الفهرس 
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Abstract
Vancomycin-resistant Enterococci has emerged worldwide as a nosocomial pathogen of major importance, and the incidence of infections caused by VRE continues to increase.
In this study, healthcare-associated surgical-site infection, urinary tract infection, and burn infection caused by VRE among 330 patients hospitalized in different surgical wards of Sohag University hospital was investigated. (48 in total) VRE strain were isolated from pus and urine samples, these isolates were identified at the species level, E. faecium was the most common isolated strain (69%) followed by E. faecalis (23%).
When we applied E test of vancomycin and teicoplanin for phenotyping of the isolates according the MICs of both antibiotics found that van A phenotype was the most common (65%), followed by van B phenotype (33%), and lastly van D phenotype (2%). Qualitative PCR was applied as a confirmatory typing method using primers for detection of van A and van B genes, van A genotype was more common (64% ) of VRE isolates, and (36%) were van B genotype.
When we applied a comparison between both methods of typing we found that the sensitivity and specificity of MIC measurement by E test were (97%), and (88%) respectively, which means that PCR was more sensitive and specific in determination of the level of vancomycin- resistance.
The highest number of VRE-associated nosocomial SSI and UTI was found in the general surgery department (41.7%) of cases, followed by gynaecology and obstetrics department (27.1%) of cases, followed by urosurgery (20.8%) and lowest rate was in plastic surgey department (10.4%).
When we assessed many risk factors in an attempt to found an association between these risk factors and occurrence of VRE-associated nosocomial SSI and UTI we found that the presence of diabetes mellitus, prolonged antibiotic use, prolonged hospital stay, and presence of externally associated device were positively associated with VRE-caused infections. VRE was more common in UTI than SSI and infected burns. VRE was also more common in female patients but this may be attributed to the higher number of female patients than male patients.
The presence of multidrug resistant VRE isolates was a serious development, because the isolates were found to have high resistance rates to ampicillin, amoxicillin-clavulonic acid, erythromycin, tetracycline, and rifampicin. We also found one strain that was resistant to linezolid which means that this strain had no therapeutic option among the available antibiotics.
In conclusion, VRE represents a current problem in Sohag University hospital. These organisms are multidrug resistant; leaving only few therapeutic options for the physicians and these strains are liable to spread rapidly in the hospital environment due the antibiotic abuse and lack of surveillance of such MDR organisms.