Detection of Endocarditis Associated Pili Genes in Enterococcus Faecalis Clinical Isolates
DOI:
https://doi.org/10.30526/38.1.3539Keywords:
Endocarditis, Pili related to biofilm, Enterococcus faecalis, EbpA, EbpB, EbpCAbstract
Out of 207 specimens,118 Enterococcus faecalis isolates were obtained from different sources (urine, root canal, wound, vagina, and blood). The commonest sites of infections were the root canal (50.8%), followed by the urinary tract (38.1%), wound (8.4%), and the vagina (2.5%). Urine, root canal, and wound samples from individuals aged 20–40 years old showed the highest prevalence of Enterococcus faecalis isolates, except for the vagina, where those over 40 years old recorded the highest rates of isolates. According to gender, females had the highest prevalence of Enterococcus faecalis isolates in urine, root canal, and vaginal samples, with the exception of the wound source, where males had a higher rate of isolates than females. The antibiotic susceptibility test results indicated that all Enterococcus isolates were resistant to these antibiotics. All Enterococcus isolates (100%) demonstrated resistance to Azithromycin, Clarithromycin, Erythromycin, Doxycycline, Minocycline, Tetracycline, and 64.7% to Gentamicin. On the other hand, 100% of the isolates showed susceptibility to Linezolid, Daptomycin, Teicoplanin, Tigecycline, and Vancomycin, while 58.8% showed susceptibility to Streptomycin, 76.4% to Ciprofloxacin, and 94.1% to Ampicillin. The PCR technique identified the presence of epbA and epbC genes in 28 Enterococcus faecalis isolates. The results of PCR showed that all of the isolates had genes epbA (111bp) and epbC (85bp).
References
Dahl A, Iversen K, Tonder N, Hoest N, Arpi M, Dalsgaard M, et al. Prevalence of infective endocarditis in Enterococcus faecalis bacteremia. J Am Coll Cardiol. 2019;74(2):193-201. https://doi.org/10.1016/j.jacc.2019.04.059.
Rosselli Del Turco E, Bartoletti M, Dahl A, Cervera C, Pericàs JM. How do I manage a patient with enterococcal bacteraemia? Clin Microbiol Infect. 2021;27(3):364-371. https://doi.org/10.1016/j.cmi.2020.10.029. Epub 2020 Nov 2.
Jett BD, Huycke MM, Gilmore MS. Virulence of enterococci. Clin Microbiol Rev. 1994;7(4):462-478. https://doi.org/10.1128/CMR.7.4.462.
MacDougall C, Johnstone J, Prematunge C, Adomako K, Nadolny E, Truong E, et al. Economic evaluation of vancomycin-resistant Enterococci (VRE) control practices: a systematic review. J Hosp Infect. 2019. https://doi.org/10.1016/j.jhin.2019.12.007.
Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiology. 2009;155(6):1749-1757. https://doi.org/10.1099/mic.0.026385-0.
Teixeira LM, Merquior VLC. Enterococcus. In: Molecular Typing in Bacterial Infections. New York: Springer; 2013. p. 17-26.
Chen X, Song YQ, Xu HY, Menghe BL, Zhang HP, Sun ZH. Genetic relationships among Enterococcus faecalis isolates from different sources as revealed by multilocus sequence typing. J Dairy Sci. 2015;98(8):5183-5193. https://doi.org/10.3168/jds.2015-9571.
Kouidhi B, Zmantar T, Mahdouani K, Hentati H, Bakhrouf A. Antibiotic resistance and adhesion properties of oral enterococci associated to dental caries. BMC Microbiol. 2011;11(1):1-7. https://doi.org/10.1186/1471-2180-11-155.
Tannock GW, Cook G. Enterococci as members of the intestinal microflora of humans. In: Gilmore MS, editor. The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance. Washington, DC: ASM Press; 2002. p. 101-132.
Flores-Mireles AL, Pinkner JS, Caparon MG, Hultgren SJ. EbpA vaccine antibodies block binding of Enterococcus faecalis to fibrinogen to prevent catheter-associated bladder infection in mice. Sci Transl Med. 2014;6(254):254ra127. https://doi.org/10.1126/scitranslmed.3009384.
Nielsen HV, Guiton PS, Kline KA, Port GC, Pinkner JS, Neiers F, et al. The metal ion-dependent adhesion site motif of the Enterococcus faecalis EbpA pilin mediates pilus function in catheter-associated urinary tract infection. MBio. 2012;3(4):e00177-12.
