Skip to main content
Download PDF

Prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, south west Ethiopia

BMC Research Notes volume 11, Article number: 281 (2018) Cite this article

A Correction to this article was published on 07 May 2019

This article has been updated

Abstract

Objective

This study was done to determine the prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, Southwest Ethiopia.

Results

The overall prevalence of Enterococci species was 5.5% (22/403). Five (22.7%) of Enterococci species were vancomycin resistant. Haemolysin, gelatinase and biofilm production was seen among 45.5, 68.2 and 77.3% of isolates respectively. The overall rate of antibiotic resistance was 95.5% (21/22). High resistance was observed against norfloxacin (87.5%), and tetracycline (77.3%). Whereas, low resistance (36.5%) was observed against ciprofloxacin and eighteen (80.8%) of the isolates were multi-drug resistant.

Introduction

Enterococci species are Gram-positive cocci that are normal inhabitants of gastrointestinal tract, oral cavity and female genital tracts in both humans and animals. However, they can also be significant pathogens responsible for serious nosocomial and community acquired infections, causing surgical wound infection, bacteraemia, endocarditis, neonatal sepsis and rarely meningitis [1,2,3].

Several virulence and pathogenicity factors have been described from the genus Enterococcus that enhances their ability to colonize human tissues, increase resistance to antibiotics, and aggravate infection outcomes [4, 5]. Moreover, the relative importance of the bacteria has increased with the occurrence of high-level resistance to multiple antimicrobials [6]. The emergence of vancomycin resistant Enterococci species (VRE) has alarmed the global community due to few options left for disease management. There is also a possibility for a resistance gene to transfer horizontally and increased virulence factors [7,8,9].

The prevalence of clinically isolated Enterococcus, especially VRE, was reported in Europe (4%), Asia–Pacific (11.9%), America (35.5%) and Latin America (12.9%) [10]. Increasing prevalence of VRE was also reported from few studies conducted in Ethiopia [11,12,13]. To our knowledge, there was no published data available on the epidemiology of Enterococci species infections among pediatric patients in Ethiopia. Therefore, this study attempted to assess the prevalence, antimicrobial susceptibility and virulence factors of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital.

Main text

Materials and methods

Study area and period

The study was conducted at Jimma University Specialized Hospital (JUSH) in Jimma town which is located southwest of Addis Ababa, Ethiopia. JUSH provides services for approximately 17,500 inpatients and 164,000 outpatients/year. This hospital based study was undertaken from April to September, 2016.

Study design and study subjects

Hospital based cross sectional study design was employed. Pediatric patients younger than 15 years old were included in this study. Family/guardians gave written consent. Clinical specimens were collected and processed at Microbiology Laboratory of the hospital. Pediatric patients who received antibiotics within the past 2 weeks were excluded.

The sample size for the study was determined by using single population proportion formula considering the prevalence of Enterococcus species among pediatric patients as fifty percent (P = 50%). Accordingly, a total of 403 children were included in this study.

Data collection

Socio-demographic and clinical data

Data on socio-demographic and clinical profile were collected. For this purpose semi-structured questioner was used for interview (history of chronic illness, hospitalization etc.,) and to extract participant’s medical record (sex, age, ward etc.,) [12, 13].

Laboratory data collection

A total of 403 different clinical specimens (urine, blood, swabs, closed abscess, body fluids and CSF) were collected from pediatric outpatient and inpatient departments following standard procedures [14].

Isolation and identification of Enterococcus species

Specimens were inoculated on appropriate culture media to isolate the bacteria. Briefly: The specimens were inoculated on Blood agar (Oxoid; Hampshire UK) with 5% sheep blood and MacConkey agar (bioMe´rieux; France). All media were kept at 37 °C for 24 h and Colonies larger than those of streptococci, usually 1–2 mm, with α, β or γ hemolysis on Blood agar or small dark-red magenta colonies on MacConkey agar were presumptively considered as Enterococcus species. Further identification was done with Gram stain, catalase production, esculin hydrolysis, salt tolerance (ability to grow in 6.5% NaCl broth) and l-pyrrolidonyl-b-naphthylamide (PYR) testing [14]. Enterococcus faecalis ATCC 29212 was used as positive control.

