scholarly journals Increase of vancomycin-resistant Enterococcus faecium strain type ST117 CT71 at Charité - Universitätsmedizin Berlin, 2008 to 2018

2020 ◽  
Author(s):  
Anna Weber ◽  
Friederike Maechler ◽  
Frank Schwab ◽  
Petra Gastmeier ◽  
Axel Kola
Keyword(s):  
Virulence Factors ◽  
Resistance Genes ◽  
Enterococcus Faecium ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Vancomycin Resistant Enterococcus ◽  
The Past ◽  
Study Population ◽  
Strain Type ◽  
Vancomycin Resistant

Abstract Background: In addition to an overall rise in vancomycin-resistant Enterococcus faecium (VREfm), an increase in certain strain types marked by sequence type (ST) and cluster type (CT) has been reported in Germany over the past few years. Outbreak analyses at Charité - Universitätsmedizin Berlin revealed the frequent occurrence of VREfm ST117 CT71 isolates in 2017 and 2018. To investigate whether ST117 CT71 have emerged in recent years or whether these strains have been circulating for a longer time, we retrospectively analyzed non-outbreak strains that occurred between 2008 and 2018 to identify frequent STs and CTs.Methods: In total, 120 VREfm isolates obtained from clinical and surveillance cultures from the years 2008, 2013, 2015, and 2018 were analyzed. Thirty isolates per year comprising the first 7 - 8 non-outbreak isolates of each quarter of the respective year were sequenced using whole genome sequencing. MLST and cgMLST were determined as well as resistance genes and virulence factors. Risk factors for VREfm ST117 were analyzed in a multivariable analysis with patient characteristics as possible confounders. Results: The percentage of VREfm of type ST117 increased from 17% in 2008 to 57% in 2018 (p=0.012). In 2008, vanA genotype accounted for 80% of all ST117 isolates compared to 6% in 2018. VanB CT71 first appeared in 2018 and predominated over all other ST117 at 43% (p<0.0001). The set of resistance genes (msrC, efmA, erm(B), dfrG, aac(6')-Ii, gyrA, parC and pbp5) and virulence factors (acm, esp, hylEfm, ecbA and sgrA) in CT71 was also found in other ST117 non-CT71 strains, mainly in CT36. The study population did not differ among the different calendar years analyzed in terms of age, gender, length of stay, or ward type (each p>0.2).Conclusion: This study revealed an increase in ST117 strains from 2008 to 2018, accompanied by a shift toward CT71 strains with the vanB genotype in 2018. We did not detect resistance or virulence traits in CT71 that could confer survival advantage compared to other CTs among ST117 strains. To date, it is not clear why ST117 and in particular strain type ST117 CT71 predominates over other strains.

scholarly journals Increase of vancomycin-resistant Enterococcus faecium strain type ST117 CT71 at Charité - Universitätsmedizin Berlin, 2008 to 2018

2020 ◽  
Author(s):  
Anna Weber ◽  
Friederike Maechler ◽  
Frank Schwab ◽  
Petra Gastmeier ◽  
Axel Kola
Keyword(s):  
Virulence Factors ◽  
Resistance Genes ◽  
Enterococcus Faecium ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Vancomycin Resistant Enterococcus ◽  
The Past ◽  
Study Population ◽  
Strain Type ◽  
Vancomycin Resistant

Abstract Background: In addition to an overall rise in vancomycin-resistant Enterococcus faecium (VREfm), an increase in certain strain types marked by sequence type (ST) and cluster type (CT) has been reported in Germany over the past few years. Outbreak analyses at Charité - Universitätsmedizin Berlin revealed the frequent occurrence of VREfm ST117 CT71 isolates in 2017 and 2018. To investigate whether ST117 CT71 have emerged in recent years or whether these strains have been circulating for a longer time, we retrospectively analyzed non-outbreak strains that occurred between 2008 and 2018 to identify frequent STs and CTs.Methods: In total, 120 VREfm isolates obtained from clinical and surveillance cultures from the years 2008, 2013, 2015, and 2018 were analyzed. Thirty isolates per year comprising the first 7 - 8 non-outbreak isolates of each quarter of the respective year were sequenced using whole genome sequencing. MLST and cgMLST were determined as well as resistance genes and virulence factors. Risk factors for VREfm ST117 were analyzed in a multivariable analysis with patient characteristics as possible confounders. Results: The percentage of VREfm of type ST117 increased from 17% in 2008 to 57% in 2018 (p=0.012). In 2008, vanA genotype accounted for 80% of all ST117 isolates compared to 6% in 2018. VanB CT71 first appeared in 2018 and predominated over all other ST117 at 43% (p<0.0001). The set of resistance genes (msrC, efmA, ermB, dfrG, aac(6')-Ii, gyrA, parC and pbp5) and virulence factors (acm, esp, hylEfm, ecbA and sgrA) in CT71 was also found in other ST117 non-CT71 strains, mainly in CT36. The study population did not differ among the different calendar years analyzed in terms of age, gender, length of stay, or ward type (each p>0.2).Conclusion: This study revealed an increase in ST117 strains from 2008 to 2018, accompanied by a shift toward CT71 strains with the vanB genotype in 2018. We did not detect resistance or virulence traits in CT71 that could confer survival advantage compared to other CTs among ST117 strains. To date, it is not clear why ST117 and in particular strain type ST117 CT71 predominates over other strains.

