Epidemiological Investigation of Enterococcus faecalis Prevalence and Antimicrobial Resistance Patterns in District Bhakkar, Pakistan

Abstract

Enterococcus faecalis is an important opportunistic pathogen associated with healthcare-associated and community-acquired infections. Increasing antimicrobial resistance among enterococci represents a significant challenge for effective infection management. However, limited information is available regarding the prevalence and antimicrobial susceptibility pattern of E. faecalis in District Bhakkar, Pakistan. This study aimed to determine the prevalence of E. faecalis among clinical specimens collected from healthcare facilities in District Bhakkar and to characterize the antimicrobial response of the recovered isolates. A cross-sectional laboratory-based study was conducted on 108 clinical specimens, including blood (n=50), tissue (n=30), sputum (n=15), and pus (n=13). Specimens were processed using standard bacteriological techniques, including enrichment, culture on selective and differential media, colony morphology, Gram staining, and preliminary biochemical testing. Antimicrobial susceptibility was assessed using the Kirby–Bauer disc diffusion method on Mueller–Hinton agar against clarithromycin, ciprofloxacin, ampicillin, kanamycin, and cefixime. Data were analyzed using descriptive and appropriate inferential statistics. E. faecalis was isolated from 66/108 specimens, giving an overall prevalence of 61.1%. The highest specimen-specific prevalence was observed in blood (70.0%), followed by sputum (60.0%), tissue (56.7%), and pus (38.5%). Isolates demonstrated characteristic Gram-positive coccal morphology and negative catalase and oxidase reactions. Antimicrobial testing showed variable inhibition-zone patterns, with comparatively greater inhibition generally observed for clarithromycin and ciprofloxacin, whereas cefixime showed minimal or absent inhibition in most isolates. The high isolation frequency of E. faecalis and the observed variability in antimicrobial response indicate a considerable clinical and antimicrobial-resistance concern in the study area. Routine laboratory surveillance, antimicrobial susceptibility testing, infection-prevention practices, and antimicrobial stewardship should be strengthened in healthcare facilities in District Bhakkar.