Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan

The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted biologica...

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Bibliographic Details
Published in:	Scientific reports Vol. 11; no. 1; p. 14780
Main Authors:	Fujiya, Yoshihiro, Harada, Tetsuya, Sugawara, Yo, Akeda, Yukihiro, Yasuda, Masako, Masumi, Ayako, Hayashi, Junichi, Tanimura, Nobuhiro, Tsujimoto, Yoshihiro, Shibata, Wataru, Yamaguchi, Takahiro, Kawahara, Ryuji, Nishi, Isao, Hamada, Shigeyuki, Tomono, Kazunori, Kakeya, Hiroshi
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 20-07-2021 Nature Publishing Group Nature Portfolio
Subjects:	631/326/107 631/326/22/1434 631/326/325/1506 692/700/459 692/700/478 Aged Antibiotic resistance Antibiotics Antimicrobial Stewardship Bacterial Proteins - genetics Carbon-Oxygen Ligases - genetics Case-Control Studies Colonization Cross Infection - microbiology Cross Infection - transmission Disease hot spots Disease Outbreaks Electrophoresis, Gel, Pulsed-Field Endemic Diseases Enterococcus Female Gel electrophoresis Genomic analysis Gram-Positive Bacterial Infections - transmission Hospitals Humanities and Social Sciences Humans Intensive care units Japan Male multidisciplinary Nosocomial infection Outbreaks Phylogeny Plasmids Plasmids - genetics Population Surveillance Pulsed-field gel electrophoresis Science Science (multidisciplinary) Vancomycin Vancomycin-Resistant Enterococci - classification Vancomycin-Resistant Enterococci - genetics Vancomycin-Resistant Enterococci - isolation & purification Japan
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Summary:	The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted biological and genomic analyses of VRE isolates, and assessed the implemented infection control measures. In total, 149 patients harboring VanA-type VRE were identified from April 2017 to October 2019, with 153 vancomycin-resistant Enterococcus faecium isolated being grouped into 31 pulsotypes using pulsed-field gel electrophoresis, wherein six sequence types belonged to clonal complex 17. Epidemic clones varied throughout the outbreak; however, they all carried vanA -plasmids (pIHVA). pIHVA is a linear plasmid, carrying a unique structural Tn 1546 containing vanA ; it moves between different Enterococcus spp. by genetic rearrangements. VRE infection incidence among patients in the “hot spot” ward correlated with the local VRE colonization prevalence. Local prevalence also correlated with vancomycin usage in the ward. Transmission of a novel transferrable vanA -plasmid among Enterococcus spp. resulted in genomic diversity in VRE in a non-endemic setting. The prevalence of VRE colonization and vancomycin usage at the ward level may serve as VRE cross-transmission indicators in non-intensive care units for outbreak control.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2045-2322 2045-2322
DOI:	10.1038/s41598-021-94213-5