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dc.contributor.authorRaven, Kathy Een
dc.contributor.authorGouliouris, Theodoreen
dc.contributor.authorBrodrick, Hayleyen
dc.contributor.authorColl, Francescen
dc.contributor.authorBrown, Nicholas Men
dc.contributor.authorReynolds, Rosyen
dc.contributor.authorReuter, Sandraen
dc.contributor.authorTörök, M Estéeen
dc.contributor.authorParkhill, Julianen
dc.contributor.authorPeacock, Sharonen
dc.date.accessioned2017-03-09T17:39:45Z
dc.date.available2017-03-09T17:39:45Z
dc.date.issued2017-04en
dc.identifier.issn1058-4838
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/262988
dc.description.abstractBackground. Vancomycin-resistant $\textit{Enterococcus faecium}$ (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 $\textit{E. faecium}$ 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 $\textit{vanA}$, 2 $\textit{vanB}$, and 1 isolate containing both $\textit{vanA}$ and $\textit{vanB}$], 93 vancomycin-susceptible $\textit{E. faecium}$) and epidemiological data were collected. Genomes were also available for $\textit{E. faecium}$ 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 $\textit{E. faecium}$ 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.mediumPrinten
dc.languageengen
dc.language.isoenen
dc.publisherOxford University Press
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.titleComplex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing.en
dc.typeArticle
prism.endingPage893
prism.publicationDate2017en
prism.publicationNameClinical infectious diseases : an official publication of the Infectious Diseases Society of Americaen
prism.startingPage886
prism.volume64en
dc.identifier.doi10.17863/CAM.8290
dcterms.dateAccepted2017-01-04en
rioxxterms.versionofrecord10.1093/cid/ciw872en
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/en
rioxxterms.licenseref.startdate2017-04en
dc.contributor.orcidParkhill, Julian [0000-0002-7069-5958]
dc.contributor.orcidPeacock, Sharon [0000-0002-1718-2782]
dc.identifier.eissn1537-6591
rioxxterms.typeJournal Article/Reviewen
pubs.funder-project-idWellcome Trust (098600/Z/12/Z)
pubs.funder-project-idAcademy of Medical Sciences (unknown)
pubs.funder-project-idMRC (MR/N029399/1)


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