Thirty years of VRE in Germany – “expect the unexpected”: The view from the National Reference Centre for Staphylococci and Enterococci

Werner, Guido; Neumann, Bernd; Weber, Robert E.; Kresken, Michael; Wendt, Constanze; Bender, Jennifer K.

doi:10.1016/j.drup.2020.100732

Cited by 58 publications

(58 citation statements)

References 145 publications

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“…A recent analysis of the complete plasmid sequences in a vast collection of E. faecium isolates (Arredondo-Alonso et al, 2020) confirmed that bacteriocins, ribosomally synthesised peptides with antibacterial activity directed against bacteria (Franz et al, 2007), were observed in hospital-associated plasmidome populations and were potentially involved in niche adaptation. Similarly, a recent study, which revealed some unpublished data on German VREfm isolates from the 1990s, classified ST117/CT24 strains as "strong producers of bacteriocins" (Werner et al, 2020). Werner et al (2020) suggested that, through these molecules, commensal enterococci could be wiped out, leading to the expansion of this specific lineage in the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 98%

“…Similarly, a recent study, which revealed some unpublished data on German VREfm isolates from the 1990s, classified ST117/CT24 strains as "strong producers of bacteriocins" (Werner et al, 2020). Werner et al (2020) suggested that, through these molecules, commensal enterococci could be wiped out, leading to the expansion of this specific lineage in the gastrointestinal tract. Our data add to these findings by providing insight into the role of VSE.…”

Section: Discussionmentioning

confidence: 98%

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Molecular Characterisation of Vancomycin-Resistant Enterococcus faecium Isolates Belonging to the Lineage ST117/CT24 Causing Hospital Outbreaks

et al. 2021

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Background: Vancomycin-resistant Enterococcus faecium (VREfm) is a successful nosocomial pathogen. The current molecular method recommended in the Netherlands for VREfm typing is based on core genome Multilocus sequence typing (cgMLST), however, the rapid emergence of specific VREfm lineages challenges distinguishing outbreak isolates solely based on their core genome. Here, we explored if a detailed molecular characterisation of mobile genetic elements (MGEs) and accessory genes could support and expand the current molecular typing of VREfm isolates sharing the same genetic background, enhancing the discriminatory power of the analysis.Materials/Methods: The genomes of 39 VREfm and three vancomycin-susceptible E. faecium (VSEfm) isolates belonging to ST117/CT24, as assessed by cgMLST, were retrospectively analysed. The isolates were collected from patients and environmental samples from 2011 to 2017, and their genomes were analysed using short-read sequencing. Pangenome analysis was performed on de novo assemblies, which were also screened for known predicted virulence factors, antimicrobial resistance genes, bacteriocins, and prophages. Two representative isolates were also sequenced using long-read sequencing, which allowed a detailed analysis of their plasmid content.Results: The cgMLST analysis showed that the isolates were closely related, with a minimal allelic difference of 10 between each cluster’s closest related isolates. The vanB-carrying transposon Tn1549 was present in all VREfm isolates. However, in our data, we observed independent acquisitions of this transposon. The pangenome analysis revealed differences in the accessory genes related to prophages and bacteriocins content, whilst a similar profile was observed for known predicted virulence and resistance genes.Conclusion: In the case of closely related isolates sharing a similar genetic background, a detailed analysis of MGEs and the integration point of the vanB-carrying transposon allow to increase the discriminatory power compared to the use of cgMLST alone. Thus, enabling the identification of epidemiological links amongst hospitalised patients.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Molecular Characterisation of Vancomycin-Resistant Enterococcus faecium Isolates Belonging to the Lineage ST117/CT24 Causing Hospital Outbreaks

et al. 2021

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“…The expansion of VRE in the human gut has been associated with a higher risk of infection, as well as diversification of clones with variable antimicrobial resistance profiles, which could impair a successful therapy, thus generating higher costs and risk of death [98][99][100]. MDRE have been a global menace for many years and, despite new therapeutic alternatives and hygiene measures, they remain highly transmissible among patients and a problem to solve in many countries [101,102]. In the EU and European Economic Area (EEA), the number of VRE infections and deaths nearly doubled between 2007 and 2015 [98] and ranked as the second greatest burden in terms of disability-adjusted life years (91.1%) [98,100].…”

