Vancomycin Resistance in Staphylococcus aureus and Enterococcus Species isolated at the University Teaching Hospitals, Lusaka, Zambia: Should We Be Worried?

  • Matenge Mutalange
  • Kaunda Yamba
  • Christine Kapesa
  • Frank Mtonga
  • Masiye Banda
  • John Bwalya Muma
  • Bernard Mudenda Hangombe
  • Lottie Hachaambwa
  • Flavien Nsoni Bumbangi
  • Geoffrey Kwenda
  • Mulemba Samutela Ms
Keywords: Enterococcus, Staphylococcus aureus, Vancomycin resistance, Zambia


Background: Staphylococcus aureus and Enterococcus species cause invasive infections such as bacteremia and infective endocarditis. Despite vancomycin being the drug of choice for drug-resistant infections caused by these species, few studies have been conducted to ascertain vancomycin resistance in the African setting. This is crucial given the rising resistance in these organisms. This study aimed to isolate S. aureus and Enterococcus species and determine their susceptibility to vancomycin and other antibiotics at the University Teaching Hospitals in Lusaka, Zambia. Methods: This was a cross-sectional study in which S. aureus and Enterococcus spp isolates from the skin, soft tissue and bloodstream infections were included. Standard microbiological and Kirby-Baur (disc diffusion and E-strips) methods were used to identify and determine the susceptibility of the organisms, respectively. Results: From 59 S. aureus isolates, 37 were from the skin and soft tissue and 22 from blood culture. Twenty-six (44.1%) of these were Methicillin-resistant S. aureus. Thirty-nine Enterococcus were isolated from blood cultures only. Of the S. aureus (16) and Enterococcus (14) isolates tested with vancomycin E-strips, none were vancomycin-resistant. However, 12.5% S. aureus and 14.3% Enterococcus showed intermediate vancomycin susceptibility. S. aureus were resistant to penicillin (93.2%), erythromycin (52.5%) and tetracycline (50.8%). Enterococcus showed resistance to penicillin (83%) and tetracycline (84.6%). Conclusions: There was no vancomycin resistance among S. aureus and Enterococcus, implying vancomycin is still a viable treatment option for invasive infections. Given the intermediate vancomycin susceptibility, treatment guided by minimum inhibitory concentration results, continued surveillance and prudent use are key.


