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Elucidating vancomycin-resistant Enterococcus faecium outbreaks: the role of clonal spread and movement of mobile
X Zhou1, M A Chlebowicz1, E Bathoorn1
1University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands.
Background:
Vancomycin-resistant Enterococcus faecium (VREfm) has emerged as a nosocomial pathogen worldwide. The dissemination of VREfm is due to both clonal spread and spread of mobile genetic elements (MGEs) such as transposons.
Objectives:
We aimed to combine vanB-carrying transposon data with core-genome MLST (cgMLST) typing and epidemiological data to understand the pathways of transmission in nosocomial outbreaks.
Methods:
Retrospectively, 36 VREfm isolates obtained from 34 patients from seven VREfm outbreak investigations in 2014 were analysed. Isolates were sequenced on a MiSeq and a MinION instrument. De novo assembly was performed in CLC Genomics Workbench and the hybrid assemblies were obtained through Unicycler v0.4.1. Ridom SeqSphere+ was used to extract MLST and cgMLST data. Detailed analysis of each transposon and their integration points was performed using the Artemis Comparison Tool (ACT) and multiple blast analyses.
Results:
Four different vanB transposons were found among the isolates. cgMLST divided ST80 isolates into three cluster types (CTs); CT16, CT104 and CT106. ST117 isolates were divided into CT24, CT103 and CT105. Within VREfm isolates belonging to CT103, two different vanB transposons were found. In contrast, VREfm isolates belonging to CT104 and CT106 harboured an identical vanB transposon.
Conclusions:
cgMLST provides a high discriminatory power for the epidemiological analysis of VREfm. However, additional transposon analysis is needed to detect horizontal gene transfer. Combining these two methods allows investigation of both clonal spread as well as the spread of MGEs. This leads to new insights and thereby better understanding of the complex transmission routes in VREfm outbreaks.
Insights
Understanding vancomycin-resistant Enterococcus faecium (VREfm) transmission requires combining whole-genome sequencing with transposon analysis. This approach reveals both clonal spread and mobile genetic element transfer, crucial for controlling VREfm outbreaks.
Area of Science:
- Microbiology
- Genomics
- Epidemiology
Background:
- Vancomycin-resistant Enterococcus faecium (VREfm) is a significant global nosocomial pathogen.
- VREfm spreads through both clonal expansion and mobile genetic elements (MGEs) like transposons.
Purpose of the Study:
- To investigate VREfm transmission pathways during nosocomial outbreaks.
- To integrate vanB-carrying transposon data with core-genome MLST (cgMLST) and epidemiological data.
Main Methods:
- Analysis of 36 VREfm isolates from seven outbreaks (2014).
- Whole-genome sequencing using MiSeq and MinION platforms.
- Hybrid assembly with Unicycler, cgMLST with SeqSphere+, and transposon analysis with ACT and BLAST.
Main Results:
- Four distinct vanB transposons were identified.
- cgMLST differentiated isolates into distinct cluster types (CTs).
- Specific CTs showed variations or identical vanB transposons, indicating complex transmission.
Conclusions:
- cgMLST offers high discriminatory power for VREfm epidemiology.
- Transposon analysis is essential for detecting horizontal gene transfer.
- Combining cgMLST and transposon analysis enhances understanding of VREfm transmission routes.
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