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dc.contributor.authorRaven, Kathy E
dc.contributor.authorGouliouris, Theodore
dc.contributor.authorBrodrick, Hayley
dc.contributor.authorColl, Francesc
dc.contributor.authorBrown, Nicholas M
dc.contributor.authorReynolds, Rosy
dc.contributor.authorReuter, Sandra
dc.contributor.authorTörök, M Estée
dc.contributor.authorParkhill, Julian
dc.contributor.authorPeacock, Sharon J
dc.date.accessioned2017-03-09T17:39:45Z
dc.date.available2017-03-09T17:39:45Z
dc.date.issued2017-04-01
dc.identifier.issn1058-4838
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/262988
dc.description.abstractBACKGROUND: Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of nosocomial infection. Here, we describe the utility of whole-genome sequencing in defining nosocomial VREfm transmission. METHODS: A retrospective study at a single hospital in the United Kingdom identified 342 patients with E. faecium bloodstream infection over 7 years. Of these, 293 patients had a stored isolate and formed the basis for the study. The first stored isolate from each case was sequenced (200 VREfm [197 vanA, 2 vanB, and 1 isolate containing both vanA and vanB], 93 vancomycin-susceptible E. faecium) and epidemiological data were collected. Genomes were also available for E. faecium associated with bloodstream infections in 15 patients in neighboring hospitals, and 456 patients across the United Kingdom and Ireland. RESULTS: The majority of infections in the 293 patients were hospital-acquired (n = 249) or healthcare-associated (n = 42). Phylogenetic analysis showed that 291 of 293 isolates resided in a hospital-associated clade that contained numerous discrete clusters of closely related isolates, indicative of multiple introductions into the hospital followed by clonal expansion associated with transmission. Fine-scale analysis of 6 exemplar phylogenetic clusters containing isolates from 93 patients (32%) identified complex transmission routes that spanned numerous wards and years, extending beyond the detection of conventional infection control. These contained both vancomycin-resistant and -susceptible isolates. We also identified closely related isolates from patients at Cambridge University Hospitals NHS Foundation Trust and regional and national hospitals, suggesting interhospital transmission. CONCLUSIONS: These findings provide important insights for infection control practice and signpost areas for interventions. We conclude that sequencing represents a powerful tool for the enhanced surveillance and control of nosocomial E. faecium transmission and infection.
dc.description.sponsorshipThis work was supported by grants from the Health Innovation Challenge Fund (grant numbers WT098600 and HICF-T5-342), a parallel funding partnership between the UK Department of Health and the Wellcome Trust. This project was also funded by a grant awarded to the Wellcome Trust Sanger Institute (grant number 098051). M. E. T. is a Clinical Scientist Fellow supported by the Academy of Medical Sciences and the Health Foundation.
dc.format.mediumPrint
dc.languageeng
dc.language.isoen
dc.publisherOxford University Press (OUP)
dc.rightsAttribution 4.0 International
dc.rightsAttribution 4.0 International
dc.rightsAttribution 4.0 International
dc.rightsAttribution 4.0 International
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.titleComplex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing.
dc.typeArticle
prism.endingPage893
prism.publicationDate2017
prism.publicationNameClin Infect Dis
prism.startingPage886
prism.volume64
dc.identifier.doi10.17863/CAM.8290
dcterms.dateAccepted2017-01-04
rioxxterms.versionofrecord10.1093/cid/ciw872
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.licenseref.startdate2017-04
dc.contributor.orcidParkhill, Julian [0000-0002-7069-5958]
dc.contributor.orcidPeacock, Sharon [0000-0002-1718-2782]
dc.identifier.eissn1537-6591
rioxxterms.typeJournal Article/Review
pubs.funder-project-idWellcome Trust (098600/Z/12/Z)
pubs.funder-project-idAcademy of Medical Sciences (unknown)
pubs.funder-project-idMedical Research Council (MR/N029399/1)
cam.issuedOnline2017-02-23


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International