Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE

Mette Pinholt; Hanna Larner-Svensson; Pia Littauer; Claus E Moser; Michael Pedersen; Lars E Lemming; Tove Ejlertsen; Turid S Søndergaard; Barbara J Holzknecht; Ulrik S Justesen; Esad Dzajic; Stefan S Olsen; Jesper B Nielsen; Peder Worning; Anette M Hammerum; Henrik Westh; Lotte Jakobsen

doi:10.1093/jac/dkv142

Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE

Mette Pinholt, Hanna Larner-Svensson, Pia Littauer, Claus E Moser, Michael Pedersen, Lars E Lemming, Tove Ejlertsen, Turid S Søndergaard, Barbara J Holzknecht, Ulrik S Justesen, Esad Dzajic, Stefan S Olsen, Jesper B Nielsen, Peder Worning, Anette M Hammerum, Henrik Westh, Lotte Jakobsen

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

OBJECTIVES: In Denmark, the incidence of vancomycin-resistant Enterococcus faecium (VREfm) has increased since 2012. The aim of this study was to investigate the epidemiology and clonal relatedness of VREfm isolates in Danish hospitals in 2012-13 using WGS. The second aim was to evaluate if WGS-based typing could replace PFGE for typing of VREfm.

METHODS: A population-based study was conducted including all VREfm isolates submitted for national surveillance from January 2012 to April 2013. All isolates were investigated by WGS, MLST and PFGE.

RESULTS: One-hundred and thirty-two isolates were included. The majority of the isolates were from clinical samples (77%). Gastroenterology/abdominal surgery (29%) and ICUs (29%) were the predominant departments with VREfm. Genomics revealed a polyclonal structure of the VREfm outbreak. Seven subgroups of 3-44 genetically closely related isolates (separated by <17 SNPs) were identified using WGS. Direct or indirect transmission of VREfm between patients and intra- and inter-regional spreading clones was observed. We identified 10 STs. PFGE identified four major clusters (13-43 isolates) and seven minor clusters (two to three isolates). The results from the typing methods were highly concordant. However, WGS-based typing had the highest discriminatory power.

CONCLUSIONS: This study emphasizes the importance of infection control measures to limit transmission of VREfm between patients. However, the diversity of the VREfm isolates points to the fact that other important factors may also affect the VREfm increase in Denmark. Finally, WGS is suitable for typing of VREfm and has replaced PFGE for typing of VREfm in Denmark.

Original language	English
Journal	Journal of Antimicrobial Chemotherapy
Volume	70
Issue number	9
Pages (from-to)	2474-2482
Number of pages	9
ISSN	0305-7453
DOIs	https://doi.org/10.1093/jac/dkv142
Publication status	Published - 2015

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Pinholt, M., Larner-Svensson, H., Littauer, P., Moser, C. E., Pedersen, M., Lemming, L. E., Ejlertsen, T., Søndergaard, T. S., Holzknecht, B. J., Justesen, U. S., Dzajic, E., Olsen, S. S., Nielsen, J. B., Worning, P., Hammerum, A. M., Westh, H., & Jakobsen, L. (2015). Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE. Journal of Antimicrobial Chemotherapy, 70(9), 2474-2482. https://doi.org/10.1093/jac/dkv142

@article{dd666a09bd5548c0a96f810506e965f8,

title = "Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE",

abstract = "OBJECTIVES: In Denmark, the incidence of vancomycin-resistant Enterococcus faecium (VREfm) has increased since 2012. The aim of this study was to investigate the epidemiology and clonal relatedness of VREfm isolates in Danish hospitals in 2012-13 using WGS. The second aim was to evaluate if WGS-based typing could replace PFGE for typing of VREfm.METHODS: A population-based study was conducted including all VREfm isolates submitted for national surveillance from January 2012 to April 2013. All isolates were investigated by WGS, MLST and PFGE.RESULTS: One-hundred and thirty-two isolates were included. The majority of the isolates were from clinical samples (77%). Gastroenterology/abdominal surgery (29%) and ICUs (29%) were the predominant departments with VREfm. Genomics revealed a polyclonal structure of the VREfm outbreak. Seven subgroups of 3-44 genetically closely related isolates (separated by <17 SNPs) were identified using WGS. Direct or indirect transmission of VREfm between patients and intra- and inter-regional spreading clones was observed. We identified 10 STs. PFGE identified four major clusters (13-43 isolates) and seven minor clusters (two to three isolates). The results from the typing methods were highly concordant. However, WGS-based typing had the highest discriminatory power.CONCLUSIONS: This study emphasizes the importance of infection control measures to limit transmission of VREfm between patients. However, the diversity of the VREfm isolates points to the fact that other important factors may also affect the VREfm increase in Denmark. Finally, WGS is suitable for typing of VREfm and has replaced PFGE for typing of VREfm in Denmark.",

author = "Mette Pinholt and Hanna Larner-Svensson and Pia Littauer and Moser, {Claus E} and Michael Pedersen and Lemming, {Lars E} and Tove Ejlertsen and S{\o}ndergaard, {Turid S} and Holzknecht, {Barbara J} and Justesen, {Ulrik S} and Esad Dzajic and Olsen, {Stefan S} and Nielsen, {Jesper B} and Peder Worning and Hammerum, {Anette M} and Henrik Westh and Lotte Jakobsen",

