Abstract:
Background: Vancomycin-resistant Enterococcus (VRE) is the genus Enterococcus that retains
either intrinsic or acquired resistance to the antibiotic vancomycin, which is used to treat serious
infections caused by these bacteria. VRE has increasingly become a major public health threat
globally, due to limited therapeutic options. Even though it becomes the most public health threat,
there is insufficient data in the study area as well as in Ethiopia. VRE causes severe infections
among patients with weakened immune systems such as cancer patients who, undergo anticancer
treatment and these infections are usually preceded by gastrointestinal colonization. Therefore, to
prevent VRE-associated infections, it is crucial to identify a patient colonized with VRE.
Objectives: This study is aimed at determining the magnitude of intestinal colonization with VRE
and associated factors among patients attending anticancer treatment at oncology wards of Jimma
Medical Center (JMC).
Methods: A comparative cross-sectional study was conducted from April 2021 to September 2021
on a total of 226 study participants at JMC, among 113 patients attending anticancer treatment at
oncology wards and an equal number of “apparently healthy clients” in Jimma, Southwest
Ethiopia. Pretested structured questionnaires were used to collect sociodemographic and clinical
data. Stool samples were collected for both groups and inoculated onto Bile Esculin Azide Agar
with and without 6 µg/ml of vancomycin plates. Enterococcus species were identified based on
their colony characteristics, gram stain, catalase test, salt tolerance, temperature tolerance, and
PYR tests. Antibiotic susceptibility tests were done using the Kirby–Bauer disk diffusion and the
Minimum Inhibition Concentration (MIC) was determined for vancomycin by the E-test strips. The
data were entered into Epidata v4.6 and were exported to SPSS v26 for analysis. Descriptive
statistics, bivariate, and multivariate logistic regression analyses were performed to evaluate the
association with the outcomes of interest at a 95% confidence interval, and a P-value <0.05 was
considered as statistically significant.
Result: In this study, a total of 226 study participants were enrolled. The overall colonization of
Enterococci species was seen in 78.8% (178 /226). Among these, VRE colonization was 8.4% (95%
CI = 4.3–12.5),15/226. VRE among patients attending anticancer treatment at oncology wards
and “apparently healthy clients” was 11/87 (12.6%) and 4/91 (4.4%), respectively. Those patients
II
attending anticancer treatment did not have a statistically significant association (p = 0.058) with
the colonization of VRE.
The present study showed that multidrug resistance was observed in 66.7% of VRE isolates. Prior
antibiotic exposure in the last three months (AOR = 4.33; 95% CI: [1.129–16.6], P = 0.033) and
history of hospital admission in the last three months (AOR = 4.088; 95% CI: [1.083–15.438],
P = 0.038) showed statistically significant association with VRE colonization.
Conclusion: In this study overall prevalence of VRE colonization was 8.4 %. A patient attending
anticancer treatment did not have a statistically significant association with the colonization of
VRE. Prior antibiotic exposure and a history of hospital admission in the past three months were
significantly associated with VRE colonization. The observed VRE with multidrug resistance
colonization needs, rational use of antibiotics, more detailed study, and implementation of
infection prevention protocols to reduce colonization by VRE among patients attending anticancer
treatment or admitted to oncology wards.