Intestinal Colonization Of Vancomyc in-Resistant Enterococci And Its Associated Factors Among Patients Attending Anticancer Treatment At Oncology Wards Of Jimma Medical Center ,Southwest, Ethiopia: A Comparative Cross-Sectional Study

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.