1. Aamodt, H., Mohn, S. C., Maselle, S., Manji, K. P., Willems, R., Jureen, R., Langeland, N. & Blomberg, B. 2015. Genetic relatedness and risk factor analysis of ampicillin-resistant and high-level gentamicin-resistant enterococci causing bloodstream infections in Tanzanian children. BMC infectious diseases, 15, 107.
2. Acar, J., Casewell, M., Freeman, J., Friis, C. & Goossens, H. 2000. Avoparcin and virginiamycin as animal growth promoters: a plea for science in decision-making. Clinical Microbiology and Infection, 6, 477-82.
3. Biswas, P. P., Dey, S., Adhikari, L. & Sen, A. 2016. Detection of vancomycin resistance in enterococcus species isolated from clinical samples and feces of colonized patients by phenotypic and genotypic methods. Indian Journal of Pathology and Microbiology, 59, 188-93.
4. Chakolwa, G., Samutela, M. T., Kwenda, G., Mulundu, G., Mwansa, J., Hang'ombe, B. M., Simulundu, E. & Lukwesa, C. 2019. Carriage rate and antimicrobial resistance profiles of Staphylococcus aureus among healthcare workers at a large tertiary referral hospital in Lusaka, Zambia. Scientific African, 5, e00105.
5. Clinical and Laboratory Standards Institute 2019. Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI supplement M100.
6. Gul, Z., Jan, A. Z., Liaqat, F. & Qureshi, M. S. 2015. Causative organisms and antimicrobial sensitivity pattern of pediatric urinary tract infections. Gomal Journal of Medical Sciences, 13.
7. Hiramatsu, K., Hanaki, H., Ino, T., Yabuta, K., Oguri, T. & Tenover, F. C. 1997. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. Journal of Antimicrobial agents and Chemotherapy, 40, 135-6.
8. Iileka, A. E., Mukesi, M., Engelbrecht, F. & Moyo, S. R. 2016. Antimicrobial susceptibility patterns of Staphylococcus aureus strains isolated at the Namibia Institute of Pathology from 2012 to 2014. Open Journal of Medical Microbiology, 6, 116.
9. Kafil, H. S. & Asgharzadeh, M. 2014. Vancomycin-resistant enteroccus faecium and enterococcus faecalis isolated from education hospital of iran. Maedica (Buchar), 9, 323-7.
10. Kirst, H. A., Thompson, D. G. & Nicas, T. I. 1998. Historical yearly usage of vancomycin. Antimicrobial agents and chemotherapy, 42, 1303-1304.
11. Leclercq, R., Derlot, E., Duval, J. & Courvalin, P. 1988. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. New England Journal of Medicine, 319, 157-161.
12. Lukwesa-Musyani, C., Hachaambwa, L., Mwansa, J. & Mwaba, J. 2015. Antibiogram Guide Edited by Microbiology DoPa. 1–9
13. Mubita, C., Syakalima, M., Chisenga, C., Munyeme, M., Bwalya, M., Chifumpa, G., Hang’ombe, B. M., Sinkala, P., Simuunza, M. & Fukushi, H. 2008. Antibiograms of faecal Escherichia coli and Enterococci species isolated from pastoralist cattle in the interface areas of the Kafue basin in Zambia. Veterinarski arhiv, 78, 179.
14. Mutuku, I. M. 2013. Molecular Characterization And Antimicrobial Resistance Patterns Of Enterococcus Species Isolated From Patients Attending Aga Khan Hospital, Nairobi, Kenya.
15. Mwamungule, S., Chimana, H. M., Malama, S., Mainda, G., Kwenda, G. & Muma, J. B. 2015. Contamination of health care workers’ coats at the University Teaching Hospital in Lusaka, Zambia: the nosocomial risk. Journal of Occupational Medicine and Toxicology, 10, 34.
16. Olawale, K. O., Fadiora, S. O. & Taiwo, S. S. 2011. Prevalence of hospital acquired enterococci infections in two primary-care hospitals in Osogbo, Southwestern Nigeria. African journal of infectious diseases, 5.
17. Olufunmiso, O., Tolulope, I. & Roger, C. 2017. Multidrug and vancomycin resistance among clinical isolates of Staphylococcus aureus from different teaching hospitals in Nigeria. African health sciences, 17, 797-807.
18. Pahadi, P. C., Shrestha, U. T., Adhikari, N., Shah, P. K. & Amatya, R. 2014. Growing Resistance to Vancomycin among Methicillin Resistant Staphylococcus Aureus Isolates from Different Clinical Samples. Journal of the Nepal Medical Association, 52.
19. Prabhu, K., Rao, S. & Rao, V. 2011. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Journal of laboratory physicians, 3, 25.
20. Ramakrishna, N., Reddy, B. K. & Murthy, D. 2014. Detection of vancomycin resistance among clinical isolates of Staphylococcus aureus in a tertiary hospital, tirupati. International Journal of Resources and Health Sciences [Internet], 31, 1150-6.
21. Rengaraj, R., Mariappan, S., Sekar, U. & Kamalanadhan, A. 2016. Detection of vancomycin resistance among Enterococcus faecalis and Staphylococcus aureus. Journal of clinical and diagnostic research: JCDR, 10, DC04.
22. Samutela, M. T., Mwansa, J. C., Kalonda, A., Mumbula, E. M., Kaile, T., Marimo, C., Korolyova, L., Hang'ombe, B. M., Simulundu, E., Musyani, C. & Kwenda, G 2015. Antimicrobial susceptibility profiles of Methicillin resistant Staphylococcus aureus isolates from the university teaching hospital, Lusaka, Zambia. Journal of Medical Sciences & Technology, 4, 19-25.
23. Tiwari, H. K. & Sen, M. R. 2006. Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India. BMC infectious diseases, 6, 156.
24. Toru, M., Beyene, G., Kassa, T., Gizachew, Z., Howe, R. & Yeshitila, B. 2018. Prevalence and phenotypic characterization of Enterococcus species isolated from clinical samples of pediatric patients in Jimma University Specialized Hospital, south west Ethiopia. BMC research notes, 11, 281.
25. WangaI, F. K., Masika, M. M., Maritim, M. C. & Seaton, R. A. 2019. Methicillin-resistant Staphylococcus aureus (MRSA) in East Africa: red alert or red herring? BMC infectious diseases, 19, 596.
26. World Health Organisation 2014. Antimicrobial resistance: global report on surveillance
How to Cite
Mutalange M, Yamba K, Kapesa C, Mtonga F, Banda M, Muma J, Hangombe B, Hachaambwa L, Bumbangi F, Kwenda G, Samutela M. Vancomycin Resistance in Staphylococcus aureus and Enterococcus Species isolated at the University Teaching Hospitals, Lusaka, Zambia: Should We Be Worried?. University of Zambia Journal of Agricultural and Biomedical Sciences [Internet]. 17Mar.2021 [cited 28May2022];5(1). Available from:
Biomedical Sciences