Abstract
Vancomycin-resistant enterococci (VRE) pose a public health challenge worldwide. While VRE bloodstream infections (VREBI) increase in Germany and Europe, population-based molecular data are scarce. We aimed to analyze the molecular epidemiology, demographic aspects, and geographical distribution of VREBI in the German Federal State of North-Rhine–Westphalia (NRW), located in the German–Dutch–Belgian border area, representing over 20% of Germany’s population. VREBI isolates were collected from hospitals across NRW between 2016 and 2019. Demographic data were gathered and anonymized upon sample collection. Multilocus sequence typing (MLST) and identification of glycopeptide resistance were carried out. Epidemiological analysis and geographical mapping were performed. Single VREBI isolates from 755 patients were analyzed. In total, 38.9% were female, and 80.0% were aged ≥ 60 years. The VREBI incidence per 100,000 inhabitants nearly tripled, from 0.52 (2016) to 1.48 (2019), particularly in male patients aged ≥ 50 years. The proportion of vanB reached 83% (n = 202/243) in 2018, overtaking vanA as the predominant glycopeptide resistance determinant, detected in close relation with ST117 isolates. The proportion of MLST sequence type (ST) 117 peaked in 2018, at 78.2% (n = 190/243). The major role of these emerging strains in invasive infections in central Europe requires novel strategies for their diagnosis, treatment, and prevention.
Highlights
Since their first description three decades ago [1,2], vancomycin-resistant enterococci (VRE) have become widespread, top-priority, multidrug-resistant organisms (MDRO) [3].Though commonly found as intestinal commensals, enterococci are capable of causing a wide range of infections, including abdominal, surgical site, and foreign body-associated infections, as well as endocarditis [4]
In Europe, the proportion of VRE among bloodstream infections caused by Enterococcus faecium has substantially increased in recent years (2015, 10.5% vs. 2019, 18.3%) [8]
VRE poses an increasingly relevant challenge worldwide, given their ability to thrive in health care settings and cause life-threatening invasive infections
Summary
Since their first description three decades ago [1,2], vancomycin-resistant enterococci (VRE) have become widespread, top-priority, multidrug-resistant organisms (MDRO) [3].Though commonly found as intestinal commensals, enterococci are capable of causing a wide range of infections, including abdominal, surgical site, and foreign body-associated infections, as well as endocarditis [4]. Since their first description three decades ago [1,2], vancomycin-resistant enterococci (VRE) have become widespread, top-priority, multidrug-resistant organisms (MDRO) [3]. VRE bloodstream infections (VREBIs) are associated with mortality twice as high as that of vancomycin-sensitive enterococci bloodstream infections (VSEBIs) [5]. This translates into increased hospital costs, excess mortality, and prolonged hospital stays [6,7]. In Europe, the proportion of VRE among bloodstream infections caused by Enterococcus faecium has substantially increased in recent years (2015, 10.5% vs 2019, 18.3%) [8]. Within this period, VREBIs have increased even more markedly in Germany, from 10.5% to 26.3% [8]
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