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Association between vancomycin-resistant Enterococcus faecium colonization and subsequent infection: a retrospective WGS study

Abstract Background Since 2012, the incidence of vancomycin-resistant Enterococcus faecium (VREfm) has increased dramatically in Copenhagen and vanA E. faecium has become endemic and polyclonal. Objectives To examine whether a patient with a positive VRE clinical sample had the same VREfm in a prece...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2020-07, Vol.75 (7), p.1712-1715
Main Authors: Rubin, Ingrid Maria Cecilia, Pedersen, Martin Schou, Mollerup, Sarah, Kaya, Hülya, Petersen, Andreas Munk, Westh, Henrik, Pinholt, Mette
Format: Article
Language:English
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Summary:Abstract Background Since 2012, the incidence of vancomycin-resistant Enterococcus faecium (VREfm) has increased dramatically in Copenhagen and vanA E. faecium has become endemic and polyclonal. Objectives To examine whether a patient with a positive VRE clinical sample had the same VREfm in a preceding screening sample (within 60 days). Methods We performed a 30 month retrospective study. From our laboratory information system (LIS), we identified all patients with an invasive VREfm isolate and a VREfm rectal screening isolate within 60 days before infection. VREfm pairs (screening isolate and invasive isolate) were whole-genome sequenced. All isolates were analysed using SeqSphere and core-genome MLST (cgMLST) types were determined. We examined all isolates for the presence of the three most dominant vanA plasmids in the Capital Region of Denmark. Two novel vanA plasmids were closed by Nanopore/Illumina sequencing. Results We found a total of 19 VREfm pairs. Of these, 13 patients had pairs with matching cgMLST types and vanA plasmids and a median number of 6 days from identification of carriage to clinical infection. One patient had a pair with non-matching cgMLST types but matching vanA plasmids and 24 days between identification of carriage to clinical infection. Five patients had pairs with non-matching cgMLST types and non-matching vanA plasmids and a median number of 18 days from identification of carriage to clinical infection. Conclusions Of our 19 pairs, 13 were a match regarding cgMLST types (68%) and 1 more (5%) had matching vanA plasmids. Infection was thus preceded by colonization with the same isolates in 13 out of 19 patients. The five mismatches (26%) could be explained by the longer interval between colonization and infection.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkaa074