**2. Prevalence of vancomycin resistant Enterococci (VRE)**

Nosocomial infections particularly by vancomycin resistant Enterococci (VRE) have become a major problem since last few years though VRE are organisms of low virulence and pathogenicity. Nosocomial infections caused by VRE are highly

prevalent in intensive care units of hospitals. These infections are particularly high in presence of underlying health factors like diabetes, liver transplantation, neutropenia, diabetes mellitus and renal dysfunction. Recently it has also been seen that VRE bloodstream infections have higher mortality rates as compared to vancomycin susceptible Enterococci (VSE) [6, 7]. Data from countries like Germany shows an increase of VRE from less than 5% in 2001 to 14.5% in 2013 mainly vancomycin resistant *E. faecium* [8]. In Europe of all the nosocomial infections reported 9.6% were of Enterococci [9]. In USA 3% of the nosocomial infections are due to VRE [10]. VRE nosocomial infections cause greater number of invasive treatment resulting in extended stay in hospital and cost [11]. Hospitals in some countries have now established VRE screening in high risk areas and isolation of patients to prevent spread of the resistant pathogen [12]. A study has shown the prevalence of VRE colonization in patients who had history of previous administration of antibiotics for more than 2 weeks were 10 times more likely of getting VRE colonization [13]. Other studies have also reported similar findings which show antibiotic exposure can cause colonization of VRE in hospital settings because of their resistance to commonly used antibiotics, virulence factors and ability to acquire genes [14].