Antimicrobial susceptibility testing

This test was carried out using disk diffusion method on Muller Hinton agar (MHA) (Oxoid; Hampshire UK) according to the recommendation of Clinical and Laboratory Standard Institute (CLSI) of 2014 [15] for the following drugs: erythromycin (E, 10 µg), chloramphenicol (C, 30 µg), tetracycline (TE, 30 µg), ampicillin (AMP, 10 μg), norfloxacin (NOR, 30 μg), ciprofloxacin (CIP, 5 μg), penicillin (P, 10 IU) and vancomycin (VA, 30 μg) ‘(Oxoid, Hampshire England). These antimicrobial agents were selected based on the availability and prescription practices in JUSH and recommendations from CLSI, 2014 [15]. Staphylococcus aureus ATCC 25923 was used as a control strain.

Detection of virulence factors

Presence of beta-hemolysis surrounding Enterococcus species colonies after 24-h on blood agar incubated aerobically at 37 °C, was considered indicative of hemolysin production [16]. Gelatinase production was confirmed by observation of liquefaction into tubes containing 4 mL of nutrient broth (Himedia; INDIA) with 12% gelatine (Difco; USA) [5]. Biofilm formation was assessed using 96-wells flat bottom microtiter plates (Becton–Dickinson; Falcon USA) following the methods adopted by Banerjee et al. and Deka [16, 17].

Data processing and analysis

Data was entered, coded and cleaned in Epi Data version 3.1 software. Then it was exported to SPSS software (version 16.0) for analysis. Descriptive statistics was used to summarize socio-demographic, clinical profiles of the study participants and susceptibility patterns of the isolates. The findings were presented in tables. Chi square test was used to measure associations between variables. At 95% confidence intervals, P-values of less than 0.05 were considered as significant.

Results

Socio-demographic characteristics of the study participants

A total of 403 children with age ranging from 0 to 14 years were included in this study. One clinical specimen was collected from each participant. More than half 53.1% (214/403) of the participants were female. The median age of study participant was 9 years. The age category distributions showed that the highest number of participants, 48.6% (196/403), were in the age group of 10–14 years. About 56.6% (228/403) of study participants were from rural setting and 54.1% (218/403) were not attending school. About 38.0% (153/403) of children’s parent/guardian had high school education and 28.3% (114/403) were farmers by occupation (Table 1).

Table 1 Socio-demographic and clinical characteristics of study participants at Jimma University Specialized Hospital, Southwest Ethiopia, April to September, 2016
Full size table

The clinical data showed that 53.2% (215/403) of the participants were hospitalized during the study time and 7.9% (32/403), 10.9% (44/403) and 32.8% (132/403) had previous history of hospitalization, invasive procedure and antibiotic use respectively. About 9.2% (37/403) of the children had confirmed chronic illness (Table 1).

Risk Factors for Vancomycin resistant Enterococcus species infection

Prevalence of VRE infection was significantly associated with current length of hospitalization for ≥ 2 weeks (P = 0.025). But there was no statistically significant difference (P value > 0.05) with hospital department, length of previous hospitalization, history of invasive procedure, history of antibiotic use, types of invasive procedure and history of chronic illness (Additional file 1).

Prevalence of Enterococcus species and virulence factors

The overall prevalence of Enterococcus species was 5.5% (22/403). The majority (19/22) of isolated Enterococcus species were positive for production of at least one of three virulence factors (Haemolysin, Gelatinase and Biofilm) (Table 2). Furthermore, 77.3, 45.5 and 68.2% of the isolates were positive for biofilm, haemolysin and gelatinase production respectively (Table 2). Seven (31.8%) strains were positive for all the three virulence properties whereas none of the virulence factors were positive for three Enterococcus isolates.

Table 2 Detection of virulence factors in Enterococcus species isolates
Full size table

Antimicrobial susceptibility patterns of isolates

The overall rate of resistance was 95.5% (21/22). High rate of resistance was observed against norfloxacin (87.5%) and tetracycline, whereas, low rate of resistance was observed against ciprofloxacin (36.4%) and vancomycin (22.7%) (Table 3).

Table 3 Antimicrobial resistance patterns of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, April to September, 2016
Full size table

Discussion

In our study, the overall prevalence of Enterococcus species was 5.5%. This result was comparable with studies reported that ranges between 5.0 and 6.2% [18,19,20,21]. The rate in our study is lower than 11.0% reported from Malaysia [22], 20.8% from Pakistan [23] and 15.3% from Tanzania [24], but higher than 3.2% in Istanbul, Turkey [25], 1.4% in São Paulo, [26] and 2.7% in Port Sudan in all age group [27]. These differences in prevalence might be due to methodological design used (retrospective and cohort), study area and study period in previous studies.

