scholarly journals Transmission of Vancomycin-Resistant Enterococci in the Hospital Setting: Uncovering the Patient–Environment Interplay

2020 ◽  
Vol 8 (2) ◽  
pp. 203 ◽  
Author(s):  
Carlos L. Correa-Martinez ◽  
Hauke Tönnies ◽  
Neele J. Froböse ◽  
Alexander Mellmann ◽  
Stefanie Kampmeier
Keyword(s):  
Core Genome ◽  
Hospital Setting ◽  
Hospital Environment ◽  
Environmental Isolates ◽  
Resistance Determinants ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
And Control ◽  
Sequence Types

Vancomycin-resistant enterococci (VRE) are relevant nosocomial pathogens with an increasing incidence in the last decades. Their transmission is optimal in the hospital setting, as it offers two potential, large reservoirs that are closely related: susceptible patients and their environment. Here we investigate the role of the hospital environment in the nosocomial transmission of VRE by establishing concrete links between contaminated surfaces and colonized/infected patients in outbreak and non-outbreak settings. Environmental and patient VRE isolates were collected between 2013 and 2019 and analyzed by whole-genome sequencing (WGS), subsequent multilocus sequence typing (MLST), and core genome (cg) MLST. Pairs of isolates differing in <3 alleles were rated as closely related, making a transmission likely. Fifty-three environmental VRE isolates were analyzed. MLST sequence types (ST) ST203 (50.0%), ST192 (21.3%), ST117 (17.3%), ST721 (8.8%), ST80 (2%), and ST1489 (0.7%) were detected, carrying the resistance determinants vanA (72.7%), vanB (24%), or both (3.3%). Of the 53 environmental isolates, 51 were found to form five clusters with genetically related patient isolates (n = 97 isolates). WGS confirms the role of the environment in the transmission dynamics of VRE in both the outbreak and non-outbreak settings, highlighting the importance of prevention and control of VRE spread.

Persistent environmental reservoirs for Vancomycin-resistant enterococci requiring repeated decontamination to achieve eradication

2002 ◽  
Vol 3 (3) ◽  
pp. 10-13 ◽  
Author(s):  
T Sexton ◽  
E Creamer ◽  
M Turley ◽  
E Smyth ◽  
E Humphreys
Keyword(s):  
Daily Basis ◽  
Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Cleaning Equipment ◽  
Hospital Infection Control ◽  
Vancomycin Resistant ◽  
Environmental Measures ◽  
And Control ◽  
Predominant Strain

V ancomycin-resistant enterococci (VRE) are increasingly recognised nosocomial pathogens in clinical areas with high antibiotic usage. Patients with chronic renal failure, including those requiring haemodialysis, are at particular risk. Investigation and control of an outbreak of VRE in two renal wards, highlighting mattresses as reservoirs and environmental measures to control VRE are reported in this paper. Outbreak control measures included standard isolation in accordance with the Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). Patients were screened on admission and weekly using a rectal swab. The inanimate environment including mattresses was also screened. Enhanced environmental decontamination was performed on a daily basis. The outbreak continued over a 20-week period with most cases occurring in the first 6 weeks. The results of screening indicated that 59 (13%) of 451 patients and 54 (8.3%) of 647 environmental samples were positive for VRE. VRE was isolated from 35 (8%) of 433 mattresses, 12 (8.1%) of 148 environmental ledges, 4 (8%) of 50 toilets, and 3 (18.8%) of 16 items of cleaning equipment. Molecular typing indicated that a predominant strain was also implicated in mattress contamination, thus highlighting a potential and important reservoir for transmission of VRE. Difficulty with eradication of VRE from the environment was encountered despite enhanced cleaning regimens and a doubling of use of disinfectant was necessary. Restriction of antibiotics, hand hygiene, hygiene and education are the cornerstone of VRE prevention and control. Lessons from this outbreak highlight the role of the environment in VRE transmission and the need for attention to the environment, especially mattress decontamination.

scholarly journals Modeling the regional spread and control of vancomycin-resistant enterococci

2013 ◽  
Vol 41 (8) ◽  
pp. 668-673 ◽  
Author(s):  
Bruce Y. Lee ◽  
S. Levent Yilmaz ◽  
Kim F. Wong ◽  
Sarah M. Bartsch ◽  
Stephen Eubank ◽  
...  
Keyword(s):  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
And Control

scholarly journals The Role of "Colonization Pressure" in the Spread of Vancomycin-Resistant Enterococci

