Identification of vancomycin-susceptible major clones of clinical Enterococcus from Algeria Nadjette Bourafa a,b,c , Ce ´ dric Abat a , Lotfi Loucif a,d , Abiola Olumuyiwa Olaitan a , Ahmed Aimen Bentorki e , Nafissa Boutefnouchet b , Jean-Marc Rolain a, * a Unite ´ de recherche sur les maladies infectieuses et tropicales e ´mergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM U 1905, IHU Me ´dite ´rrane ´e Infection, Faculte ´ de Me ´decine et de Pharmacie, Aix-Marseille Universite ´, Marseille, France b Laboratoires de microbiologie et biochimie applique ´e, De ´partement de biochimie, Faculte ´ des sciences, Universite ´ Badji Mokhtar-Annaba, Annaba 23000, Algeria c De ´partement de biologie, Faculte ´ des sciences de la nature et de la vie, Universite ´ Mohamed Cherif Messaadia de Souk Ahras, Souk Ahras, Algeria d Laboratoire de Biotechnologie des Mole ´cules Bioactives et de la Physiopathologie Cellulaire (LBMBPC), Faculte ´ des sciences de la nature et de la vie, Universite ´ Batna 2, Batna, Algeria e Laboratoire de microbiologie, CHU Dorban, Annaba, Algeria 1. Introduction Enterococci are part of the commensal flora of the intestinal tract of humans and animals; they also colonize the skin, oral cavity and genital tract and are widespread in the environment [1]. Despite their commensal lifestyle, enterococci may cause serious and even fatal human infections and have become one of the main pathogens causing nosocomial and extrahospital infections [1,2]. Enterococcus faecalis has been the most frequently species encountered in human pathology [3,4]. However, currently there has been an increase in clinical cases caused by Enterococcus faecium reported in the USA and Europe [4–7]. The rise of E. faecium hospital-acquired infections is essentially due to the increasing use of vancomycin and broad-spectrum antimicrobials in hospital settings [5]. The E. faecium species is characterized by its remarkable genome plasticity, making it capable of acquiring multiple resistance genes, colonizing patients and persisting in hospital settings [2,5,6,8]. The ability of enterococci to grow and persist in hostile conditions and their transmission through hand contact ensures their survival in hospital environments and increases the species reservoirs [1]. Enterococci are inherently resistant to certain Journal of Global Antimicrobial Resistance 6 (2016) 78–83 A R T I C L E I N F O Article history: Received 2 February 2016 Received in revised form 20 March 2016 Accepted 22 March 2016 Keywords: Epidemiological features Clonality analysis High-risk hospital lineages Algeria A B S T R A C T 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. ß 2016 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +33 4 91 32 43 75; fax: +33 4 91 38 77 72. E-mail address: jean-marc.rolain@univ-amu.fr (J.-M. Rolain). Contents lists available at ScienceDirect Journal of Global Antimicrobial Resistance jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/jg ar http://dx.doi.org/10.1016/j.jgar.2016.03.009 2213-7165/ß 2016 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.