In our study, length of current hospitalization for ≥ 2 weeks was significantly important factor (P = 0.025). Our study finding is concordant with most previous studies from Egypt [28]. Longer hospital stays can indicate a greater chance of receiving antibiotics and also a longer exposure time to possible pathogen selection or transmission.

The current study showed that 22.7% of the isolates were resistant to vancomycin which is comparable with finding from Tabriz in Iran [29] and Mansoura in Egypt [28], but higher than the prevalence reported from Turkey, 1.55% [30]; 10% [31] and 16% [32] from Iran. But lower than the findings from Serbia, 54% [33]; Iran [34] and Nigeria, 42.9% [20] in clinical isolates from all age groups. The increased prevalence of VRE infection in our study might be associated with the availability and use of vancomycin in Jimma Specialized Hospital.

In our study, penicillin and ampicillin resistance was seen in 63.6 and 54.5% of Enterococcal isolates, respectively; which is relatively comparable with study result reported from China in all age group [35] and Jimma, Ethiopia [12]. On the other hand, our finding is lower than findings from India [36, 37]. In our study 63.6% of the isolates were resistant against erythromycin which is similar with 67.0% reported in Port Sudan from all age group [27] and 63.2% from both Gondar and Jimma, Ethiopia in stool isolates from adults in separate study [12, 13]. However, lower than reported from Osogbo, Nigeria from all age group [20] and in Dilla, Ethiopia [11] but, higher than study findings from Iran [34], India [37] and China [35].

Higher rate of resistance to chloramphenicol (63.6%) was also observed which is comparable with study from Tanzania [24] and much higher than resistance rate reported from Gondar, 12.4% [13] and Dilla, 3.8% [11] in Ethiopia. In this study, lower rate of resistance was seen against ciprofloxacin (36.4%) which is comparable with study reported in Sudan [27] and India [38] and in Gondar, Ethiopia where the rate was 33.8% among isolates from stool specimens [13]. Resistance rate may go parallel with frequent use and availability of the drug in the local health institutions in the past times.

Among the total of the Enterococcal isolates, 68.2% were gelatinase producer which is in agreement with study reported from Skopje, Macedonia [39] and Porto Alegre, Brazil [40] and higher than 3.7% in Dilla, Ethiopia from faecal isolates [11] and lower than compared to 84% in Cairo, Egypt from clinical isolates in all age groups [41]. This variation might be due to difference in distribution of virulent strains in different geographical areas. Haemolysin was produced by 45.5% of the Enterococci species isolate which is comparable with the result of a study conducted in Skopje, Macedonia where 50% of the isolates produces haemolysin [39]. However, it is higher than those reported from Varanasi, North India and South India with 36.6 and 16.5%, respectively [16, 42]; and from Norway, 17% [43] and very low compared to 2% from Dilla, Ethiopia for isolates from faecal sources [11].

In this study, 77.3% of the isolates were biofilm formers. This is similar with previous report from Iraq, 77.3% [44] and comparable to Porto Alegre, Brazil, 74% [40] and higher than 26.12% in North India [16], 32.5% in Bangalore, India [42], and 64.4% in Dhaka [9]. The differences in biofilm formation might be due to strain variation. Unlike report from Dhaka [9] and India [16] where there was strong association between virulent factors production and antibiotic resistance, the findings of our study showed no association between them, however, all biofilm formers and gelatinase producers showed high resistance.

Conclusion

The finding of this study indicated the presence of Enterococci species with different virulence factors. Enterococcus species have shown an increased rate of resistance to most tested drugs particularly to vancomycin. This finding demands an attention from health policy makers for intensified actions to promote rational use of antibiotics in health care settings and surveillance studies in order to monitor changes in enterococcal resistance patterns.

Limitations of the study

Because of lack of API 20 strep strip or biochemical reagents for species identification, we were unable to detect different species of Enterococci species and could not see the association of virulent factors as well as antimicrobial resistance profile against the type of isolated species.

Vancomycin resistance was determined using disk diffusion method.

Change history

  • 07 May 2019

    Following publication of the original article [1], the authors reported that one of the authors’ names was spelled incorrectly. In this Correction the incorrect and correct author name are shown.

Abbreviations

VRE:

vancomycin resistant Enterococci species

HIV:

human immunodeficiency virus

JUSH:

Jimma University Specialized Hospital

References

  1. Sood S, Malhotra M, Das B, Kapil A. Enterococcal infections and antimicrobial resistance. Indian J Med Res. 2008;128(2):111–21.

