Transmission of Vancomycin-Resistant Enterococci in the Hospital Setting: Uncovering the Patient-Environment Interplay.

Carlos L Correa-Martinez,Stefanie Kampmeier,Neele J Froböse,Hauke Tönnies,Alexander Mellmann

doi:10.3390/microorganisms8020203

Carlos L Correa-Martinez, Stefanie Kampmeier + Show 3 more

Open Access

https://doi.org/10.3390/microorganisms8020203

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Journal: Microorganisms	Publication Date: Jan 31, 2020
Citations: 37	License type: CC BY 4.0

Affiliation: University Hospital Münster

Abstract

Vancomycin-resistant enterococci (VRE) are relevant nosocomial pathogens with an increasing incidence in the last decades. Their transmission is optimal in the hospital setting, as it offers two potential, large reservoirs that are closely related: susceptible patients and their environment. Here we investigate the role of the hospital environment in the nosocomial transmission of VRE by establishing concrete links between contaminated surfaces and colonized/infected patients in outbreak and non-outbreak settings. Environmental and patient VRE isolates were collected between 2013 and 2019 and analyzed by whole-genome sequencing (WGS), subsequent multilocus sequence typing (MLST), and core genome (cg) MLST. Pairs of isolates differing in <3 alleles were rated as closely related, making a transmission likely. Fifty-three environmental VRE isolates were analyzed. MLST sequence types (ST) ST203 (50.0%), ST192 (21.3%), ST117 (17.3%), ST721 (8.8%), ST80 (2%), and ST1489 (0.7%) were detected, carrying the resistance determinants vanA (72.7%), vanB (24%), or both (3.3%). Of the 53 environmental isolates, 51 were found to form five clusters with genetically related patient isolates (n = 97 isolates). WGS confirms the role of the environment in the transmission dynamics of VRE in both the outbreak and non-outbreak settings, highlighting the importance of prevention and control of VRE spread.

Highlights

Vancomycin-resistant enterococci (VRE) are Gram-positive microorganisms that significantly contribute to the burden of healthcare-associated infections
whole-genome sequencing (WGS) resulted in four singletons and eight clusters of genetically closely related strains (≤3 alleles differing between the genotypes) comprising 2–20 isolates
We investigated the role of the contaminated hospital environment and its impact on VRE transmission, consiMdeLrSinTgSTthat these microorganisms are ablveantogesnuortvypivee on iennavnirimonamteesnutraflSascTue8rs0ffaocresseSavnTed1r1ap7l ayteieanrSstsT[11r8e9]2v.eTahleedSaTnd2ai0slyt3isnicstagnSedTn7ce2ot1imc prealrSaiTtsio1on4n8so9hfiVpsRbEvaeitnswoAleaetnesboovbtathnaBignreodupfrvsovaamonnfAB+

Summary

Introduction

Vancomycin-resistant enterococci (VRE) are Gram-positive microorganisms that significantly contribute to the burden of healthcare-associated infections. Considering the significantly higher mortality rate of VRE infections as compared to those caused by vancomycin-susceptible enterococci [6,7], and in view of the well-documented inter- and intra-species transmission of resistance genes [8,9], it has become necessary to adopt infection control strategies worldwide aimed at reducing the spread of VRE [10]. The clinical and epidemiological impact of VRE on the severity and burden of enterococcal disease [4,6,7], points out the relevance of identifying and understanding the conditions favoring the development and transmission of VRE in order to prevent their spread and reduce the incidence of infections.

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