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Title: Vancomycin-resistant Enterococcus faecium sequence type 796 - rapid international dissemination of a new epidemic clone.
Austin Authors: Mahony, Andrew A ;Buultjens, Andrew H;Ballard, Susan A;Grabsch, Elizabeth A ;Xie, Shirley;Seemann, Torsten;Stuart, Rhonda L;Kotsanas, Despina;Cheng, Allen C;Heffernan, Helen;Roberts, Sally A;Coombs, Geoffrey W;Bak, Narin;Ferguson, John K;Carter, Glen C;Howden, Benjamin P ;Stinear, Timothy P;Johnson, Paul D R 
Affiliation: Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia
Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3000 Australia
Department of Microbiology, Austin Health, Heidelberg, Victoria, Australia
Melbourne Bioinformatics, The University of Melbourne, Parkville, VIC 3010 Australia
Monash Infectious Diseases, Monash Health, Clayton, VIC 3168 Australia
Department of Infectious Diseases, Alfred Health, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC 3181 Australia
Antimicrobial Reference Laboratory, Institute of Environmental Science and Research (ESR), Wellington, 5022 New Zealand
Department of Clinical Microbiology, Auckland District Health Board, Auckland, 1051 New Zealand
School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA 6150 Australia
Microbiology Department, PathWest Laboratory Medicine - WA, Fiona Stanley Hospital, Murdoch, WA 6150 Australia
Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia 5000 Australia
Division of Microbiology, Health Pathology, NSW Department of Immunology and Infectious Diseases, John Hunter Hospital, University of Newcastle, Newcastle, NSW 2305 Australia
Issue Date: 2018
Date: 2018-03-22
Publication information: Antimicrobial resistance and infection control 2018; 7: 44
Abstract: 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. 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. 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. 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.
DOI: 10.1186/s13756-018-0335-z
ORCID: 0000-0003-3152-116X
Journal: Antimicrobial resistance and infection control
PubMed URL: 29588851
Type: Journal Article
Subjects: Infection control
Molecular epidemiology
Whole genome sequencing
Appears in Collections:Journal articles

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