    CAS  PubMed  Google Scholar 

  2. Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update:- antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Health care Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29(11):996–1011.

    Article  Google Scholar 

  3. Fisher K, Phillips C. The ecology, epidemiology and virulence of Enterococcus. Microbiology. 2009;155(6):1749–57.

    Article  CAS  Google Scholar 

  4. Duprè I, Zanetti S, Schito AM, Fadda G, Sechi LA. Incidence of virulence determinants in clinical Enterococcus faecium and Enterococcus faecalis isolates collected in Sardinia (Italy). J Med Microbiol. 2003;52(6):491–8.

    Article  Google Scholar 

  5. Marra A, Dib-Hajj F, Lamb L, Kaczmarek F, Shang W, Beckius G, et al. Enterococcal virulence determinants may be involved in resistance to clinical therapy. Diagn Microbiol Infect Dis. 2007;58(1):59–65.

    Article  CAS  Google Scholar 

  6. Iwen PC, Kelly DM, Linder J, Hinrichs SH, Dominguez EA, Rupp ME, et al. Change in prevalence and antibiotic resistance of Enterococcus species isolated from blood cultures over an 8-year period. Antimicrob Agents Chemother. 1997;41(2):494.

    Article  CAS  Google Scholar 

  7. Mundy L, Sahm D, Gilmore M. Relationships between enterococcal virulence and antimicrobial resistance. Clin Microbiol Rev. 2000;13(4):513–22.

    Article  CAS  Google Scholar 

  8. Furuno JP, Perencevich EN, Johnson JA, Wright M-O, McGregor JC, Morris JG Jr, et al. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci species co-colonization. Emerg Infect Dis. 2005;11(10):1539–44.

    Article  CAS  Google Scholar 

  9. Akhter J, Ahmed S, Saleh A, Anwar S. Antimicrobial resistance and in vitro biofilm-forming ability of Enterococcus species isolated from urinary tract infection in a tertiary care hospital in Dhaka. Bangladesh Med Res Counc Bull. 2014;40(1):6–9.

    Article  CAS  Google Scholar 

  10. Driscoll T, Crank C. vancomycin-resistant Enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015;8:217–30.

    Google Scholar 

  11. Birri DJ, Brede DA, Tessema GT, Nes IF. Bacteriocin production, antibiotic susceptibility and prevalence of haemolytic and gelatinase activity in faecal lactic acid bacteria isolated from healthy Ethiopian infants. Microb Ecol. 2013;65(2):504–16.

    Article  CAS  Google Scholar 

  12. Abamecha A, Wondafrash B, Abdissa A. Antimicrobial resistance profile of Enterococcus species isolated from intestinal tracts of hospitalized patients in Jimma, Ethiopia. BMC Res Notes. 2015;8(1):213.

    Article  Google Scholar 

  13. Abebe W, Endris M, Tiruneh M, Moges F. Prevalence of vancomycin resistant Enterococci species and associated risk factors among clients with and without HIV in Northwest Ethiopia: a cross-sectional study. BMC Public Health. 2014;14(1):185.

    Article  Google Scholar 

  14. England PH. Identification of Streptococcus species, Enterococcus species and morphologically similar organisms. UK Stand Microbiol Investig. 2014;4:1–36.

    Google Scholar 

  15. CLSI. Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. CLSI document M100-S24. Wayne: Clinical and Laboratory Standards Institute; 2014.

    Google Scholar 

  16. Banerjee T, Anupurba S. Prevalence of virulence factors and drug resistance in clinical isolates of Enterococci species: a study from North India. J Pathogens. 2015;2015:1–7.

    Article  Google Scholar 

  17. Deka V. Comparison of tissue culture plate method, tube method and congo red agar method for the detection of biofilm formation by coagulase negative Staphylococcus isolated from non-clinical isolates. Int J Curr Microbiol Appl Sci. 2014;3(10):810–5.

    Google Scholar 

  18. Tseng MH, Lo WT, Lin WJ, Teng CS, Chu ML, Wang CC. Changing trend in antimicrobial resistance of pediatric uropathogens in Taiwan. Pediatr Int. 2008;50(6):797–800.

    Article  Google Scholar 

  19. Marcus N, Ashkenazi S, Samra Z, Cohen A, Livni G. Community-acquired Enterococcal urinary tract infections in hospitalized children. Pediatr Nephrol. 2011;27(1):109–14.

    Article  Google Scholar 

  20. Olawale KO, Fadiora SO, Taiwo SS. Prevalence of hospital acquired Enterococci species infections in two primary-care hospitals in Osogbo, Southwestern Nigeria. Afr J Infect Dis. 2011;5(2).

