Evaluation for the association of virulence determinants among e.faecalis with its clinical outcome

Aims. Enterococci have been frequently encountered organism in nosocomial infections. Enrichment of virulence factors in E.faecalis and the propensity with which they get disseminated to other species and genus invokes attention towards this organism. A study was sought to investigate the presence of four virulence determinants - enterococcal surface protein (esp), aggregation substance (agg), gelatinase (gelE) and cytolysin (cylA) among clinical E.faecalis isolates. A relevancy between the role of the virulence determinant possessed and clinical implication of the isolate was analyzed. Methods. A total of 126 E.faecalis obtained from urinary tract, pyogenic, blood stream and intraabdominal and pelvic infections was used for the study. Expression of three virulence determinants esp, cylA and gelE was detected by biofilm formation on polystyrene surface, hemolysin production and gelatin liquification respectively. PCR was used for genotypic assay. Results. esp (67.5%) was the frequent virulence factor detected followed by, cylA, agg and gelE. Discrepancy was met between phenotypic and genotypic assay methods. Harborage of multiple virulence factors was common among urinary tract isolates and blood isolates. Concomitant presence of two virulence genes dominated. Conclusion. An association between esp and urinary tract infection, agg and intraabdomianl and pelvic infection and cylA and blood stream infection was noted. These organisms may serve as potential reservoirs to disseminate the virulence genes to other isolates and are of considerable importance in an hospital setting.