Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone
Date
2018
Authors
Mahony, A.A.
Buultjens, A.H.
Ballard, S.A.
Grabsch, E.A.
Xie, S.
Seemann, T.
Stuart, R.L.
Kotsanas, D.
Cheng, A.
Heffernan, H.
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Journal article
Citation
Antimicrobial Resistance and Infection Control, 2018; 7(1):44-1-44-9
Statement of Responsibility
Andrew A. Mahony, Andrew H. Buultjens, Susan A. Ballard, Elizabeth A. Grabsch, Shirley Xie, Torsten Seemann, Rhonda L. Stuart, Despina Kotsanas, Allen Cheng, Helen Heffernan, Sally A. Roberts, Geoffrey W. Coombs, Narin Bak, John K. Ferguson, Glen C. Carter, Benjamin P. Howden, Timothy P. Stinear, and Paul D.R. Johnson
Conference Name
Abstract
Background: Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of hospital-acquired infections. New, presumably better-adapted strains of VRE appear unpredictably; it is uncertain how they spread despite improved infection control. We aimed to investigate the relatedness of a novel sequence type (ST) of vanB E. faecium - ST796 - very near its time of origin from hospitals in three Australian states and New Zealand. Methods: Following near-simultaneous outbreaks of ST796 in multiple institutions, we gathered then tested colonization and bloodstream infection isolates' antimicrobial resistance (AMR) phenotypes, and phylogenomic relationships using whole genome sequencing (WGS). Patient meta-data was explored to trace the spread of ST796. Results: A novel clone of vanB E. faecium (ST796) was first detected at one Australian hospital in late 2011, then in two New Zealand hospitals linked by inter-hospital transfers from separate Melbourne hospitals. ST796 also appeared in hospitals in South Australia and New South Wales and was responsible for at least one major colonization outbreak in a Neonatal Intensive Care Unit without identifiable links between centers. No exceptional AMR was detected in the isolates. While WGS analysis showed very limited diversity at the core genome, consistent with recent emergence of the clone, clustering by institution was observed. Conclusions: Evolution of new E. faecium clones, followed by recognized or unrecognized movement of colonized individuals then rapid intra-institutional cross-transmission best explain the multi-center, multistate and international outbreak we observed.
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© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.