The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Clinical Laboratory/State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China.
Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, People's Republic of China.
Emerg Microbes Infect. 2024 Dec;13(1):2361030. doi: 10.1080/22221751.2024.2361030. Epub 2024 Jun 5.
Surveillance systems revealed that the prevalence of vancomycin-resistant (VREfm) has increased. We aim to investigate the epidemiological and genomic characteristics of VREfm in China.
We collected 20,747 non-redundant isolates from inpatients across 19 hospitals in six provinces between January 2018 and June 2023. VREfm was confirmed by antimicrobial susceptibility testing. The prevalence was analyzed using changepoint package in R. Genomic characteristics were explored by whole-genome sequencing.
5.59% (1159/20,747) of isolates were resistant to vancomycin. The prevalence of VREfm increased in Guangdong province from 5% before 2021 to 20-50% in 2023 ( < 0.0001), but not in the other five provinces. Two predominant clones before 2021, ST17 and ST78, were substituted by an emerging clone, ST80, from 2021 to 2023 (88.63%, 195/220). All ST80 VREfm from Guangdong formed a single lineage (SC11) and were genetically distant from the ST80 VREfm from other countries, suggesting a regional outbreak. All ST80 VREfm in SC11 carried a new type of plasmid harbouring a cassette, which was embedded in a Tn-like structure flanked by IS and IS. However, no conjugation-related gene was detected and no transconjugant was obtained in conjugation experiment, indicating that the outbreak of ST80 VREfm could be attributed to clonal transmission.
We revealed an ongoing outbreak of ST80 VREfm with a new -harbouring plasmid in Guangdong, China. This clone has also been identified in other provinces and countries, foreboding a risk of wider spreading shortly. Continuous surveillance is needed to inform public health interventions.
监测系统显示，耐万古霉素肠球菌（VREfm）的流行率有所增加。我们旨在研究中国 VREfm 的流行病学和基因组特征。
我们收集了 20747 例来自 19 家医院的非冗余住院患者分离株，这些分离株来自六个省份，时间跨度为 2018 年 1 月至 2023 年 6 月。通过抗菌药物敏感性试验确认 VREfm。使用 R 中的 changepoint 包分析流行率。通过全基因组测序探索基因组特征。
20747 例分离株中，有 5.59%（1159/20747）对万古霉素耐药。广东省 VREfm 的流行率从 2021 年之前的 5%增加到 2023 年的 20-50%（<0.0001），但其他五个省份没有增加。2021 年前的两个主要克隆，ST17 和 ST78，被 2021 年至 2023 年期间出现的新兴克隆 ST80 取代（88.63%，195/220）。广东所有 ST80 VREfm 形成单一谱系（SC11），与来自其他国家的 ST80 VREfm 在遗传上相距甚远，提示存在区域性暴发。SC11 中的所有 ST80 VREfm 均携带一种新型质粒，该质粒带有一个 盒，嵌入在由 IS 和 IS 侧翼的Tn 样结构中。然而，在接合实验中未检测到与接合相关的基因，也未获得转导子，表明 ST80 VREfm 的暴发可能归因于克隆传播。
我们揭示了中国广东地区持续发生的携带新型质粒的 ST80 VREfm 暴发。该克隆也已在其他省份和国家发现，预示着短期内有更广泛传播的风险。需要持续监测以提供公共卫生干预措施的信息。