Section: Use Of Bacteriocins To Fight Against Vre Human Infectionsmentioning

confidence: 99%

Enterococcus spp. as a Producer and Target of Bacteriocins: A Double-Edged Sword in the Antimicrobial Resistance Crisis Context

et al. 2021

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Enterococcus spp. are one of the most frequent producers of bacteriocins (enterocins), which provides them with an advantage to compete in their natural environment, which is the gut of humans and many animals. The enterocins’ activity against microorganisms from different phylogenetic groups has raised interest in Enterococcus spp. in different contexts throughout the last decades, especially in the food industry. Nevertheless, some species can also cause opportunistic life-threatening infections and are frequently multidrug-resistant (MDR). Vancomycin-resistant Enterococcus (VRE), in particular, are an ongoing global challenge given the lack of therapeutic options. In this scenario, bacteriocins can offer a potential solution to this persistent threat, either alone or in combination with other antimicrobials. There are a handful of studies that demonstrate the advantages and applications of bacteriocins, especially against VRE. The purpose of this review is to present a current standpoint about the dual role of Enterococcus spp., from important producers to targets needed to be controlled, and the crucial role that enterocins may have in the expansion of enterococcal populations. Classification and distribution of enterocins, the current knowledge about the bacteriocinome of clinical enterococci, and the challenges of bacteriocin use in the fight against VRE infections are particularly detailed.

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“…In a systematic review and meta-analysis, Wada et al [ 40 ] reported 25.3% VRE prevalence in Nigeria. Europe has been the hot spot for VRE since it was first reported in humans in the 1980s [ 7 , 40 , 41 ] and was also the first continent to collectively move for the ban of avoparcin as a growth promoter [ 42 ]. It is therefore expected that more studies would be reported from that continent.…”

Section: Discussionmentioning

confidence: 99%

“…Enterococcal-resistant strains were thought to have emerged as a result of human antimicrobials use and their use as growth promoters in the livestock industry [ 5 ]. A good example is the use of avoparcin, which has been used as a feed additive to support livestock growth in Europe, including Turkey [ 6 , 7 , 8 ]. Avoparcin and vancomycin belongs to the same glycopeptide family of antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Vancomycin-Resistant Enterococcus (VRE) in Companion Animals: The First Meta-Analysis and Systematic Review

Wada

Irekeola

et al. 2021

Antibiotics

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Antimicrobial resistance in companion animals is a major public health concern worldwide due to the animals’ zoonotic potential and ability to act as a reservoir for resistant genes. We report on the first use of meta-analysis and a systematic review to analyze the prevalence of vancomycin-resistant Enterococcus (VRE) in companion animals. Databases such as MedLib, PubMed, Web of Science, Scopus, and Google Scholar were searched. The information was extracted by two independent reviewers and the results were reviewed by a third. Two reviewers independently assessed the study protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence data. OpenMeta analyst and comprehensive meta-analysis (CMA) were used for the meta-analysis. The random effect model was used, and publication bias was assessed using the Eggers test and funnel plot. Between-study heterogeneity was assessed, and the sources were analyzed using the leave-one-out meta-analysis, subgroup analysis and meta-regression. Twenty-two studies met the eligibility criteria, but because some studies reported the prevalence of VRE in more than one companion animal, they were considered as individual studies, and 35 studies were therefore added to the final meta-analysis. Sampling period of the included studies was from 1995–2018. Of the 4288 isolates tested in the included studies, 1241 were VRE. The pooled prevalence of VRE in companion animals was estimated at 14.6% (95% CI; 8.7–23.5%; I2 = 97.10%; p < 0.001). Between-study variability was high (t2 = 2.859; heterogeneity I2 = 97.10% with heterogeneity chi-square (Q) = 1173.346, degrees of freedom (df) = 34, and p < 0.001). The funnel plot showed bias, which was confirmed by Eggers test (t-value = 3.97165; p = 0.00036), and estimates from the leave-one-out forest plot did not affect the pooled prevalence. Pooled prevalence of VRE in dogs and cats were 18.2% (CI = 9.4–32.5%) and 12.3%, CI = 3.8–33.1%), respectively. More studies were reported in Europe than in any other continent, with most studies using feces as the sample type and disc diffusion as the detection method. With the emergence of resistant strains, new antimicrobials are required in veterinary medicine.

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Thirty years of VRE in Germany – “expect the unexpected”: The view from the National Reference Centre for Staphylococci and Enterococci

Cited by 58 publications

References 145 publications

Molecular Characterisation of Vancomycin-Resistant Enterococcus faecium Isolates Belonging to the Lineage ST117/CT24 Causing Hospital Outbreaks

Molecular Characterisation of Vancomycin-Resistant Enterococcus faecium Isolates Belonging to the Lineage ST117/CT24 Causing Hospital Outbreaks

Enterococcus spp. as a Producer and Target of Bacteriocins: A Double-Edged Sword in the Antimicrobial Resistance Crisis Context

Prevalence of Vancomycin-Resistant Enterococcus (VRE) in Companion Animals: The First Meta-Analysis and Systematic Review

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