Introduction and spread of vancomycin-resistant Enterococcus faecium (VREfm) at a German tertiary care medical center from 2004 until 2010: a retrospective whole-genome sequencing (WGS) study of the molecular epidemiology of VREfm.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Aila Caplunik-Pratsch, Bärbel Kieninger, Veronika A Donauer, Johanna M Brauer, Vanessa M K Meier, Corinna Seisenberger, Anca Rath, Daniel Loibl, Anja Eichner, Jürgen Fritsch, Wulf Schneider-Brachert
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引用次数: 0

Abstract

Background: In most of Europe and especially in Germany, there is currently a concerning rise in the number of hospital-acquired infections due to vancomycin-resistant Enterococcus faecium (VREfm). Therefore, there is a need to improve our understanding of the way VREfm spreads in hospitals. In this study, we investigated the molecular epidemiology of VREfm isolates from the first appearance at our university hospital in 2004 until 2010. There is only very scarce information about the molecular epidemiology of VREfm from this early time in Germany.

Methods: Our analysis includes all available first VREfm isolates of each patient at our tertiary care center collected during the years 2004-2010. If available, additional consecutive VREfm isolates from some patients were analyzed. We used multilocus sequence typing (MLST) and core genome multilocus sequence typing (cgMLST) for the analysis and description of nosocomial transmission pathways as well as the detection of outbreaks.

Results: VREfm isolates from 158 patients and 76 additional subsequent patient isolates were included in the analysis. Until 2006, detections of VREfm remained singular cases, followed by a peak in the number of VREfm cases in 2007 and 2008 with a subsequent decline to baseline in 2010. MLST and cgMLST analysis show significant changes in the dominant sequence types (STs) and complex types (CTs) over the study period, with ST192 and ST17 being responsible for the peak in VREfm cases in 2007 and 2008. The four largest clusters detected during the study period are comprised of these two STs. Cluster analysis shows a focus on specific wards and departments for each cluster. In the early years of this study (2004-2006), all analyzed VREfm stemmed from clinical specimens, whereas since 2007, approximately half of the VREfm were detected by screening. Of the 234 VREfm isolates analyzed, 96% had a vanB and only 4% had a vanA resistance genotype.

Conclusions: This retrospective study contributes significant knowledge about regional VREfm epidemiology from this early VREfm period in Germany. One remarkable finding is the striking dominance of vanB-positive VREfm isolates over the entire study period, which is in contrast with countrywide data. Analysis of cgMLST shows the transition from sporadic VRE cases at our institution to a sharp increase in VRE numbers triggered by oligoclonal spread and specific outbreak clusters with the dominance of ST192 and ST17.

2004 年至 2010 年耐万古霉素肠球菌 (VREfm) 在德国一家三级医疗中心的引入和传播:一项关于 VREfm 分子流行病学的回顾性全基因组测序 (WGS) 研究。
背景:在欧洲大部分地区,尤其是在德国,耐万古霉素肠球菌(VREfm)引起的医院获得性感染目前呈上升趋势,令人担忧。因此,我们需要进一步了解 VREfm 在医院中的传播方式。在这项研究中,我们调查了从 2004 年首次在我校医院出现到 2010 年期间 VREfm 分离物的分子流行病学。在德国,关于早期 VREfm 分子流行病学的信息非常少:我们的分析包括 2004 年至 2010 年期间在我们的三级医疗中心收集到的每位患者的首次 VREfm 分离物。如果有的话,我们还分析了一些患者的其他连续 VREfm 分离物。我们使用多焦点序列分型(MLST)和核心基因组多焦点序列分型(cgMLST)来分析和描述医院内传播途径并检测疫情:来自 158 名患者的 VREfm 分离物和 76 名后续患者的分离物被纳入分析。直到 2006 年,检测到的 VREfm 病例仍为单一病例,2007 年和 2008 年 VREfm 病例数量达到高峰,随后在 2010 年降至基线。MLST 和 cgMLST 分析表明,在研究期间,主要序列类型(ST)和复合类型(CT)发生了显著变化,ST192 和 ST17 是造成 2007 年和 2008 年 VREfm 病例高峰的原因。研究期间检测到的四个最大的聚类均由这两种 ST 组成。聚类分析显示,每个聚类都集中在特定的病房和部门。在本研究的最初几年(2004-2006 年),所有分析出的 VREfm 都来自临床标本,而自 2007 年以来,约有一半的 VREfm 是通过筛查发现的。在分析的 234 个 VREfm 分离物中,96% 具有 vanB 耐药基因型,只有 4% 具有 vanA 耐药基因型:这项回顾性研究为了解德国 VREfm 早期的地区 VREfm 流行病学提供了重要信息。一个引人注目的发现是,在整个研究期间,vanB 阳性的 VREfm 分离物占据了显著优势,这与全国范围的数据形成了鲜明对比。对 cgMLST 的分析表明,我院的 VRE 病例从零星发生过渡到 VRE 数量的急剧增加,这是由 ST192 和 ST17 的寡克隆传播和特定疫情集群引发的。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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