Identification of vancomycin-susceptible major clones of clinical Enterococcus from Algeria

The main objectives of this study were to characterize clinical strains of Enterococcus spp. isolated from Algerian inpatients and outpatients, to investigate their susceptibility to antibiotics and to analyse their phylogenetic relatedness. A total of 85 non-duplicate Enterococcus spp. isolates collected between 2010 and 2013 from various clinical samples, including urine, vaginal swab, pus, blood and semen, from Algerian inpatients (n = 62) and outpatients (n = 23) were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/MS). Antibiotic susceptibility testing was performed using disk diffusion and Etest methods. Clonal relatedness was analysed using multilocus sequence typing (MLST). Enterococcus faecalis was the most predominant species (75.3%), followed by Enterococcus faecium (21.2%), Enterococcus gallinarum (2.4%) and Enterococcus casseliflavus (1.2%). High-level resistance to aminoglycosides was significantly more prevalent in hospitalized patients than in outpatients. None of the E. faecalis and E. faecium isolates were resistant to vancomycin. High genetic diversity was observed among the E. faecalis isolates, with the identification of a new clonal complex (CC256), as well as the detection of E. faecalis ST6 and E. faecium lineages ST17, ST18 and ST78 associated with hospital isolates. This is the first report of E. faecalis ST6 and E. faecium ST17 and ST18 in Algeria. Although acquired vancomycin resistance was not observed among the enterococcal strains, there is a continued need to monitor the level of antibiotic resistance among enterococci as well as the evolution of the E. faecalis/E. faecium ratio.