  21. Kabew G, Abebe T, Miheret A. A retrospective study on prevalence and antimicrobial susceptibility patterns of bacterial isolates from urinary tract infections in Tikur Anbessa Specialized Teaching Hospital Addis Ababa, Ethiopia, 2011. Ethiop J Health Dev. 2013;27(2):111–7.

    Google Scholar 

  22. Nor NSM, Abu NA, Rashid MA, Ismail MM, Razak RKRA. Bacterial pathogens and antibiotic resistance patterns in children with urinary tract infection in a Malaysian tertiary hospital. Med J Malays. 2015;70(3):153–7.

    Google Scholar 

  23. Gul Z, Jan AZ, Liaqat F, Qureshi MS. Causative organisms and antimicrobial sensetivity pattern of pediatric urinary tract infection. Gomal J Med Sci. 2015;13(2).

  24. Aamodt H, Mohn SC, Maselle S, Manji KP, Willems R, Jureen R, et al. Genetic relatedness and risk factor analysis of ampicillin-resistant and high-level gentamicin-resistant Enterococci species causing bloodstream infections in Tanzanian children. BMC Infect Dis. 2015;15:2–9.

    Article  Google Scholar 

  25. Sezer RG. Antimicrobial resistance patterns of uropathogens among children in Istanbul, Turkey. Southeast Asian J Trop Med Public Health. 2011;42(2):355–62.

    PubMed  Google Scholar 

  26. Lo DS, Shieh HH, Ragazzi SL, Koch VH, Martinez MB, Gilio AE. Community-acquired urinary tract infection: age and gender-dependent etiology. Jornal brasileiro de nefrologia. 2013;35(2):93–8.

    Article  Google Scholar 

  27. Shingeray OH. Prevalence and antimicrobial susceptibility pattern of bacteria causing postoperative wound infections in Port-Sudan. J Biomed Pharm Res. 2013;2(6):82–5.

    Google Scholar 

  28. Moemen D, Tawfeek D, Badawy W. Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt. Braz J Microbiol. 2015;46(3):777–83.

    Article  CAS  Google Scholar 

  29. Kafil HS, Asgharzadeh M. Vancomycin-resistant Enteroccus faecium and Enterococcus faecalis isolated from education hospital of iran. Maedica (Buchar). 2014;9(4):323–7.

    PubMed  PubMed Central  Google Scholar 

  30. Kara A, Devrim I, Bayram N, Katipoglu N, Kiran E, Oruc Y, et al. Risk of vancomycin-resistant Enterococci species bloodstream infection among patients colonized with vancomycin-resistant Enterococci species. Braz J Infect Dis. 2015;19(1):58–61.

    Article  Google Scholar 

  31. Pourshafie M, Talebi M, Saifi M. 876 characterization of Enterococci species causing catheter-associated urinary tract infections in children in Iran. Arch Dis Child. 2012;97(Suppl 2):A251–2.

    Article  Google Scholar 

  32. Pourakbari B, Aghdam MK, Mahmoudi S, Ashtiani MTH, Sabouni F, Movahedi Z, et al. High frequency of vancomycin-resistant Enterococcus faecalis in an Iranian referral children medical hospital. Maedica. 2012;7(3):201.

    PubMed  PubMed Central  Google Scholar 

  33. Mihajlović-Ukropina M, Medić D, Jelesić Z, Gusman V, Milosavljević B, Radosavljević B. Prevalence of different Enterococcal species isolated from blood and their susceptibility to antimicrobial drugs in Vojvodina, Serbia, 2011–2013. Afr J Microbiol Res. 2014;8(8):819–24.

    Article  Google Scholar 

  34. Rafiei Tabatabaei S, Karimi A, Navidinia M, Fallah F, Tavakkoly Fard A, Rahbar M. A study on prevalence of vancomycin-resistant Enterococci species carriers admitted in a children hospital in Iran. Annu Biol Res. 2012;3(12):5441–5.

    Google Scholar 

  35. Jia W, Li G, Wang W. Prevalence and antimicrobial resistance of Enterococcus species: a hospital-based study in China. Int J Environ Res Public Health. 2014;11(3):3424–42.

    Article  Google Scholar 

  36. Kapoor L, Randhawa V, Deb M. Antimicrobial resistance of enterococcal blood isolates at a pediatric care hospital in India. J Infect Dis. 2005;58(2):101–3.

