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Outbreak of vancomycin-resistant Enterococcus faecium ST1133 in paediatric patients with acute lymphoblastic

Thaís Muniz Vasconcelos1, Dany Mesa1, Luiza Souza Rodrigues2

  • 1Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil.

Journal of Global Antimicrobial Resistance
|November 24, 2023
PubMed
Abstract

Insights

An outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in children with leukemia was investigated. Whole-genome sequencing identified the ST117 lineage, highlighting the need for antimicrobial stewardship to control VREfm spread in vulnerable patients.

Area of Science:

  • Microbiology
  • Genomics
  • Infectious Diseases

Background:

  • Vancomycin-resistant Enterococcus faecium (VREfm) poses a significant threat, particularly in immunocompromised populations.
  • Paediatric patients with hematological malignancies are at high risk for VREfm colonization and infection.

Purpose of the Study:

  • To investigate an outbreak of VREfm in paediatric patients at Hospital Pequeno Príncipe.
  • To characterize the genetic makeup and resistance mechanisms of the VREfm strains involved.

Main Methods:

  • Whole-genome sequencing (WGS) was employed to analyze VREfm isolates.
  • Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for species identification.
  • Antimicrobial susceptibility testing (MIC) and in silico multilocus sequence typing (MLST) were performed.

Main Results:

  • Five VREfm isolates from two paediatric patients with acute lymphoblastic leukemia were identified.
  • All isolates exhibited high-level vancomycin resistance (MIC ≥256 mg/L).
  • WGS revealed the presence of plasmids, insertion sequences, phages, and multiple resistance (vanA, ermB, aac(6 olyl)-aph(2 olyl), dfrG) and virulence genes (acm, efaAfm).
  • All isolates belonged to the ST117 lineage (ST1133 via novel MLST), a known epidemic strain.

Conclusions:

  • The ST117 VREfm lineage is circulating among paediatric patients, raising significant concerns.
  • Effective management requires the development of new antimicrobial agents and robust antimicrobial stewardship programs.
  • Controlling VREfm spread is crucial, especially in oncohematological patients.
Keywords:
Acute lymphoblastic leukaemiaAntibioticsPaediatricsST117 (ST1133)Vancomycin-resistant Enterococcus faecium

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