Critical genomic insights into vancomycin-resistant Enterococcus faecium in Lebanon.

Area of Science:

• Microbiology
• Genomics
• Public Health

Background:

• Vancomycin-resistant Enterococcus faecium (VRE) is a significant global health concern, particularly in resource-limited settings.
• Lebanon's healthcare system faces challenges that may exacerbate the spread of antimicrobial resistance (AMR).
• Limited genetic data exists for VRE isolates in Lebanon, hindering effective control strategies.

Purpose of the Study:

• To investigate the genetic characteristics, antimicrobial resistance (AMR) phenotypes, and resistome of VRE isolates from hospitalized patients in Lebanon.
• To identify sequence types (STs), plasmid types, and virulence genes within these VRE isolates.
• To analyze the genetic relatedness of Lebanese VRE isolates with previously reported strains.

Main Methods:

• VRE isolates were collected from hospitalized patients in Lebanon.
• Isolates were identified using MALDI-TOF MS and antimicrobial susceptibility was determined via disk diffusion and E-test.
• Whole genome sequencing (Illumina) and bioinformatics analyses were performed to identify AMR genes, STs, and plasmid types.

Main Results:

• VRE isolates exhibited resistance to vancomycin, telavancin, ampicillin, erythromycin, norfloxacin, levofloxacin, and nitrofurantoin.
• Identified VRE belonged to ST203 (67%), ST612 (22%), and a novel ST2711 (11%), all within the globally prevalent CC17 lineage.
• Phylogenetic analysis showed clustering of ST203 isolates with previously reported Lebanese VRE genomes.

Conclusions:

• VRE poses a growing burden in low-resource countries like Lebanon, driven by multidrug-resistant hospital-associated lineages.
• The emergence of resistance to last-resort antibiotics like telavancin is alarming and requires urgent attention.
• Enhanced surveillance, alternative treatment strategies, and robust antimicrobial stewardship programs are crucial for controlling VRE spread.