    CAS  Google Scholar 

  37. Gangurde N, Mane M, Phatale S. Prevalence of Multidrug Resistant Enterococci species in a Tertiary Care Hospital in India: a Growing Threat. Open J Med Microbiol. 2014;04(01):11–5.

    Article  Google Scholar 

  38. Srivastava P, Mehta R, Nirwan P, Sharma M, Dahiya S. Prevalence and antimicrobial susceptibility of Enterococcus species isolated from different clinical samples in a Tertiary Care Hospital of North India. Issues. 2011;2012:2013.

    Google Scholar 

  39. Jankoska G, Trajkovska-Dokic E, Panovski N, Popovska-Jovanovska K, Petrovska M. Virulence factors and antibiotic resistance in Enterococcus faecalis isolated from urine samples. Prilozi. 2008;29(1):57–66.

    CAS  PubMed  Google Scholar 

  40. Comerlato CB, Resende MCC, Caierão J, d’Azevedo PA. Presence of virulence factors in Enterococcus faecalis and Enterococcus faecium susceptible and resistant to vancomycin. Memórias do Instituto Oswaldo Cruz. 2013;108(5):590–5.

    Article  CAS  Google Scholar 

  41. Hashem Y, Yassin A, Amin M. Molecular characterization of Enterococcus species clinical isolates from Cairo, Egypt. Indian J Med Microbiol. 2015;33(5):80.

    Article  Google Scholar 

  42. Upadhyaya G, Umapathy KLR. Comparative study for the presence of Enterococcal virulence factors gelatinase, hemolysin and biofilm among clinical and commensal isolates of Enterococcus faecalis. J Lab Phys. 2010;2:100–4.

    Google Scholar 

  43. Sun J, Sundsfjord A, Song X. Enterococcus faecalis from patients with chronic periodontitis: virulence and antimicrobial resistance traits and determinants. Eur J Clin Microbiol Infect Dis. 2012;31(3):267–72.

    Article  CAS  Google Scholar 

  44. Al-Duliami AA, Nauman NG, Salman AR. Hasan A-RS. Virulence factors of Enterococci species isolated from nosocomial and community acquired infections. Diyala J Pure Sci. 2011;7(3):2222–8373.

    Google Scholar 

Download references

Authors’ contributions

MT, GB, ZG and TK were responsible for the formulation and designing of the research topic, acquisition of data and data analysis, interpretation of results and drafting of the manuscript. RH and BY contributed in the designing the study, supervised the data collection process and data analysis, writing as well as the review of the drafted manuscript. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis. All authors read and approved the final manuscript.

Acknowledgements

The authors here by thank Jimma University, Ethiopian Ministry of Health and Armauer Hansen research institute for their material support and Jimma University Specialized Hospital staff.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

All the data pertinent to this study are presented in the manuscript. Raw data can be presented by principal investigator upon reasonable request.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The study was examined and approved by Institutional Review Board (IRB) of health institute, Jimma University under ethical letter no. RPGe/102/2016. The issued letter of IRB can be presented on request. Written informed consent was obtained from each participant parents or guardians prior to inclusion in the study.

Funding

No funding was allocated for this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Authors and Affiliations

  1. Dubo St General Hospital, Areka, Ethiopia

    Milkiyas Toru

  2. School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, POBox 378, Jimma, Ethiopia

    Getnet Beyene & Tesfaye Kassa

  3. Arbaminch College of Health Sciences, Arbaminch, Ethiopia

    Zeleke Gizachew

  4. Armauer Hansen Research Institute, Addis Ababa, Ethiopia

    Rawleigh Howe & Biruk Yeshitila

Authors
  1. Milkiyas Toru
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Getnet Beyene
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tesfaye Kassa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zeleke Gizachew
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rawleigh Howe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Biruk Yeshitila
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Getnet Beyene.

Additional files

Additional file 1.

Socio Demographic and clinical characteristics of pediatric patients infected with Vancomycin Resistant Enterococci species (VRE) and Vancomycin sensitive Enterococci species (VSE) at Jimma University Specialized hospital, April to September, 2016.

Additional file 2.

Association between virulence factors and antimicrobial resistance of Enterococcus species isolated from clinical samples of pediatric patients.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Toru, M., Beyene, G., Kassa, T. et al. Prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, south west Ethiopia. BMC Res Notes 11, 281 (2018). https://doi.org/10.1186/s13104-018-3382-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-018-3382-x

Keywords

BMC Research Notes

ISSN: 1756-0500

Contact us