Frequency of Virulence-Associated Genes in Enterococccus faecalis Isolated in Kuwait Hospitals

Objective: The objective of this study was to investigate the carriage of 6 virulence-associated genes in Enterococcus faecalis isolates obtained from patients in 8 hospitals in Kuwait. Materials and Methods: In total, 466 E. faecalis isolates were obtained from 313 urine samples, 68 wound swabs, 36 blood samples, 25 rectal swabs, 12 high vaginal swabs and 12 miscellaneous sources. Genes for gelatinase(gelE),aggregation substance (aggA), hemolysin activation factor (cylA), enhanced expression of pheromone (eep), enterococcal surface protein (esp), and E. faecalis endocarditis antigen A (efaA) were detected in PCR assays. Results: Of 466 isolates, 423 (90.8%) were positive for 1 and up to 5 genes. However, none of the genes was detected in all of the isolates. The prevalence of the individual genes was eep: 31.9%; esp: 31.5%; gelE: 28.5%; efaA: 27.9%; aggA: 23.4%, and cylA: 18.5%. Of the 423 positive isolates, 148 (34.9%) were positive for 2 genes and 52 (12.3%), 15 (3.5%) and 5 (0.9%) isolates were positive for 3, 4 and 5 virulence genes, respectively. The efaA and esp combination was detected in isolates from all clinical sources. Conclusion: The study showed a high prevalence of virulence genes in E. faecalis isolated in Kuwait hospitals. The absence of a dominant gene in all of the isolates suggests that infections by E. faecalis may require the involvement of multiple virulence factors.