Table 4 Correlation observed for the prevalence of single/multipl

Table 4 Correlation observed for the prevalence of single/multiple-virulence-markers along with Enterococcus spp. diversity in the landscape.     No. of isolates (%)     S. No Combination of virulence-marker/s Total enterococci E. faecalis E. faecium E. durans E. hirae Other Enterococcus spp. Spearman correlation (r s ) p-Valuea 1 gelE + 30(35.71)

17(20.24) 8(9.52) 3(3.57) 1(1.19) 1(1.19) 1 0.0083 ** 2 esp + 4(4.76) 0 2(2.38) 1(1.19) 1(1.19) 0 1 0.0083 ** 3 efaA + 4(4.76) 1(1.19) 2(2.38) 0 1(1.19) 0 0.8208 0.0667 4 ace + 2(2.38) 1(1.19) 0 0 1(1.19) 0 0.4472 0.225 Cilengitide 5 gelE + esp + 22(26.19) 17(20.24) 2(2.38) 3(3.57) 0 0 0.9747 0.0083 ** 6 gelE + efaA + 6(7.14) 4(4.76) 2(2.38) 0 0 0 0.8944 0.0417 * 7 gelE + ace + efaA + Smad inhibitor 2(2.38) 2(2.38) 0 0 0 0 0.7071 0.1167 8 gelE + efaA + esp + 15(17.86) 10(11.9) 4(4.76) 0 1(1.19) 0 0.8208 0.0667 a p-Value was calculated using Wilcoxon matched pair test. **/* p-value summary for significantly effective pairing. The coselection of resistance to vancomycin, methicillin, gentamicin, streptomycin and ciprofloxacin with gelE virulence-marker was observed in the landscape [see Additional file 2]. An E. faecium isolate was observed with resistance to gentamicin and MAR to vancomycin, erythromycin and rifampicin

along

with gelE + efaA + esp + virulence-determinants. The notoriety of E. faecium strains with multiple-antimicrobial-resistance especially VRE in debilitating the disease conditions is well established [10]. The combination of virulence-traits cytolysin-aggregation substance has been demonstrated to be highly coevolved and is efficiently transferred to the sensitive recipients by conjugation [36]. On the other hand a clinical strain of E. faecium having a conjugative plasmid, highly related to pCF10 of E. faecalis, has been shown to confer transferable high-level vancomycin resistance via conjugation [37]. These evidences indicate the possible transfer of linked virulence-traits and of antimicrobial-resistance viz., vancomycin resistance in the landscape. Further the persistence of VRE in the environment even in the absence of antimicrobial selection pressure has been attributed to multiple types of PSK systems or Toxin-Antitoxin (TA) systems [28, 38, 39]. Though till date no role has been assigned to TA systems with respect to linked traits like multiple-antimicrobial-resistance and multiple-virulence-markers in VRE; it is possible that such systems might be playing pivotal role in persistence and dissemination of perilous antimicrobial-resistant pathogenic enterococci.

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