Nallapareddy SR, Singh KV, Sillanpaa J, Garsin DA, Hook M, Erlandsen SL, et al. Endocarditis and biofilm-associated pili of Enterococcus faecalis. J Clin Invest. 2006;116:2799-2807. https://doi.org/10.1172/JCI29021.
Nielsen HV, Flores-Mireles AL, Kau AL, Kline KA, Pinkner JS, Neiers F, Normark S, Henriques-Normark B, Caparon MG, Hultgren SJ. Pilin and sortase residues critical for endocarditis- and biofilm-associated pilus biogenesis in Enterococcus faecalis. J Bacteriol. 2013;195:4484-4495. https://doi.org/10.1128/JB.00451-13.
Bourgogne A, Singh KV, Fox KA, Pflughoeft KJ, Murray BE, Garsin DA. EbpR is important for biofilm formation by activating expression of the endocarditis and biofilm-associated pilus operon (ebpABC) of Enterococcus faecalis OG1RF. J Bacteriol. 2007;189(17):6490-6493. https://doi.org/10.1128/JB.00594-07. Epub 2007 Jun 22.
Bera S, Tank SK. Screening and identification of newly isolated Pseudomonas sp. for biodegrading the textile azodye CI Procion Red H-3B. J Appl Microbiol. 2021;130(6):1949-1959. https://doi.org/10.1111/jam.14920.
Harley JP, Prescott LM. Laboratory Exercises in Microbiology. 5th ed. New York: McGraw Hill; 2002.
Brown A, Smith H. Benson’s Microbiological Applications, Laboratory Manual in General Microbiology, Short Version. New York: McGraw-Hill Education; 2014.
Ling TK, Tam PC, Liu ZK, Cheng AF. Evaluation of VITEK 2 rapid identification and susceptibility testing system against gram-negative clinical isolates. J Clin Microbiol. 2001;39(8):2964-2966. https://doi.org/10.1128/JCM.39.8.2964-2966.2001.
Rodríguez-Niklitschek C. Clinical implications of Enterococcus faecalis microbial contamination in root canals of devitalized teeth: A literature review. Rev Odontol Mex. 2015;19(3):181-18.
Hussein HH, Abood FM, Alhelal AG. Some virulence factors of Enterococcus faecalis isolated from root canal infections combined with effect of some irrigation solutions against E. faecalis. Syst Rev Pharm. 2020;11(6):742-748. https://doi.org/10.31838/srp.2020.6.109.
Daood II, Shareef SY, Al Jubory IH, Almukhtar SH. Evaluation and antimicrobial susceptibility testing of Enterococcus faecalis isolated from high vagina. EurAsian J BioSci. 2020;14(1).
Al-Jmor SA. Detection of some virulence factors of vancomycin-resistant Enterococcus faecalis and the effect of Punica granatum and Thuja orientalis extracts on it. MSc thesis. Baghdad: College of Science, Baghdad University; 2012.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 31st ed. CLSI Supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2021.
Al-Shawi DAN, Al-Quraishi G. Multidrug-resistant Enterococcus faecalis isolated from root canals and its relationship with the presence of some virulence genes. Egypt J Hosp Med. 2023;90(1):172-178. https://doi.org/10.21608/ejhm.2023.279256.
Shridhar S, Dhanashree B. Antibiotic susceptibility pattern and biofilm formation in clinical isolates of Enterococcus spp. Interdiscip Perspect Infect Dis. 2019:1-6. https://doi.org/10.1155/2019/7854968.
Al-Taie A, Denkdemir FR, Sharief Z, Buyuk AS, Şardaş S. The long view on COVID-19 theranostics and oral antivirals: living with endemic disease and lessons from molnupiravir. OMICS. 2022;26(6):324-328. https://doi.org/10.1089/omi.2022.0045.
Kadhem HS, Flayyih MT. Isolation and identification of vancomycin-resistant Enterococcus faecalis. Iraqi J Sci. 2014;55(4B):1811-1816.
Salih AM. Effect of fructophilic lactic acid bacteria suspension on biofilm formed by Enterococcus faecalis. MSc thesis. Baghdad: College of Science, Baghdad University; 2022.
Diab M, Salem D, El-Shenawy A, El-Far A, Abdelghany A, Awad AR, El Defrawy I, Shemis M. Detection of high level aminoglycoside resistance genes among clinical isolates of Enterococcus species. Egypt J Med Hum Genet. 2019;20:28. https://doi.org/10.1186/s43042-019-0032-3.
