Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya.
Department of Microbiology, Tripoli Medical Center, Tripoli, Libya.
Microb Drug Resist. 2020 Nov;26(11):1390-1398. doi: 10.1089/mdr.2019.0095. Epub 2020 Mar 16.
The purpose of the study was to investigate the molecular characteristics and genetic relatedness of the first reported cases of vancomycin-resistant enterococci (VRE) from the Tripoli Medical Center, Libya. In total, 43 VRE isolates were obtained from various clinical sites throughout the years 2013-2014, including 40 -type and 2 type vancomycin-resistant isolates and 1 -type . Of the 42 , 19 isolates were subjected to whole genome sequencing. Core genome multilocus sequence typing (cgMLST) analysis revealed three sequence clusters (SCs) of clonally related isolates, which were linked to different hospital wards. The first two VRE isolates, isolated early 2013 from patients in the medical intensive care unit, were grouped in SC1 (MLST [ST] 78, ) and differed in only 3 of 1423 cgMLST alleles. The SC2 ( = 16, special care baby unit, neonatal intensive care unit, pediatric surgery ward, and oncology ward) and SC3 ( = 1, antenatal ward) were all ST80 VRE, but the single SC3 isolate differed in 233 alleles compared with SC2. Within SC2, isolates differed in 1-23 alleles. Comparison with a larger database of strains indicated that all isolates clustered within the previously defined hospital clade A1. A combination of Resfinder and mlplasmid analysis identified the presence of resistance genes on different plasmid predicted genetic elements among different SCs. In conclusion, this study documents the first isolates causing outbreaks with VRE in the Libyan health care system. Further surveillance efforts using molecular typing methods to monitor spread of multidrug-resistant bacteria in the Libyan health care system are urgently needed.
这项研究的目的是调查来自利比亚的黎波里医疗中心的首批报告的耐万古霉素肠球菌（VRE）的分子特征和遗传相关性。在 2013 年至 2014 年期间，从各个临床部位共获得了 43 株 VRE 分离株，包括 40 株 -型和 2 株 vancomycin-resistant 分离株和 1 株 -型。在 42 株中，有 19 株进行了全基因组测序。核心基因组多位点序列分型（cgMLST）分析显示，有 3 个克隆相关分离株的序列簇（SC），这些分离株与不同的医院病房有关。前两个 VRE 分离株于 2013 年初从医疗重症监护病房的患者中分离出来，它们被归为 SC1（MLST [ST] 78，），仅在 1423 个 cgMLST 等位基因中有 3 个不同。SC2（ = 16，特殊护理婴儿单位、新生儿重症监护病房、小儿外科病房和肿瘤科病房）和 SC3（ = 1，产前病房）均为 ST80 VRE，但单个 SC3 分离株与 SC2 相比有 233 个等位基因不同。在 SC2 内，分离株的差异为 1-23 个等位基因。与更大的 菌株数据库进行比较表明，所有分离株均聚集在先前定义的医院 A1 群内。Resfinder 和 mlplasmid 分析的组合鉴定了不同 SC 中不同质粒预测遗传元件上的抗性基因的存在。总之，本研究记录了利比亚卫生保健系统中首次引起 VRE 爆发的分离株。迫切需要使用分子分型方法进行进一步监测，以监测利比亚卫生保健系统中多药耐药菌的传播。