1998 ◽  
Vol 158 (10) ◽  
pp. 1127 ◽  
Author(s):  
Marc J. M. Bonten ◽  
Sarah Slaughter ◽  
Anton W. Ambergen ◽  
Mary K. Hayden ◽  
Jean van Voorhis ◽  
...  
Keyword(s):  
Colonization Pressure ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Molecular epidemiology of vancomycin-resistant enterococci isolated from non-tertiary-care and tertiary-care hospitals in Korea

2014 ◽  
Vol 142 (11) ◽  
pp. 2372-2377 ◽  
Author(s):  
M. K. JUNG ◽  
S. H. AHN ◽  
W. G. LEE ◽  
E. H. LEE
Keyword(s):  
Inhibitory Concentration ◽  
Clonal Complex ◽  
Tertiary Care ◽  
Molecular Characteristics ◽  
Insertion Sequences ◽  
Vancomycin Resistant Enterococci ◽  
Clonal Relatedness ◽  
Vancomycin Resistant ◽  
Tertiary Care Hospitals ◽  
Sequence Types

SUMMARYThis study compared the molecular characteristics of vancomycin-resistantEnterococcus faecium(VREF) isolates recovered from 20 non-tertiary-care hospitals (36 isolates) and three tertiary-care hospitals (26 isolates) in diverse geographical areas of Korea from October 2010 to April 2011. All isolates carried thevanAgene only, but 42% and 73% of non-tertiary and tertiary-care isolates expressed the VanB phenotype (teicoplanin minimum inhibitory concentration ⩽16 μg/ml). All isolates harboured insertion sequences, IS1542and IS1216V, within Tn1546. The isolates from tertiary-care hospitals tended to have reduced Tn1546lengths by deletion of sequences adjacent to IS elements. Multilocus sequence typing revealed eight sequence types within clonal complex 17 (CC17), but DNA fingerprinting by rep-PCR did not show clonal relatedness between the intra- and inter-hospital isolates. These results suggest thatvanA, which has prevailed in tertiary-care hospitals of Korea since the 1990s, had been transferred horizontally to non-tertiary-care hospitals while the genetic rearrangement driven by evolutionary adaptation to adverse environments may have occurred in tertiary-care hospitals.

scholarly journals Prevalence, Persistence, and Molecular Characterization of Glycopeptide-Resistant Enterococci in Norwegian Poultry and Poultry Farmers 3 to 8 Years after the Ban on Avoparcin

2006 ◽  
Vol 72 (1) ◽  
pp. 516-521 ◽  
Author(s):  
M. Sørum ◽  
P. J. Johnsen ◽  
B. Aasnes ◽  
T. Rosvoll ◽  
H. Kruse ◽  
...  
Keyword(s):  
Pcr Analysis ◽  
Poultry Production ◽  
Resistance Determinants ◽  
Poultry Farms ◽  
Growth Promoting ◽  
Poultry Farmers ◽  
Sequence Types ◽  
Junction Fragment

ABSTRACT Environmental reservoirs of glycopeptide-resistant enterococci (GRE) in Norway have been linked to former growth promoting use of the glycopeptide avoparcin in poultry production. We have examined the prevalence of fecal GRE in poultry and poultry farmers 3 to 8 years after the Norwegian avoparcin ban in 1995 and performed molecular analyses of the GRE population. Fecal samples from poultry farmers and their flocks on 29 previously avoparcin-exposed farms were collected on five occasions during the study period (1998 to 2003). All flocks (100%) were GRE positive in 1998. Throughout the study period, 78.5% of the poultry samples were GRE positive. Glycopeptide-resistant Enterococcus faecium (GREF) was isolated from 27.6% of the farmer samples in 1998 and from 27.8% of the samples collected between 1998 and 2003. The prevalence of fecal GRE in poultry declined significantly during the study period, but prevalence in samples from the farmers did not decline. PCR analysis revealed a specific Tn1546-plasmid junction fragment in 93.9% of E. faecium isolates. A putative postsegregation killing (PSK) system linked to Tn1546 was detected in 97.1% of the isolates examined. Multilocus sequence typing of glycopeptide-susceptible (n = 10) and -resistant (n = 10) E. faecium isolates from humans (n = 10) and poultry (n = 10) on two farms displayed 17 different sequence types. The study confirms the continuing persistence of a widespread common plasmid-mediated vanA-pRE25-PSK element within a heterogeneous GRE population on Norwegian poultry farms 8 years after the avoparcin ban. Moreover, it suggests an important role of PSK systems in the maintenance of antimicrobial resistance determinants in reservoirs without apparent antimicrobial selection.

