Magnitude of Drug-resistant Enterococcus species from Intestinal Tracts of Hospitalized Pediatric Patients in Jimma University Specialized Hospital, Southwest, Ethiopia

Research Article

J Bacteriol Mycol. 2019; 6(1): 1094.

Magnitude of Drug-resistant Enterococcus species from Intestinal Tracts of Hospitalized Pediatric Patients in Jimma University Specialized Hospital, Southwest, Ethiopia

Gebrish S¹, Fikadu B¹ and Asfaw T²*

¹Department of Medical Laboratory Science, Debre Berhan Health Science College, Debre Berhan, Ethiopia

²Department of Medical Laboratory Science, College of Medicine, Debre Berhan University, Debre Berhan, Ethiopia

*Corresponding author: Tsegahun Asfaw, Department of Medical Laboratory Science, College of Medicine, Debre Berhan University, Debre Berhan, Ethiopia

Received: December 26, 2018; Accepted: January 18, 2019; Published: January 25, 2019


Background: Multi-drug-resistant enterococci are the major source of infection as well as nosocomial spread. There is scarcity of data on drugresistant enterococci in developing country including Ethiopia. Therefore, the present study aimed to determine the magnitude of drug resistant Enterococcus species from intestinal tracts of hospitalized pediatric patients at Jimma University specialized hospital.

Method: The study was conducted among hospitalized pediatric patients at Jimma University Specialized Hospital, from February 15 to March 25, 2016. Rectal swabs was collected and processed for bacterial isolation and susceptibility testing. The isolates was identified to species level by cultural characteristics, Gram’s stain, catalase test and other biochemical tests. Susceptibility testing to antimicrobial agents was done using Kirby-Bauer disk diffusion method.

Result: Enterococci were isolated from 12 (23%) of the study participants. The isolates were Enterococcus faecium (50%), Enterococcus faecalis (33.3%) and Enterococcus gallinarum (16.7%). Among 12 tested Enterococci isolates, 5 (41.7%) were resistant to ampicillin, 7 (58.3%) to streptomycin, 6 (50%) to gentamycin. 7 (58.3%) to ciprofloxacin, 5 (41.7%) to norfloxacin and 8 (66.7%) to erythromycin. Multiple drug resistance was observed among 75% of E. faecium and E. faecalis. Vancomycin resistant Enterococci were observed in 16.7% of E. faecium isolates.

Conclusion: This study reveals high rate of fecal colonization by multidrugresistant enterococci and prevalence of vancomycin resistance strains. Thus periodic surveillance of antibiotic susceptibilities is recommended to detect emerging resistance and to prevent its spread.

Keywords: Magnitude; Drug-resistance; Enterococcus species; Pediatric Patients


Enterococci are normal inhabitant of the gastrointestinal tract. However, they can also be significant pathogens causing several infections. The most common nosocomial infections caused by these organism are urinary tract infections (associated with instrumentations and antimicrobials administration) [1]. The emergence of vancomycin resistance enterococci (VRE) is a global issue due to few option left for disease management. Besides drug resistant Enterococci can colonize the intestinal tract of hospitalized patients and become major source of infection as well as nosocomial spread [2,3].

In humans, enterococcal infections may be caused by at least 12 species but most clinical infections are due to either Enterococcus faecalis or E. faecium. E. faecalis is the most common cause (80-90 %) followed by E. faecium (10-15 %). Occasional infections are due to Enterococcus gallinarum, Enterococcus raffinosus, Enterococcus casseliflavus, Enterococcus avium, Enterococcus pseudoavium, Enterococcus malodoratus, Enterococcus mundtii, Enterococcus durans, and Enterococcus hirae [4]. The proportion of isolates of motile Enterococci (E. gallinarum, E. casseliflavus) is low. But they are intrinsically resistant to vancomycin and inappropriate treatment may contribute to morbidity and mortality [5].

Several studies have documented that enterococcal infections are most commonly caused by the patient’s own commensal flora. Colonization may occur long before or immediately before infection, but it plays a major role in the development of nosocomial infection [2]. Despite the importance of these etiologic agents there is dearth of information regarding antimicrobial resistance of Enterococcus species isolated from intestinal tract of hospitalized patients in Ethiopia. Thus, the present study will be conducted to determine antimicrobial resistance pattern of fecal enterococci isolates from hospitalized pediatric patients.


