive care.Emerging infectious diseases.,no.9,September 2005.
[18]  Sotake 5.1 Clask N, Rimland, Wolfe f.s. and turnover f.c 1997. Detection Vancomycin resistant enterococci in fecal samples by PCR. Journal of clinical microbiology (35). No 9. 23 25-30.
[19]  Reina M.Flores, PharmD James A. & Thomas W M.S.RPH 2006: Vancomycin resistant enterococci approach to treatment and control http://www.moffitt/. Cancer Control Journal (3) NO.1:1-7.
[20]  Petrich, A.k.,. k.E.Luinstra, D. Groves, M,A. Chenesky and J.B.Mahony.1999; direct detection of Van A and Van B genes in clinical specimens for rapid identification of vancomycin resistant enterococci using multiplex PCR. MOL. Cell. PROBES. 13; 275-281.
[21]  Perez-Hernandez, Mendez-Alvarez s, Claverie-Martin f; PCR assay for rapid detection of vancomycin resistant enterococci. Diagn. Microbiol. Infect Dis 2002., 42; 273-7.
[22]  Singh-Naz N, Sleemi A, Pikis A, Patel K, Compos J. (1999): Vancomycin resistant Enterococci faecium colonization in children. J CLIN MICROBIOL.37; 413-6.
[23]  Singh N,Leger MM, CampbellJ, Short B, Campos JM (2005): Control of vancomycin resistant enterococci in the neonatal intensive care uint.Infection control hosp epidemiol 2005 jul; 26(7) :646-9.
[24]  Sachiko Satake, Nancye clark, David Rimland, and Fred C. (1997): DETECTION OF Vancomycin resistant enterococci in fecal Samples by PCR. Journal of clinical microbiology sep. 1997, 2325-233024-Suzanne M, William E, Trick, Fred C. and lance p. Peterson: Composition of PCR assay to culture for surveillance detection of vancomycin resistant enterococci. Journal of clinical microbiology 2013 Oct. 4 and 05-4807. (41) No. 10.
[25]  Suzanne M, William E, Trick, Fred C. and lance p. Peterson: Composition of PCR assay to culture for surveillance detection of vancomycin resistant enterococci. Journal of clinical microbiology 2013 Oct. 4 and 05 – 4807. (41) No. 10.
[26]  Schleifer.K, H.and Kilpper Balz 1984: Transfer of Streptococcus feacalis and Streptococcus francium to the genus Enterococcus now. Enterococcus feacalis comb nov.Int.J.Syst. Bacteriol 34:31-34.
[27]  Susan L Fraser, col., Juilia lim, Donskey M.D and David H.,: enterococcal infections: http://www
[28]  Quale, J., Laudman, D. &, Atwood E. (1996) Experience with a hospital –wide outbreak of vacomycin-resistant enterococci Am J Infection control 24,372-379(MEDLIN).
[29]  Claeys KC, Zasowski EJ, Lagnf AM, Rybak MJ. Comparison of outcomes between patients with single versus multiple positive blood cultures for Enterococcus: Infection versus illusion. Am J Infect Control. 2016 Jan 1. 44 (1):47-9.
[30]  Yesim Cetinkaya, Pamela Falk, and Glen Mayhall (Vancomycin-Resistant Enterococci)Clin. Microbiol. Rev. October 2000 vol. 13 no. 4 686-707 1 October 2000.
[31]  Siegel JD, Rhinehart E, Jackson M, et al. 2011: The Healthcare Infection Control Practices Advisory Committee (HICPAC). Management of Multidrug-Resistant Organisms In Healthcare Settings, CDC-INFO.