PDF(Pubmed)
Abstract：
Outbreaks caused by vancomycin-resistant enterococci that transcend jurisdictional boundaries are occurring worldwide. This study focused on a vancomycin-resistant enterococcus outbreak that occurred between 2018 and 2021 across two cities in Hiroshima, Japan. The study involved genetic and phylogenetic analyses using whole-genome sequencing of 103 isolates of vancomycin-resistant enterococci to identify the source and transmission routes of the outbreak. Phylogenetic analysis was performed using core genome multilocus sequence typing and core single-nucleotide polymorphisms; infection routes between hospitals were inferred using BadTrIP. The outbreak was caused by Enterococcus faecium sequence type (ST) 80 carrying the vanA plasmid, which was derived from strain A10290 isolated in India. Of the 103 isolates, 93 were E. faecium ST80 transmitted across hospitals. The circular vanA plasmid of the Hiroshima isolates was similar to the vanA plasmid of strain A10290 and transferred from E. faecium ST80 to other STs of E. faecium and other Enterococcus species by conjugation. The inferred transmission routes across hospitals suggest the existence of a central hospital serving as a hub, propagating vancomycin-resistant enterococci to multiple hospitals. Our study highlights the importance of early intervention at the key central hospital to prevent the spread of the infection to small medical facilities, such as nursing homes, with limited medical resources and a high number of vulnerable individuals.
摘要：
由万古霉素耐药肠球菌引起的超越管辖范围的暴发正在全球范围内发生。这项研究的重点是2018年至2021年在广岛两个城市爆发的耐万古霉素肠球菌。日本。该研究涉及使用对103株耐万古霉素肠球菌的全基因组测序进行的遗传和系统发育分析，以确定爆发的来源和传播途径。使用核心基因组多位点序列分型和核心单核苷酸多态性进行系统发育分析；使用BadTrIP推断医院之间的感染途径。疫情是由携带vanA质粒的屎肠球菌序列型(ST)80引起的,它来自在印度分离的菌株A10290。在103个分离株中，93例是在医院之间传播的屎肠球菌ST80。广岛分离株的环状vanA质粒与菌株A10290的vanA质粒相似，并通过接合从屎肠球菌ST80转移到屎肠球菌的其他ST和其他肠球菌。推断的跨医院传播路线表明存在作为枢纽的中心医院，向多家医院传播耐万古霉素肠球菌。我们的研究强调了在主要中心医院进行早期干预以防止感染传播到小型医疗设施的重要性，比如疗养院，医疗资源有限，弱势群体数量众多。
