Contents lists available at ScienceDirect Acta Tropica journal homepage: www.elsevier.com/locate/actatropica Vancomycin and florfenicol resistant Enterococcus faecalis and Enterococcus faecium isolated from human urine in an Egyptian urban-rural community Kamelia Osman a , Tara Rava Zolnikov b, ⁎ , Jihan Badr c , Heba Naim a , Mai Hanafy a , Ayman Elbehiry d,e , Aalaa Saad c a Department of Microbiology, Faculty of Veterinary Medicine, Cairo University, Egypt b Department of Community Health, National University, San Diego, CA USA c Animal Health Research, Institute, Dokki, Egypt d Department of Bacteriology, Mycology and Immunology, University of Sadat City, Egypt e Department of Public Health, College of Public Health and Health Informatics, Qassim University, Saudi Arabia ARTICLE INFO Keywords: Enterococcus faecalis Faecium Antibiotic resistance Biofilm formation Vancomycin resistance genes Chloramphenicol–florfenicol resistance genes Human urine ABSTRACT Multidrug resistance is one of the top three threats to global public health. Understanding resistance of bacteria is important to help decrease resistance and improve the development of novel antimicrobial agents or other alternative tools to combat public health challenges. Thus, the goal of this study was to investigate the vanco- mycin and florfenicol resistance genes of five E. faecalis and 15 E. faecium isolated from patients with urinary tract infections. There were 20 Enterococcus obtained from the library collection of randomly selected private hospitals located in the city of El Qanater El Khayreya; these samples were isolated during 2017. Samples were evaluated for their phenotypic characterization of virulence factors, antimicrobial resistance and PCR was conducted to detect the prescence of the vancomycin vanABC and florfenicol resistance genes encoding the catAB, fexAB and cfu. There were six different antibiotic resistance profiles observed. The 20 isolates showed resistance to clindamycin, oxytetracycline and gentamycin. Resistance was evident to ciprofloxacin, norfloxacin and florfenicol in the absence of the cfr gene in all of the 20 Enterococcus isolates. In addition, all isolates produced biofilms and were classified as extensive drug resistant. MAR indices of the isolates were >0.6. The MAR index of human isolates of enterococci suggest these pathogens originate from a high-risk source of con- tamination where antibiotics are often used. This information highlights a possible public health concern to the Egyptian community. The results also suggest the emergence of a linezolid sensitive-vancomycin resistant E. faecium and E. faecalis in the absence of the cfr gene. To date, the ESKAPE pathogens (Enterococcus species, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are the leading cause of nosocomial infections throughout the world. The infections caused by Enterococcus spp. are now the third most common at hospitals worldwide (Zhang et al., 2017) and are frequently recorded as the cause of urinary tract infections (UTIs), wound infections, bacteremia, and endocarditis in humans (Fraser, 2018), with E. faecalis and E. faecium as the most prevailing species (>90%) in human populations (Fraser, 2018). The World Health Organization (WHO) has reiterated the fact that treatment failure due to resurgence of drug resistant or- ganisms will be a primary challenge faced in this millennium. One of the classes that chloramphenicol-florfenicol resistance (cfr) gene confers resistance to its phenicols. Reports of cfr among enterococcal isolates in human clinical enterococcal isolates have re- mained sporadic (Deshpande et al., 2015) and an in-depth global dis- tribution of E. faecalis and E. faecium isolates for cfr with a special emphasis on the correlation with the florfenicol resistance genes has not currently been researched. Within this context, the purpose of our study was to characterize a collection of enterococci isolated from patients with diagnosed UTIs. A study was conducted in 2017 in order to encounter information about the presence of the five resistance genes, cfr, catAB and fexAB, chloramphenicol-resistant E. faecalis, and E. faecium isolates which ex- hibited elevated resistance of florfenicol-chloramphenicol. Several randomly selected private hospitals located in the city of El Qanater El Khayreya were chosen to be a part of this study; these libraries were used to collect enterococci strains which were assessed in this study. https://doi.org/10.1016/j.actatropica.2019.105209 Received 6 September 2019; Received in revised form 4 October 2019; Accepted 5 October 2019 ⁎ Corresponding author. E-mail address: tarazolnikov@gmail.com (T.R. Zolnikov). Acta Tropica 201 (2020) 105209 Available online 07 October 2019 0001-706X/ © 2019 Elsevier B.V. All rights reserved. T