Study area

The study was conducted at Jimma university specialized hospital, Jimma town, south west Ethiopia. It is located 352km southwest of Addis Ababa. It provides services for approximately 9000 inpatients and 80000 outpatients each year with bed capacity of 450 beds. According to the national 2015 census, this town had a total population of 120,960 of whom 60,824 were men and 60136 were women.

Study design and periods

Cross sectional study was conducted to determine the magnitude of drug resistance Enterococcus species from intestinal tracts of hospitalized Pediatric patients aged 0 to15 years from February 15 to march 25, 2016.

Sampling technique and sample size

52 patients, who had at least 2 days of hospital stay at Pediatric ward of Jimma University specialized hospital were enrolled by using convenience sampling technique.

Inclusion and exclusion criteria

Pediatric patients aged 0 to 15 years and having at least 48 hour hospital stay during the study period and fulfill the inclusion criteria was included while who cannot respond to the interview and for children without getting permission from guardian and consent was excluded.

Data collection techniques

Scio-demographic data was collected by pretested questionnaires after obtaining a written informed consent from study participants. Fecal samples were collected in sterile plastic stool containers and then were transferred to the laboratory. From critically ill patients rectal swabs were collected using sterile cotton swab moistened in sterile normal saline solution at intensive care units. Then, the swabs were immersed in well-labeled Cary-Blair semi-solid medium prepared in screw-capped tubes.

Culture and identification: Stool specimens and rectal swabs were inoculated onto Enterococci selective media [Bile Esculin azide agar plates with and without 6μg/ml of vancomycin to recover vancomycin-susceptible isolates and incubated at 37°C for 24h. Colonies showing macroscopically morphological differences and whose colony morphology was consistent with that of Enterococci [colonies with colourless or grey and surrounded by a black halo (hydrolysis of esculin)] were subcultured and identified as Enterococci by additional tests (gram stain, catalase test, 6.5% NaCl test, growth at 45°C and motility test) as recommended by Facklam and Collins [6], Manero and Blanch [7]. Identification of these isolates to species level was performed by API-20 Streptococcus system (bioMe´rieux). For further identification, stock cultures were stored at BHI Broth containing 50% glycerol at -20°C.

Antibiotic susceptibility testing: Antimicrobial susceptibility studies were performed by disc diffusion (Kirby-Bauer) method according to Clinical Laboratory Standards Institute (CLSI) for different tested drugs.

Data processing, analysis

The collected data was clearly summarized, filled and processed by using SPSS version 21. The data was analyzed by using SPSS version 21. Descriptive statistics was employed to examine the finding, and the result was presented by using tables, charts and graphs. The association between independent and dependent variables was determined. P-value less than 0.005 was considered as statistically significant value.

Quality assurance

The questionnaires was pretested a week before actual data collection. The quality of reagents and equipment was checked and used according to manufacturer directions. The data was collected by trained data collectors and the result was recorded carefully and correctly. Standard operating procedure was applied during specimen collection, culture, drug susceptibility test and biochemical test.

Ethical consideration

The study protocol was reviewed and approved by the ethical and review committee of Jimma University. For all study participant the objective of the study was explained and written informed consent was obtained. Those positive for enterococcus was referred to their respective clinicians for further management.


Demographic characteristics

Among 52 participants, 27 (52%) were males and 25 (48%) were females. The mean age of the patient’s was 3 years. 78.8% study participant had a history of exposure to one or more antimicrobial agent in the last 2 weeks and 21.2% were without exposure and the average hospital stay was 17.5 days with a range of 2-45days (Table 1).

Citation: Gebrish S, Fikadu B and Asfaw T. Magnitude of Drug-resistant Enterococcus species from Intestinal Tracts of Hospitalized Pediatric Patients in Jimma University Specialized Hospital, Southwest, Ethiopia. J Bacteriol Mycol. 2019; 6(1): 1094.