Expansion of Vancomycin-Resistant Enterococcus faecium in an Academic Tertiary Hospital in Southwest Germany: a Large-Scale Whole-Genome-Based Outbreak Investigation
Expansion of Vancomycin-Resistant Enterococcus faecium in an Academic Tertiary Hospital in Southwest Germany: a Large-Scale Whole-Genome-Based Outbreak Investigation
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DOI：
10.1128/aac.01978-18
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发表时间：
2019-05-01
影响因子：
4.9
通讯作者：
Peter, Silke
中科院分区：
文献类型：
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作者：
Liese, Jan;Schuele, Leonard;Peter, Silke
万古霉素耐药屎肠球菌（VREfm）是医院暴发的常见原因。2015年下半年，我校医学中心VREfm的发病率急剧上升。采用新一代测序（NGS）技术对2010年至2016年从患者身上分离到的首批VREfm分离株（n = 773）进行分析，以破译流行病学变化、疫情动态和可能的传播途径。对VREfm分离株进行全基因组测序、序列类型提取和系统发育分析。我们检查了流行病学数据、房间占用数据和患者转移，并计算了患者与患者接触的强度评分。系统发育分析结果显示，共有38个NGS集群和110个单克隆。VREfm的增加主要是由于两个新引入的NGS集群的扩大，其中vanb型菌株由多位点序列分型（MLST）确定为序列型80 （ST80）和ST117。通过将系统发育信息与流行病学数据相结合，可以证明院内传播，但其程度低于仅基于流行病学数据的最初预期。暴发克隆体不断从其他医院输入，表明区域范围内流行病学形势发生了变化。通过跟踪院内患者转移情况，可以确定导致VREfm在医院内传播的两个主要轴。基于ngs的疫情分析揭示了VREfm的地方和区域流行病学的巨大变化，强调了卫生保健网络在VREfm传播中的作用。
Vancomycin-resistant Enterococcus faecium (VREfm) is a frequent cause of nosocomial outbreaks. In the second half of 2015, a sharp increase in the incidence of VREfm was observed at our university medical center. Next-generation sequencing (NGS) was used to analyze the first isolates of VREfm recovered from patients between 2010 and 2016 (n = 773) in order to decipher epidemiological change, outbreak dynamics, and possible transmission routes. VREfm isolates were analyzed using whole-genome sequencing followed by sequence type extraction and phylogenetic analysis. We examined epidemiological data, room occupancy data, and patient transferals and calculated an intensity score for patient-to-patient contact. Phylogenetic analysis revealed the presence of 38 NGS clusters and 110 single clones. The increase of VREfm was caused mainly by the expansion of two newly introduced NGS clusters, comprising VanB-type strains determined by multilocus sequence typing (MLST) as sequence type 80 (ST80) and ST117. By combining phylogenetic information with epidemiological data, intrahospital transmission could be demonstrated, however to a lesser extent than initially expected based solely on epidemiological data. The outbreak clones were continuously imported from other hospitals, suggesting a change in the epidemiological situation at a regional scale. By tracking intrahospital patient transferals, two major axes could be identified that contributed to the spread of VREfm within the hospital. NGS-based outbreak analysis revealed a dramatic change in the local and regional epidemiology of VREfm, emphasizing the role of health care networks in the spread of VREfm.