Antimicrobial Resistance Distribution and Quorum-Sensing Regulation of Enterococcal Strains, Isolated from Hospitalized Patients

Background: Enterococci are intrinsically resistant/tolerant to various antimicrobial agents and can also acquire and combine different mechanisms of resistance, including quorum-sensing regulation, to most active compounds, which makes enterococcal infection treatment even more challenging. The aim of this study was to evaluate the pattern of antimicrobial resistance and to analyze the frequency of quorum-sensing asa1 and esp genes in clinical isolates representing the genus Enterococcus. Methods: Multiplex PCR assays were performed for the identification of 110 enterococcal isolates and the determination of their antibiotic susceptibility and the presence of asa1/esp genes. Additionally, the antibiotic resistance of the isolates was tested by the Kirby-Bauer disk diffusion method. Results: 90% of the isolates were identified as Enterococcus faecalis and 10% as Enterococcus faecium. Quorum-sensing regulation genes were present in 109 isolates. Aminoglycoside (aac(6 ')/aph(2 '')-, quinolone (emeA)-, beta-lactams (TEM)-, and vancomycin (vanA)-resistance genes were detected in 108 isolates. All of the isolates tested were vanB negative. According to the Kirby-Bauer method, 39% of the isolates expressed multidrug resistance (MDR) and 33% of the MDR E. faecium were vancomycin-resistant. Conclusion: The large percentage of MDR enterococci possessing asa1/esp genes indicated a possible connection between quorum-sensing regulation and drug resistance. Therefore, the regular monitoring of the antimicrobial resistance of Enterococcus spp., and the identification of virulence factors are needed. It is also important to prevent host colonization through the elimination of factors leading to the expression of quorum-sensing genes.

Automated summary

This study evaluated the pattern of antimicrobial resistance and the frequency of quorum-sensing asa1 and esp genes in clinical isolates of Enterococcus. The results showed a high percentage of multidrug resistant enterococci possessing asa1/esp genes, indicating a possible connection between quorum-sensing regulation and drug resistance. Therefore, regular monitoring of antimicrobial resistance and identification of virulence factors in Enterococcus spp. are necessary. It is also important to prevent host colonization through the elimination of factors leading to the expression of quorum-sensing genes.