note = "{\textcopyright} The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.",

year = "2015",

doi = "10.1093/jac/dkv142",

language = "English",

volume = "70",

pages = "2474--2482",

journal = "Journal of Antimicrobial Chemotherapy",

issn = "0305-7453",

publisher = "Oxford University Press",

number = "9",

}

Pinholt, M, Larner-Svensson, H, Littauer, P, Moser, CE, Pedersen, M, Lemming, LE, Ejlertsen, T, Søndergaard, TS, Holzknecht, BJ, Justesen, US, Dzajic, E, Olsen, SS, Nielsen, JB, Worning, P, Hammerum, AM, Westh, H & Jakobsen, L 2015, 'Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE', Journal of Antimicrobial Chemotherapy, vol. 70, no. 9, pp. 2474-2482. https://doi.org/10.1093/jac/dkv142

TY - JOUR

T1 - Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE

AU - Pinholt, Mette

AU - Larner-Svensson, Hanna

AU - Littauer, Pia

AU - Moser, Claus E

AU - Pedersen, Michael

AU - Lemming, Lars E

AU - Ejlertsen, Tove

AU - Søndergaard, Turid S

AU - Holzknecht, Barbara J

AU - Justesen, Ulrik S

AU - Dzajic, Esad

AU - Olsen, Stefan S

AU - Nielsen, Jesper B

AU - Worning, Peder

AU - Hammerum, Anette M

AU - Westh, Henrik

AU - Jakobsen, Lotte

N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

PY - 2015

Y1 - 2015

N2 - OBJECTIVES: In Denmark, the incidence of vancomycin-resistant Enterococcus faecium (VREfm) has increased since 2012. The aim of this study was to investigate the epidemiology and clonal relatedness of VREfm isolates in Danish hospitals in 2012-13 using WGS. The second aim was to evaluate if WGS-based typing could replace PFGE for typing of VREfm.METHODS: A population-based study was conducted including all VREfm isolates submitted for national surveillance from January 2012 to April 2013. All isolates were investigated by WGS, MLST and PFGE.RESULTS: One-hundred and thirty-two isolates were included. The majority of the isolates were from clinical samples (77%). Gastroenterology/abdominal surgery (29%) and ICUs (29%) were the predominant departments with VREfm. Genomics revealed a polyclonal structure of the VREfm outbreak. Seven subgroups of 3-44 genetically closely related isolates (separated by <17 SNPs) were identified using WGS. Direct or indirect transmission of VREfm between patients and intra- and inter-regional spreading clones was observed. We identified 10 STs. PFGE identified four major clusters (13-43 isolates) and seven minor clusters (two to three isolates). The results from the typing methods were highly concordant. However, WGS-based typing had the highest discriminatory power.CONCLUSIONS: This study emphasizes the importance of infection control measures to limit transmission of VREfm between patients. However, the diversity of the VREfm isolates points to the fact that other important factors may also affect the VREfm increase in Denmark. Finally, WGS is suitable for typing of VREfm and has replaced PFGE for typing of VREfm in Denmark.

AB - OBJECTIVES: In Denmark, the incidence of vancomycin-resistant Enterococcus faecium (VREfm) has increased since 2012. The aim of this study was to investigate the epidemiology and clonal relatedness of VREfm isolates in Danish hospitals in 2012-13 using WGS. The second aim was to evaluate if WGS-based typing could replace PFGE for typing of VREfm.METHODS: A population-based study was conducted including all VREfm isolates submitted for national surveillance from January 2012 to April 2013. All isolates were investigated by WGS, MLST and PFGE.RESULTS: One-hundred and thirty-two isolates were included. The majority of the isolates were from clinical samples (77%). Gastroenterology/abdominal surgery (29%) and ICUs (29%) were the predominant departments with VREfm. Genomics revealed a polyclonal structure of the VREfm outbreak. Seven subgroups of 3-44 genetically closely related isolates (separated by <17 SNPs) were identified using WGS. Direct or indirect transmission of VREfm between patients and intra- and inter-regional spreading clones was observed. We identified 10 STs. PFGE identified four major clusters (13-43 isolates) and seven minor clusters (two to three isolates). The results from the typing methods were highly concordant. However, WGS-based typing had the highest discriminatory power.CONCLUSIONS: This study emphasizes the importance of infection control measures to limit transmission of VREfm between patients. However, the diversity of the VREfm isolates points to the fact that other important factors may also affect the VREfm increase in Denmark. Finally, WGS is suitable for typing of VREfm and has replaced PFGE for typing of VREfm in Denmark.

U2 - 10.1093/jac/dkv142

DO - 10.1093/jac/dkv142

M3 - Journal article

C2 - 26031466

SN - 0305-7453

VL - 70

SP - 2474

EP - 2482

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

IS - 9

ER -

Multiple hospital outbreaks of vanA Enterococcus faecium in Denmark, 2012-13, investigated by WGS, MLST and PFGE

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