Surveillance of vancomycin-resistant enterococci reveals shift in dominating clones and national spread of a vancomycin-variable vanA Enterococcus faecium ST1421-CT1134 clone, Denmark, 2015 to March 2019

Hammerum, Anette M.; Justesen, Ulrik Stenz; Pinholt, Mette; Roer, Louise; Kaya, Hülya; Worning, Peder; Nygaard, Sanne; Kemp, Michael; Clausen, Marianne Engell; Nielsen, Karen Leth; Samulioniené, Jurgita; Kjærsgaard, Mona; Østergaard, Claus; Coia, John; Søndergaard, Turid Snekloth; Gaïni, Shahin; Schønning, Kristian; Westh, Henrik; Hasman, Henrik; Holzknecht, Barbara Juliane

doi:10.2807/1560-7917.es.2019.24.34.1900503

Cited by 51 publications

(64 citation statements)

References 9 publications

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“…This study reports an increasing incidence of VRE infections in an Italian hospital from 2016 to 2018 that is in line with reports from other European countries [9][10][11][12]. It is also in line with the literature showing that VREfm has overtaken VREfs as agents of hospitalacquired infections [21].…”

Section: Resultssupporting

confidence: 91%

“…Recently, VRE incidence has been showing an upward trend in several European countries, including Italy (www. ecdc.europa.eu/en/publications-data/surveillanceantimicrobial-resistance-europe-2017) [9][10][11][12]. Although nine vancomycin resistance gene clusters have been described to date, vanA and vanB (both transferable) are still those most commonly found.…”

Section: Introductionmentioning

confidence: 99%

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Trend of clinical vancomycin-resistant enterococci isolated in a regional Italian hospital from 2001 to 2018

et al. 2020

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A retrospective study of the epidemiology of vancomycin-resistant enterococci (VRE) in a regional hospital of central Italy in 2001-2018 demonstrated an increased VRE prevalence since 2016. A total of 113 VRE isolates, 89 E. faecium (VREfm) and 24 E. faecalis (VREfs), were collected in the study period. All strains showed highlevel resistance to vancomycin; 107 also showed teicoplanin resistance. Altogether, 84 VREfm and 20 VREfs carried vanA, whereas 5 VREfm and 1 VREfs carried vanB. MLST analysis documented that 89 VREfm isolates mainly belonged to ST78, ST80, and ST117. Most strains were isolated from 2001 to 2007, ST78 being the predominant clone. VREfm re-emerged in 2016 with a prevalence of the ST80 lineage. Most VREfs were isolated from 2001 to 2006; although they belonged to 7 different STs, there was a prevalence of ST88 and ST6. Notably, ST88 was sporadically recovered throughout the study period. The increasing rate of VREfm isolation from 2016 to 2018 may be related to the influx of new successful clones and to the renewed and widespread use of vancomycin. Improved infection control measures in hospital wards should be adopted to limit the spread of new epidemic VRE strains.

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Section: Resultssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Trend of clinical vancomycin-resistant enterococci isolated in a regional Italian hospital from 2001 to 2018

et al. 2020

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“… 8 By 2019 this clone had spread from the capital region to all five Danish regions, and the Faroe Islands. 9 Early identification of VVEs and their reversion mechanism is important for therapeutic and infection control measures.…”

Section: Introductionmentioning

confidence: 99%

Alternative vanHAX promoters and increased vanA-plasmid copy number resurrect silenced glycopeptide resistance in Enterococcus faecium

Wagner

Janice

Sivertsen

et al. 2020

Journal of Antimicrobial Chemotherapy

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Background Vancomycin variable enterococci (VVE) are van-positive isolates with a susceptible phenotype that can convert to a resistant phenotype during vancomycin selection. Objectives To describe a vancomycin-susceptible vanA-PCR positive ST203 VVE Enterococcus faecium isolate (VVESwe-S) from a liver transplantation patient in Sweden which reverted to resistant (VVESwe-R) during in vitro vancomycin exposure. Methods WGS analysis revealed the genetic differences between the isolates. Expression of the van-operon was investigated by qPCR. Fitness and stability of the revertant were investigated by growth measurements, competition and serial transfer. Results The VVESwe-R isolate gained high-level vancomycin (MIC >256 mg/L) and teicoplanin resistance (MIC = 8 mg/L). VVESwe-S has a 5′-truncated vanR activator sequence and the VVESwe-R has in addition acquired a 44 bp deletion upstream of vanHAX in a region containing alternative putative constitutive promoters. In VVESwe-R the vanHAX-operon is constitutively expressed at a level comparable to the non-induced prototype E. faecium BM4147 strain. The vanHAX operon of VVESwe is located on an Inc18-like plasmid, which has a 3–4-fold higher copy number in VVESwe-R compared with VVESwe-S. Resistance has a low fitness cost and the vancomycin MIC of VVESwe-R decreased during in vitro serial culture without selection. The reduction in MIC was associated with a decreased vanA-plasmid copy number. Conclusions Our data support a mechanism by which vancomycin-susceptible VVE strains may revert to a resistant phenotype through the use of an alternative, constitutive, vanR-activator-independent promoter and a vanA-plasmid copy number increase.

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“…However, ST203 was a minor clone in Stockholm, which accounted for only approximately 1% of the CC17 VREfm isolates during 2018-2019. The national spread VVE clone (ST1421-CT1134 vanA E. faecium) in Denmark [14] has not been observed in Stockholm yet, nevertheless we should be alert to the cross-border spread.…”

Section: Discussionmentioning

confidence: 88%

“…Among CC17 isolates in Stockholm, ST80 predominated and was followed by ST761, ST17, ST117 and ST1495. In Denmark, ST203, ST80 and ST1421 were most prevalent among VRE/VVE E. faecium isolates [5,14]. However, ST203 was a minor clone in Stockholm, which accounted for only approximately 1% of the CC17 VREfm isolates during 2018-2019.…”

Section: Discussionmentioning

confidence: 99%

Genomic analysis revealed distinct transmission clusters of vancomycin-resistant Enterococcus faecium ST80 in Stockholm, Sweden

Fang

Fröding

Ullberg

et al. 2021

Journal of Hospital Infection

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Surveillance of vancomycin-resistant enterococci reveals shift in dominating clones and national spread of a vancomycin-variable vanA Enterococcus faecium ST1421-CT1134 clone, Denmark, 2015 to March 2019

Cited by 51 publications

References 9 publications

Trend of clinical vancomycin-resistant enterococci isolated in a regional Italian hospital from 2001 to 2018

Trend of clinical vancomycin-resistant enterococci isolated in a regional Italian hospital from 2001 to 2018

Alternative vanHAX promoters and increased vanA-plasmid copy number resurrect silenced glycopeptide resistance in Enterococcus faecium

Genomic analysis revealed distinct transmission clusters of vancomycin-resistant Enterococcus faecium ST80 in Stockholm, Sweden

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