An Outbreak of ST80 Vancomycin-Resistant Enterococcus faecium in a Hospital in Guangzhou, China: Clinical and Genomic Epidemiology Study from 2022 to 2023.
{"title":"An Outbreak of ST80 Vancomycin-Resistant <i>Enterococcus faecium</i> in a Hospital in Guangzhou, China: Clinical and Genomic Epidemiology Study from 2022 to 2023.","authors":"Yawen Deng, Xiaoying Xie, Baiji Chen, Zhixan Zhang, Jiaoni Lan, Yi Luan, Guanhua Rao, Peng Han, Chaohui Duan","doi":"10.1177/10766294251361345","DOIUrl":null,"url":null,"abstract":"<p><p>A notable increase in the incidence of vancomycin-resistant <i>Enterococcus faecium</i> (VREfm) was observed at a hospital in Guangzhou, China, during 2022-2023. We conducted a retrospective cross-sectional study from January 1, 2022, to August 31, 2023, to investigate the clinical and genomic characteristics of VREfm. Clinical data were extracted from electronic medical records, and infection control measures were reviewed from the relevant department. VREfm confirmation was performed using antimicrobial susceptibility testing. Genomic characteristics were analyzed via the whole-genome sequencing. The prevalence of VREfm among <i>E. faecium</i> isolates rose significantly from 13.3% (10/75) in 2022 to 26.4% (40/151) by August 2023 (<i>p</i> < 0.001). Concurrently, usage of third-generation cephalosporins increased by 8.4% (22.47 to 24.36 defined daily doses per 100 patient days), carbapenems by 34% (51.47-68.97), and vancomycin by 18% (21.15-24.97) (all <i>p</i> ≤ 0.001). Molecular analysis revealed ST80/CC17 (78%, 39/50) as the dominant clone, carrying <i>vanA</i> and virulence genes (<i>scm</i>, <i>acm,</i> and <i>fss3</i>), suggesting clonal expansion of a lineage rarely reported in Guangzhou. Our study documented an outbreak of ST80/CC17 <i>vanA</i>-positive VREfm, characterized by virulence genes (<i>scm</i>, <i>acm,</i> and <i>fss3</i>) and clonal dominance (78%, 39/50). The temporal association between reduced sodium hypochlorite disinfection (2.7-fold decline, <i>p</i> = 0.002), increased antibiotic selective pressure, and pathogen transmission highlights multifactorial drivers of this epidemic. These findings underscore the complex multifactorial nature of pathogen transmission, including the role of antibiotic use, infection control measures, and environmental factors in the spread of multidrug-resistant clones. Strengthened infection control strategies-integrating targeted disinfection, antibiotic stewardship, and genomic surveillance-are imperative to curb the spread of such multidrug-resistant clones.</p>","PeriodicalId":18701,"journal":{"name":"Microbial drug resistance","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Microbial drug resistance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10766294251361345","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
A notable increase in the incidence of vancomycin-resistant Enterococcus faecium (VREfm) was observed at a hospital in Guangzhou, China, during 2022-2023. We conducted a retrospective cross-sectional study from January 1, 2022, to August 31, 2023, to investigate the clinical and genomic characteristics of VREfm. Clinical data were extracted from electronic medical records, and infection control measures were reviewed from the relevant department. VREfm confirmation was performed using antimicrobial susceptibility testing. Genomic characteristics were analyzed via the whole-genome sequencing. The prevalence of VREfm among E. faecium isolates rose significantly from 13.3% (10/75) in 2022 to 26.4% (40/151) by August 2023 (p < 0.001). Concurrently, usage of third-generation cephalosporins increased by 8.4% (22.47 to 24.36 defined daily doses per 100 patient days), carbapenems by 34% (51.47-68.97), and vancomycin by 18% (21.15-24.97) (all p ≤ 0.001). Molecular analysis revealed ST80/CC17 (78%, 39/50) as the dominant clone, carrying vanA and virulence genes (scm, acm, and fss3), suggesting clonal expansion of a lineage rarely reported in Guangzhou. Our study documented an outbreak of ST80/CC17 vanA-positive VREfm, characterized by virulence genes (scm, acm, and fss3) and clonal dominance (78%, 39/50). The temporal association between reduced sodium hypochlorite disinfection (2.7-fold decline, p = 0.002), increased antibiotic selective pressure, and pathogen transmission highlights multifactorial drivers of this epidemic. These findings underscore the complex multifactorial nature of pathogen transmission, including the role of antibiotic use, infection control measures, and environmental factors in the spread of multidrug-resistant clones. Strengthened infection control strategies-integrating targeted disinfection, antibiotic stewardship, and genomic surveillance-are imperative to curb the spread of such multidrug-resistant clones.
期刊介绍：
Microbial Drug Resistance (MDR) is an international, peer-reviewed journal that covers the global spread and threat of multi-drug resistant clones of major pathogens that are widely documented in hospitals and the scientific community. The Journal addresses the serious challenges of trying to decipher the molecular mechanisms of drug resistance. MDR provides a multidisciplinary forum for peer-reviewed original publications as well as topical reviews and special reports.
MDR coverage includes:
Molecular biology of resistance mechanisms
Virulence genes and disease
Molecular epidemiology
Drug design
Infection control.
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