Conclusions

VRE has become an important nosocomial pathogen because of its rapid spread, high mortality rates associated with infections, limited options for treatment and the possibility of transferring vancomycin resistance genes to other more virulent and more prevalent pathogens such as S. aureus.

The present study focused on the isolates of enterococci with acquired resistance to antibiotics and to generate knowledge of the occurence of enterococci in Gaza City and of their possible threat to human health due to Vancomycin resistance development.

From this study the following conclusions were drawn:

1. Ninety four percent of the hospitalized patients and 89% of individuals living in the community carried enterococci in their gastrointestinal tracts.

2. Among hospitalized patients E. faecium was the predominant species (37%) followed by E. faecalis (28%), E.  gallinarum (14%), E. durans (9%) and E. avium (6%), while among non-hospitalized individuals E. faecalis was the predominant species identified) 34%) followed by E. faecium (27%), E. avium (14%), E.  gallinarum (11%) and E. durans (3%).

3. VRE were isolated from 69.1%of hospitalized patients and 43.8%of individuals living in the community

4. Among hospitalized patients E. faecium has the highest resistance rate to vancomycin (86.5 %), while E. avium has the lowest resistance rate (16.7 %), while among non-hospitalized individuals E. faecium has the highest resistance rate to Vancomycin, while E. durans has the lowest resistance rate (33.3%).

5. VRE carriers were found more frequently in the pediatric ICU ward of AL-Naser hospital (94.1%) than in the rest of all hospitals wards, followed by AL-Shifa ICU (81.3%), AL-Naser oncology (73.3%), AL-Shifa renal unit  (52.9%), AL-Naser General pediatric (47.1%) and AL-Shifa oncology (44.4%).

6. High percentage of multiple drug resistance was found for the majority of the isolated strains, with higher levels in hospitalized patients in comparison  to non- hospitalized individuals.

7. High percentage of aminoglycoside, chloramphenicol, tetracycline, erythromycin, cephalosporins, quinolone and penicillins resistance was also observed.

8. Linezolid resistance among hospitalized patients isolaltes was (2.1%), whereas there was no linezolid resistance among non-hospitalized individuals isolates. This is alarming because linezolid is considered by many as the only remedy, for VRE.

9. Among hospitalized patients, E. faecium isolates has the highest resistance range (MIC=32-512) μg/ml, while E. durans and E. avium has the lowest range (MIC= 2-16) μg/ml, whereas among non-hospitalized isolates, MIC range of E. faecium (16-256) μg/ml, while E. gallinarum has the lowest range of (MIC = 2-8) μg/ml.

10. Risk factors for acquiring VRE in non-hospitalized individuals included age (children and aging people), education level (uneducated individuals were significantly exposed), traveling abroad, previous hospital admission and antibiotics consumption.

11. High percentage of subjects (81%) lacked knowledge about antibiotic resistance.

12. Few physicians (11.0%) lacked knowledge regarding the proper use of vancomycin.