0 simulator , and is compared with the NDMR , MAODV-SIM , and HLAR  protocols in terms of the packet delivery ratio, end-to-end delay, delay jitter, protocol overhead, and the recovery time of link failures.
We compared the performance of the MRFR with the NDMR , MAODV-SIM , and HLAR  protocols in terms of the packet delivery ratio, end-to-end delay and delay jitter, protocol overhead, and recovery time of link failures.
Overall, the MRFR-2 protocol (Option 2 of MRFR) shows a higher packet delivery ratio than HLAR, NDMR, and MAODV-SIM.
After analysing the prevalence of resistance to aminoglycosides, the tested strains were divided into two groups: one group with HLSR phenotype (HLSR+) and one group with HLAR phenotype (HLAR+).
According to a recent report , the prevalence of HLAR is stable, but high.
In conclusion, this study highlights that the increasing prevalence of HLAR among Enterococcus strains is a reason to strictly enforce antibiotic policies coupled with greater adherence to infection control measures to prevent the spread of antimicrobial-resistant bacteria.
This resistance may not be expressed as HLAR, but synergy will not occur with these agents.
In addition to HLAR and ampicillin resistance, rapid spread of vancomycin resistance has resulted in limited therapeutic options (1).
faecalis showing HLAR phenotype Enzyme Activity on aminoglycoside Gentamicin Streptomycin Streptomycin adenyltransferase Absent Present 3' Phosphotransferase Absent Absent 2' Phosphotransferase & 6' Present Absent acetyltransferase (acetylase) Enzyme Activity on aminoglycoside Tobramycin- Amikacin- Netilmicin Kanamycin Streptomycin adenyltransferase Absent Absent 3' Phosphotransferase Absent Present 2' Phosphotransferase & 6' Present Present acetyltransferase (acetylase) Table II.
The total isolates of Enterococci, which showed HLAR is 20 (09+11) which is concordant to study of Purva Mathur et al (26%).
Although, the rate of HLAR in a particular setup depends on the antibiotic usage in an institution, that is the reason why in various studies the percentage of HLAR ranges from 7% to almost 100%.
The present study concluded that there is an emergence of HLAR in our setup and as these isolates have very limited treatment options combination therapy must be started based only on sensitivity pattern with lesser use of higher antibiotics like vancomycin and teicoplanin, so that resistant strains to these antibiotics can be prevented from emerging.