Chabuck ZA, Al-Charrakh AH, Al-Sa’adi MA. Prevalence of vancomycin-resistant enterococci in Hilla City, Iraq. Med J Babylon. 2011;8(3):326-340.
Praharaj IS, Parija SC. Phenotypic & genotypic characterization of vancomycin-resistant Enterococcus isolates from clinical specimens. Indian J Med Res. 2013;138:549-556.
Abdrabaa MK, Flayyih MT. Autolysis activity of vancomycin-resistant Staphylococcus epidermidis. Iraqi J Biotechnol. 2019;18(2):1-10.
Karimi A, Ghalavand Z, Fallah F, Eslami P, Parvin M, Alebouyeh M, Rashidan M. Prevalence of virulence determinants and antibiotic resistance patterns of Enterococcus faecalis strains in patients with community-acquired urinary tract infections in Iran. Int J Environ Health Res. 2018;28(6):599-608. https://doi.org/10.1080/09603123.2018.1497777.
Akpaka PE, Kissoon S, Jayaratne P, Wilson C, Golding GR, Nicholson AM, Smith A. Genetic characteristics and molecular epidemiology of vancomycin-resistant Enterococci isolates from Caribbean countries. PLoS One. 2017;12(10):e0185920. https://doi.org/10.1371/journal.pone.0185920.
Wan-Ting L, En-Zhong C, Ling Y, Chen P, Qun W, Zhenbo X, Ding-Qiang C. Emerging resistance mechanisms for 4 types of common anti-MRSA antibiotics in Staphylococcus aureus: A comprehensive review. Microb Pathog. 2021;156:104915. https://doi.org/10.1016/j.micpath.2021.104915.
Al-Jarousha AK, Saed AM, Afifi H. Prevalence of multidrug-resistant enterococci in nosocomial infection in Gaza Strip. J Al-Aqsa Univ. 2008;12:15-24.
Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev. 2007;20(3):440-458.
Yilema A, Moges F, Tadele S, Endris M, Kassu A, Abebe W, Ayalew G. Isolation of enterococci, their antimicrobial susceptibility patterns and associated factors among patients attending at the University of Gondar Teaching Hospital. BMC Infect Dis. 2017;17:1-8. https://doi.org/10.1186/s12879-017-2363-3.
Kafil HS, Mobarez AM, Moghadam MF. Adhesion and virulence factor properties of enterococci isolated from clinical samples in Iran. Indian J Pathol Microbiol. 2013;56:238-242. https://doi.org/10.4103/0377-4929.120375.
Gozalan A, Coskun-Ari FF, Ozdem B, Unaldi O, Celikbilek N, Kirca F, Aydogan S, Muderris T, Guven T, Acikgoz ZC, Durmaz R. Molecular characterization of vancomycin-resistant Enterococcus faecium strains isolated from carriage and clinical samples in a tertiary hospital, Turkey. J Med Microbiol. 2015;64(7):759-766. https://doi.org/10.1099/jmm.0.000088.
Singh KV, Nallapareddy SR, Murray BE. Importance of the ebp (endocarditis and biofilm-associated pilus) locus in the pathogenesis of Enterococcus faecalis ascending urinary tract infection. J Infect Dis. 2007;195(11):1671-1677. https://doi.org/10.1086/517524.
Lores-Mireles AL, Pinkner JS, Caparon MG, Hultgren SJ. EbpA vaccine antibodies block binding of Enterococcus faecalis to fibrinogen to prevent catheter-associated bladder infection in mice. Sci Transl Med. 2014;6:254ra127. https://doi.org/10.1126/scitranslmed.3009384.
Montealegre MC, La Rosa SL, Roh JH, Harvey BR, Murray BE. The Enterococcus faecalis EbpA pilus protein: attenuation of expression, biofilm formation, and adherence to fibrinogen start with the rare initiation codon ATT. MBio. 2015;6(3):e00467-15. https://doi.org/10.1038/s41598-020-78998-5.
Gajewska J, Chajęcka-Wierzchowska W, Byczkowska-Rostkowska Z, Saki M. Biofilm formation capacity and presence of virulence determinants among Enterococcus species from milk and raw milk cheeses. Life. 2023;13(2):495. https://doi.org/10.3390/life13020495.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Ibn AL-Haitham Journal For Pure and Applied Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
licenseTerms