scholarly journals The rise and the fall of a Pseudomonas aeruginosa epidemic lineage in a hospital

2020 ◽  
Author(s):  
Marie Petitjean ◽  
Paulo Juarez ◽  
Alexandre Meunier ◽  
Etienne Daguindau ◽  
Hélène Puja ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Infection Control ◽  
Efflux Pump ◽  
Bacterial Genome ◽  
Hospital Setting ◽  
Control Measures ◽  
Hospital Environment ◽  
Epidemic Strain ◽  
Over Time

AbstractThe biological features that allow a pathogen to survive in the hospital environment are mostly unknown. The extinction of bacterial epidemics in hospitals is mostly attributed to changes in medical practice, including infection control, but the role of bacterial adaptation has never been documented. We analyzed a collection of Pseudomonas aeruginosa isolates belonging to the Besançon Epidemic Strain (BES), responsible for a 12-year nosocomial outbreak, using a genotype-to-phenotype approach. Bayesian analysis estimated the emergence of the clone in the hospital five years before its opening, during the creation of its water distribution network made of copper. BES survived better than the reference strains PAO1 and PA14 in a copper solution due to a genomic island containing 13 metal-resistance genes and was specifically able to proliferate in the ubiquitous amoeba Vermamoeba vermiformis. Mutations affecting amino-acid metabolism, antibiotic resistance, lipopolysaccharide biosynthesis, and regulation were enriched during the spread of BES. Seven distinct regulatory mutations attenuated the overexpression of the genes encoding the efflux pump MexAB-OprM over time. The fitness of BES decreased over time in correlation with its genome size. Overall, the resistance to inhibitors and predators presumably aided the proliferation and propagation of BES in the plumbing system of the hospital. The pathogen further spread among patients via multiple routes of contamination. The decreased prevalence of patients infected by BES mirrored the parallel and convergent genomic evolution and reduction that affected bacterial fitness. Along with infection control measures, this may have participated in the extinction of BES in the hospital setting.ImportanceBacterial pathogens are responsible for nosocomial outbreaks, but the sources of contamination of the hospitals are mostly unclear and the role of bacterial evolution in the extinction of outbreaks has never been considered. Here, we found that an epidemic strain of the pathogen Pseudomonas aeruginosa contaminated the drinking water network of a hospital due to its tolerance to copper and predatory amoeba, both present in the water pipes. The extinction of the outbreak occurred concomitantly with parallel and convergent genome evolution and a reduction in the size of the bacterial genome that correlated with the fitness of the pathogen. Our data suggest that pathogen evolution participated in the extinction of an outbreak in a hospital setting.

Antimicrobial-Resistant Gram-Positive Bacteria in PD Peritonitis and the Newer Antibiotics Used to Treat Them

2005 ◽  
Vol 25 (4) ◽  
pp. 313-319 ◽  
Author(s):  
William Salzer
Keyword(s):  
Methicillin Resistant Staphylococcus Aureus ◽  
Natural Habitat ◽  
Gram Positive ◽  
Gram Positive Bacteria ◽  
The Past ◽  
Vancomycin Resistant Enterococci ◽  
Resistant Strains ◽  
Vancomycin Resistant ◽  
Novel Antibiotics

The incidence of resistant gram-positive bacteria in nosocomial and, more recently, community-acquired infections is increasing. Staphylococci, because of their natural habitat on the skin, have always been the leading cause of peritonitis in patients receiving peritoneal dialysis (PD). These organisms have demonstrated a remarkable ability to develop resistance to antibiotics, first with penicillin, then antistaphylococcal penicillins (methicillin-resistant Staphylococcus aureus), and more recently, strains expressing resistance to vancomycin (vancomycin-intermediate and vancomycin-resistant S. aureus) have emerged. Enterococci are normal inhabitants of the gastrointestinal tract and occasionally cause PD peritonitis. In the past 15 years, vancomycin-resistant enterococci have emerged as significant pathogens in many areas. In the past 5 years, novel antibiotics that have activity on gram-positive bacteria, including vancomycin-resistant strains, have become available. The problem of resistant gram-positive bacteria in PD peritonitis, their therapy, and the role of these newer agents, quinupristin/dalfopristin, linezolid, and daptomycin, are reviewed.

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