Dissemination of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium between humans and fishes

Vancomycin-resistant enterococci (VRE) are a major public health concern, yet little is known about their circulation in fish. This study investigated the occurrence, glycopeptide resistance genotypes, virulence characteristics, and sequence types (STs) of VRE isolated from diseased fishes and humans. Isolates were identified using multiplex polymerase chain reaction (PCR) assay and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and tested for antimicrobial susceptibility. VRE isolates were screened for the presence of glycopeptide resistance genes and eight virulence genes. Multilocus sequence typing (MLST) was determined to assess the clonality of VRE isolates from fishes and humans. Among 60 human samples, 20 Enterococcus species isolates (33.33%) including Enterococcus faecalis and Enterococcus faecium (10 of each), were identified. The overall prevalence of E. faecalis was 42.86% (30/70) in Oreochromis niloticus and 48.0% (24/50) in Clarias gariepinus. E. faecium was found in 15.71% (11/70) of Oreochromis niloticus and 14.0% (7/50) of Clarias gariepinus. Over 50% of human isolates were multidrug resistant (MDR) and 30% exhibited an extensive drug resistant (XDR) phenotype. Fish isolates also displayed high MDR (70.83%) and XDR (29.17%) rates. Forty-nine (53.26%; 34 from fish and 15 from human) isolates were VRE including 30 isolates of E. faecalis (VREfs) and 19 isolates of E. faecium (VREfm). The vanA gene was the most frequent among VREfs (83.33%) and VREfm (100%) isolates. The vanB gene was found in 26.67% of VREfs and 15.79% of VREfm. Three out of 10 VREfm (30%) and 2/24 (8.33%) VREfs isolates of fish origin carried both vanA and vanB genes. vanC gene was found in 13.33% (4/30) of VREfs of human and fish origin. One VREfs isolate from human urine carried both vanA and vanC genes. High frequency of the virulence genes gelE, sprE, asa1, esp, and cylA were observed; efa and ace gene was more associated with VREfs, while hyl gene was more frequently detected in VREfm. Different combinations of virulence genes suggesting synergistic pathogenic potential. MLST revealed both overlapping and host-specific STs among the examined Enterococcus isolates from humans and fish. Experimental infection of O. niloticus with VREfs and VREfm caused a 100% and 60% mortality rate within 6 days postinfection, respectively with characteristic disease symptoms. The emergence of VRE and the high prevalence of virulence traits could be regarded as an alarming situation. The call for increased infection control and antibiotic stewardship measures is timely and relevant to combat the spread of VRE in fish and humans.