scholarly journals Increase of vancomycin-resistant Enterococcus faecium strain type ST117 CT71 at Charité - Universitätsmedizin Berlin, 2008 to 2018

2019 ◽  
Author(s):  
Anna Weber ◽  
Friederike Maechler ◽  
Frank Schwab ◽  
Petra Gastmeier ◽  
Axel Kola
Keyword(s):  
Virulence Factors ◽  
Resistance Genes ◽  
Enterococcus Faecium ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Vancomycin Resistant Enterococcus ◽  
Study Population ◽  
Strain Type ◽  
Vancomycin Resistant ◽  
Sequence Types

Abstract In addition to an overall rise in vancomycin-resistant Enterococcus faecium (VREfm), an increase in certain other strain types has been reported in Germany over the past few years. Outbreak analyses at Charité - Universitätsmedizin Berlin revealed the frequent occurrence of VREfm ST117 CT71 isolates in 2017 and 2018. To investigate whether ST117 CT71 have emerged in recent years or whether these strains have been circulating for a longer time, we retrospectively analyzed non-outbreak strains that occurred between 2008 and 2018 to identify frequent sequence types (STs) and cluster types (CTs). Methods In total, 120 VREfm isolates obtained from clinical and surveillance cultures from the years 2008, 2013, 2015, and 2018 were analyzed. Thirty isolates per year comprising the first 7 to 8 non-outbreak isolates of each quarter of the respective year were sequenced using whole genome sequencing. MLST and cgMLST were determined as well as resistance genes and virulence factors. Risk factors for VREfm ST117 were analyzed in a multivariable analysis with patient characteristics as possible confounders. Results The percentage of VREfm of type ST117 increased from 17% in 2008 to 57% in 2018 (p=0.012). In 2008, vanA genotype accounted for 80% of all ST117 isolates compared to 6% in 2018. VanB CT71 first appeared in 2018 and predominated over all other ST117 at 43% (p<0.0001). The set of resistance genes and virulence factors in CT71 (msrC, efmA, ermB, dfrG, and aac(6')-Ii) and virulence factors (acm, esp, hyl, ecbA and sgrA) was also found in other ST117 non-CT71 strains, mainly in CT36. The study population did not differ among the different calendar years analyzed in terms of age, gender, length of stay, or ward type (each p>0.2). Conclusion This study revealed an increase in ST117 strains from 2008 to 2018, accompanied by a shift toward CT71 strains with the vanB genotype in 2018. We did not detect resistance or virulence traits in CT71 that could confer survival advantage compared to other CTs among ST117 strains. To date, it is not clear why ST117 and in particular strain type ST117 CT71 predominates over other strains.

scholarly journals Low Occurrence of Virulence Determinants in Vancomycin-Resistant Enterococcus from Clinical Samples in Southwest Nigeria

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Folasade Muibat Adeyemi ◽  
Nana-Aishat Yusuf ◽  
Rashidat Ronke Adeboye ◽  
Omotayo Opemipo Oyedara
Keyword(s):  
Virulence Factors ◽  
Molecular Identification ◽  
Resistance Genes ◽  
Clinical Samples ◽  
Screening Methods ◽  
Vancomycin Resistant Enterococcus ◽  
Virulence Determinants ◽  
Southwest Nigeria ◽  
Vancomycin Resistant ◽  
Polymerase Chain

Background: The virulence factors of enterococci play a major role in the pathogenicity of enterococcal strains. Objectives: This study aimed to evaluate virulence factors and detect selected virulence and resistance genes in vancomycin-resistant Enterococcus (VRE) from clinical samples from southwest Nigeria. Methods: The VRE isolates (n = 85) recovered from clinical samples were characterized using conventional microbiology techniques, and molecular identification was made with ddlE primers. Phenotypic screening for five virulence determinants and detection of virulence and resistance genes using a polymerase chain reaction were carried out. Results: Phenotypic identification revealed 61 Enterococcus faecium and 24 Enterococcus faecalis. All the isolates hydrolyzed bile. Moreover, 88.2% of the isolates produced biofilm; however, 72.9% of the isolates produced gelatinase enzyme. Altogether, six isolates (7%) produced all five virulence factors. The least virulence factor expressed by the two species E. faecium and E. faecalis was DNase at 21.3% and 29.2% followed by cytolysin at 27.9% and 41.7%, respectively. Only 25 isolates (29.4%), including 23 E. faecium (37.7%) and only 2 (8.3%) E. faecalis isolates, revealed bands with molecular identification. Additionally, VRE isolates showed bands for asa1 (16%); only 1 (4%) isolate had the hyl gene and vanB gene, respectively. Conclusions: The absence of vanA and low detection of vanB resistance genes suggest the possible presence of other van types and emphasizes the need for further investigations on the incidence of other van genes using molecular screening methods in enterococci isolates in Nigeria for surveillance purposes. Moreover, the low occurrence of virulence genes implies that there might be other mediators of pathogenicity involved in Enterococcus virulence traits.

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