Population dynamics in colonizing vancomycin-resistant E. faecium isolated from immunosuppressed patients.
J Glob Antimicrob Resist, 2022/2/05;
Both A[1], Kruse F[1], Mirwald N[1], Franke G[1], Christner M[1], Huang J[1], Hansen JL[1], Kröger N[2], Berneking L[1], Lellek H[2], Aepfelbacher M[1], Rohde H[3]
Affiliations
PMID: 35134550DOI: 10.1016/j.jgar.2022.01.027
Impact factor: 4.349
Abstract
objectives: Vancomycin-resistant Enterococcus faecium and Enterococcus faecalis (VRE) are a common cause of healthcare-associated infections. Whole genome sequencing based typing methods yield the highest discriminatory power for outbreak surveillance in the hospital. We here analysed the clonal composition of enteric VRE populations of at-risk patients over several weeks to characterize VRE population diversity and dynamics.
methods: Five bone marrow transplant recipients (three colonized with vanA-positive isolates, two colonized with vanB-positive isolates) contributed three rectal swabs over a course of several weeks. 14 VRE colonies per swab were analysed by core genome multi locus sequence typing (cgMLST) and typing of the van-element.
results: VRE populations were clonally diverse in 3/5 patients and population composition changed dynamically over the time of observation. Besides new acquisition of VRE isolates, shared van-elements localised on nearly identical plasmids between clonally different isolates indicate horizontal gene transfer as a mechanism behind VRE population diversity within single patients.
conclusion: Outbreak detection relies on typing of isolates, usually by analysing one isolate per patient. We here show that this approach is insufficient for outbreak surveillance of VRE in highly vulnerable patients as it does not take into account VRE population heterogeneity and horizontal gene transfer of the resistance element.
Keywords: bone marrow transplantation; hospital hygiene; phylogeny; population dynamics; vancomycin resistant enterococci; whole genome sequencing
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