Whole-genome sequencing reveals transmission of vancomycin-resistant Enterococcus faecium in a healthcare network
Brodrick, Hayley J
Raven, Kathy E
Török, M Estée
Genome Medicine 2016, 8: 4. doi:10.1186/s13073-015-0259-7
MetadataShow full item record
Brodrick, H. J., Raven, K. E., Harrison, E., Blane, B., Reuter, S., Török, M. E., Parkhill, J., & et al. (2016). Whole-genome sequencing reveals transmission of vancomycin-resistant Enterococcus faecium in a healthcare network. Genome Medicine, 8 (4)https://doi.org/10.1186/s13073-015-0259-7
Background: Bacterial whole-genome sequencing (WGS) has the potential to identify reservoirs of multidrug-resistant organisms and transmission of these pathogens across healthcare networks. We used WGS to define transmission of vancomycin-resistant enterococci (VRE) within a long-term care facility (LTCF), and between this and an acute hospital in the United Kingdom (UK). Methods: A longitudinal prospective observational study of fecal VRE carriage was conducted in a LTCF in Cambridge, UK. Stool samples were collected at recruitment, and then repeatedly until the end of the study period, discharge or death. Selective culture media were used to isolate VRE, which were subsequently sequenced and analysed. We also analysed the genomes of 45 Enterococcus faecium bloodstream isolates collected at Cambridge University Hospitals NHS Foundation Trust (CUH). Results: Forty-five residents were recruited during a 6-month period in 2014, and 693 stools were collected at a frequency of at least one week apart. Fifty-one stool samples from 3/45 participants (7%) were positive for vancomycin-resistant E. faecium. Two residents carried multiple VRE lineages, and one carried a single VRE lineage. Genome analyses based on single nucleotide polymorphisms (SNPs) in the core genome indicated that VRE carried by each of the three residents were unrelated. Participants had extensive contact with the local healthcare network. We found that VRE genomes from LTCF residents and hospital-associated bloodstream infection were interspersed throughout the phylogenetic tree, with several instances of closely related VRE strains from the two settings. Conclusions: A proportion of LTCF residents are long-term carriers of VRE. Evidence for genetic relatedness between these and VRE associated with bloodstream infection in a nearby acute NHS Trust indicate a shared bacterial population.
We gratefully acknowledge the contribution of the staff at the LTCF in sample collection, and thank the patients who agreed to participate. We thank Kirsty Ambridge and Angela Kidney for technical assistance. We are grateful for assistance from the library construction, sequencing and core informatics teams at the Wellcome Trust Sanger Institute. This publication presents independent research supported by the Health Innovation Challenge Fund (WT098600, HICF-T5-342), a parallel funding partnership between the Department of Health and Wellcome Trust. The views expressed in this publication are those of the author(s) and not necessarily those of the Department of Health or Wellcome Trust. MET is a Clinician Scientist Fellow supported by the Academy of Medical Sciences, The Health Foundation and the NIHR Cambridge Biomedical Research Centre.
Academy of Medical Sciences (unknown)
Wellcome Trust (098600/Z/12/Z)
National Institute for Health Research (NIHRDH-HICF-T5-342)
External DOI: https://doi.org/10.1186/s13073-015-0259-7
This record's URL: https://www.repository.cam.ac.uk/handle/1810/253031
Creative Commons Attribution 4.0 International License
Licence URL: http://creativecommons.org/licenses/by/4.0/