Loai A Siddig^1,, Omnia M Hamid¹, Nasreldin Elhadi², Magdi A Bayoumi³

Objective: in this study, we evaluate the prevalence, antimicrobial profiles, and vancomycin resistance (van) genotype ‎of fecal Enterococcus isolates from hospitalized and non-hospitalized patients in Khartoum locality hospitals, Sudan. ‎Methodology: This is a cross-sectional study, conducted between Oct 2018 and March 2020 at four tertiary hospitals in the ‎Khartoum locality. A total number of 588 fecal samples were collected and processed using microbiological culture media ‎‎ (Bile Esculin agar), gram stain, and gram-positive biochemical set tests to identify Enterococci species. Antibiogram of ‎Enterococci strains was performed, and the disk diffusion method of Kirby-Bauer has been used with the broth microdilution‎ method for vancomycin ‎minimum inhibitory concentration. A multiplex polymerase chain reaction assay was used to provide simultaneous identification at ‎the species level and detection of vancomycin resistance (van) genotypes characterization.‎ Results: All tested enterococci were confirmed to the species level, van genes were detected, and the MIC values determined vancomycin. Overall, Enterococcal species were isolated from 170/588 (28.9%) of the study subjects. Among the ‎Enterococcus isolates, 70 (41.2%) were isolated from hospitalized patients, and 100 (58.8%) were isolated from non-hospitalized patients. The isolates were E. faecium 108 (63.5%), followed by E. faecalis 43 (25.3%) ‎and 19 (11.2%) other Enterococcus spp. Enterococcus isolates show overall high resistance to ceftazidime (80.0%), ‎followed by amoxicillin-clavulanic acid (70%), gentamycin (69.4%), and erythromycin (52.4%). A higher ‎prevalence of resistance to ampicillin, rifampin, and teicoplanin was detected in E. faecium than that in E. faecalis and ‎other Enterococcus spp., while a greater prevalence of resistance to ceftazidime, and ciprofloxacin was ‎found in E. faecalis. ‎Twenty-five (14.7%) strains of fecal Enterococci were found to be vancomycin resistant with vanA 19 (11.2%), vanB 5 ‎‎(2.9%), and 1 (0.6%) vanC1 genotypes. The most predominant van producer strains were E. faecium [18, 16.7%; vanA (n= ‎‎17) & vanB (n= 1)] followed by E. faecalis [6, 14.0%; vanA (n= 2), and vanB (n= 4)] and Other Enterococcus spp. [1, 5.3%; ‎vanC1 (n= 1)].‎ Conclusion: The present study provides the first comprehensive report ‎of the ‎antimicrobial ‎resistance pattern ‎ and shows Khartoum localities are repositories for the vancomycin resistance ‎Enterococcus with vanA, vanB, and vanC1 genotypes in human feces of both hospitalized and non-hospitalized patients. ‎It is imperative to track and implement infection control measures in both settings to prevent the spread of these strains.‎

fecal enterococci, vancomycin-resistant enterococci, van genotypes, Khartoum, Sudan