Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
Department of Infection Prevention, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
J Hosp Infect. 2021 May;111:132-139. doi: 10.1016/j.jhin.2021.02.007. Epub 2021 Feb 11.
Vancomycin-resistant enterococci (VRE) may cause nosocomial outbreaks. This article describes all VRE carriers that were identified in 2018 at Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
To investigate the genetic relatedness of VRE isolates and the possibility of a common environmental reservoir using environmental sampling and whole-genome sequencing (WGS).
Infection control measures consisted of contact isolation, contact surveys, point prevalence screening, environmental sampling, cleaning and disinfection. VRE isolates were sequenced using a MiSeq sequencer (Illumina, San Diego, CA, USA), and assembled using SPAdes v.3.10.1. A minimal spanning tree and a neighbour joining tree based on allelic diversity of core-genome multi-locus sequence typing and accessory genes were created using Ridom SeqSphere+ software (Ridom GmbH, Münster, Germany).
Over a 1-year period, 19 VRE carriers were identified; of these, 17 were part of two outbreaks. Before environmental cleaning and disinfection, 55 (14%) environmental samples were VRE-positive. Fifty-one isolates (23 patient samples and 28 environmental samples) were available for WGS analysis. Forty-four isolates were assigned to ST117-vanB, five were assigned to ST17-vanB, and two were assigned to ST80-vanB. Isolates from Outbreak 1 (N=22) and Outbreak 2 (N=22) belonged to ST117-vanB; however, WGS showed a different cluster type with 257 allelic differences.
WGS of two outbreak strains provided discriminatory information regarding genetic relatedness, and rejected the hypothesis of a common environmental reservoir. A high degree of environmental contamination was associated with higher VRE transmission. Quantification of environmental contamination may reflect the potential for VRE transmission and could therefore support the infection control measures.
耐万古霉素肠球菌（VRE）可能引起医院感染暴发。本文描述了 2018 年在荷兰蒂尔堡 Elisabeth-Tweesteden 医院发现的所有 VRE 携带者。
通过环境采样和全基因组测序（WGS），调查 VRE 分离株的遗传相关性和共同环境储库的可能性。
感染控制措施包括接触隔离、接触调查、点患病率筛查、环境采样、清洁和消毒。使用 MiSeq 测序仪（Illumina，圣地亚哥，CA，美国）对 VRE 分离株进行测序，使用 SPAdes v.3.10.1 进行组装。使用 Ridom SeqSphere+软件（Ridom GmbH，明斯特，德国）基于核心基因组多位点序列分型和辅助基因的等位基因多样性创建最小生成树和邻接树。
在 1 年期间，发现了 19 名 VRE 携带者；其中，17 名是两次暴发的一部分。在环境清洁和消毒之前，55 份（14%）环境样本呈 VRE 阳性。有 51 株分离物（23 株患者样本和 28 株环境样本）可用于 WGS 分析。44 株被分配到 ST117-vanB，5 株被分配到 ST17-vanB，2 株被分配到 ST80-vanB。暴发 1（N=22）和暴发 2（N=22）的分离株属于 ST117-vanB；然而，WGS 显示出不同的聚类类型，有 257 个等位基因差异。
对两起暴发菌株的 WGS 提供了遗传相关性的鉴别信息，并否定了共同环境储库的假设。高度的环境污染与更高的 VRE 传播相关。环境污染的量化可能反映 VRE 传播的潜力，因此可以支持感染控制措施。
