Prevalence of vancomycin-resistant enterococcus causing urinary tract infection in a tertiary care hospital of Eastern India

Background: The increasing prevalence of urinary tract infection (UTI) caused by vancomycin-resistant Enterococcus (VRE) is of particular concern within many institutions because of limited treatment options. Objective: The objective of the study is to estimate the prevalence of VRE amongst the urinary pathogens along with detection of the antimicrobials effective against VRE in vitro. Materials and Methods: This hospital-based descriptive cross-sectional study was performed from January 1, 2019, to December 31, 2020, with 1037 adult patients developing symptoms of UTI. Mid-stream urine was collected in proper aseptic manner for microbiological culture to isolate and identify the bacterial pathogen. Collected urine samples were screened for pus cells and bacteria. This was followed by plating on (basal media), blood agar (enriched media), and MacConkey's agar media (differential and selective media), followed by overnight incubation at 37°C. Species confirmation and minimum inhibitory concentration value determination were done by automation. Results: Out of total 1037 collected urine samples, 693 were culture positive for bacterial etiology (66.8%). 457 urine cultures were positive for Enterococcus spp., of which 41 were vancomycin resistant (8.97%). A total of 18 Enterococcus faecalis isolates (4.72%) were vancomycin resistant, whereas significantly higher number of Enterococcus faecium, i.e., 23 isolates (30.26%) were vancomycin resistant (P < 0.01). All of 41 VRE isolates were resistant to ampicillin. No trends were observed for resistance against nitrofurantoin, tigecycline, linezolid, and daptomycin. These remained highly effective against VRE across the study period. Conclusion: Since VRE is emerging as a prevalent uropathogen with limited therapeutic options, the use of vancomycin demands judicious administration to treat UTI. Hence, antimicrobial stewardship deserves a crucial role to play.