Kyriaki Xanthopoulou1,2, Silke Peter1,3, David Tobys1,2, Michael Behnke1,4, Ariane G Dinkelacker1,3, Simone Eisenbeis1,5, Jane Falgenhauer1,6, Linda Falgenhauer1,7, Moritz Fritzenwanker1,6, Hannah Gölz1,8, Georg Häcker1,8, Paul G Higgins1,2, Can Imirzalioglu1,6, Nadja Käding1,9, Winfried V Kern10, Evelyn Kramme1,9, Axel Kola1,4, Alexander Mischnik1,9, Siegbert Rieg1,10, Anna M Rohde1,4, Jan Rupp1,9, Evelina Tacconelli1,5, Maria J G T Vehreschild1,11,12, Sarah V Walker1,2, Petra Gastmeier1,4, Harald Seifert1,2. 1. German Centre for Infection Research (DZIF), Braunschweig, Germany. 2. Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany. 3. Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany. 4. Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany. 5. Division of Infectious Disease, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany. 6. Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany. 7. Institute of Hygiene and Environmental Medicine, Justus Liebig University Giessen, Giessen, Germany. 8. Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany. 9. Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany. 10. Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Centre and Faculty of Medicine, Freiburg, Germany. 11. University of Cologne, Department I of Internal Medicine, Cologne, Germany. 12. Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt am Main, Germany.
Abstract
OBJECTIVES: To analyse the rectal carriage rate and the molecular epidemiology of vancomycin-resistant Enterococcus faecium (VREfm) recovered from patients upon hospital admission. METHODS: Adult patients were screened at six German university hospitals from five different federal states upon hospital admission for rectal colonization with VREfm between 2014 and 2018. Molecular characterization of VREfm was performed by WGS followed by MLST and core-genome MLST analysis. RESULTS: Of 16350 patients recruited, 263 were colonized with VREfm, with increasing prevalence rates during the 5 year study period (from 0.8% to 2.6%). In total, 78.5% of the VREfm were vanB positive and 20.2% vanA positive, while 1.2% harboured both vanA and vanB. The predominant ST was ST117 (56.7%) followed by ST80 (15%), ST203 (10.9%), ST78 (5.7%) and ST17 (3.2%). ST117/vanB VREfm isolates formed a large cluster of 96 closely related isolates extending across all six study centres and four smaller clusters comprising 13, 5, 4 and 3 isolates each. In contrast, among the other STs inter-regional clonal relatedness was rarely observed. CONCLUSIONS: To our knowledge, this is the largest admission prevalence and molecular epidemiology study of VREfm. These data provide insight into the epidemiology of VREfm at six German university hospitals and demonstrate the remarkable inter-regional clonal expansion of the ST117/vanB VREfm clone.
OBJECTIVES: To analyse the rectal carriage rate and the molecular epidemiology of vancomycin-resistant Enterococcus faecium (VREfm) recovered from patients upon hospital admission. METHODS: Adult patients were screened at six German university hospitals from five different federal states upon hospital admission for rectal colonization with VREfm between 2014 and 2018. Molecular characterization of VREfm was performed by WGS followed by MLST and core-genome MLST analysis. RESULTS: Of 16350 patients recruited, 263 were colonized with VREfm, with increasing prevalence rates during the 5 year study period (from 0.8% to 2.6%). In total, 78.5% of the VREfm were vanB positive and 20.2% vanA positive, while 1.2% harboured both vanA and vanB. The predominant ST was ST117 (56.7%) followed by ST80 (15%), ST203 (10.9%), ST78 (5.7%) and ST17 (3.2%). ST117/vanB VREfm isolates formed a large cluster of 96 closely related isolates extending across all six study centres and four smaller clusters comprising 13, 5, 4 and 3 isolates each. In contrast, among the other STs inter-regional clonal relatedness was rarely observed. CONCLUSIONS: To our knowledge, this is the largest admission prevalence and molecular epidemiology study of VREfm. These data provide insight into the epidemiology of VREfm at six German university hospitals and demonstrate the remarkable inter-regional clonal expansion of the ST117/vanB VREfm clone.
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