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Abstract：
BackgroundVancomycin-resistant enterococci (VRE) are increasing in Denmark and Europe. Linezolid and vancomycin-resistant enterococci (LVRE) are of concern, as treatment options are limited. Vancomycin-variable enterococci (VVE) harbour the vanA gene complex but are phenotypically vancomycin-susceptible.AimThe aim was to describe clonal shifts for VRE and VVE in Denmark between 2015 and 2022 and to investigate genotypic linezolid resistance among the VRE and VVE.MethodsFrom 2015 to 2022, 4,090 Danish clinical VRE and VVE isolates were whole genome sequenced. We extracted vancomycin resistance genes and sequence types (STs) from the sequencing data and performed core genome multilocus sequence typing (cgMLST) analysis for Enterococcus faecium. All isolates were tested for the presence of mutations or genes encoding linezolid resistance.ResultsIn total 99% of the VRE and VVE isolates were E. faecium. From 2015 through 2019, 91.1% of the VRE and VVE were vanA E. faecium. During 2020, to the number of vanB E. faecium increased to 254 of 509 VRE and VVE isolates. Between 2015 and 2022, seven E. faecium clusters dominated: ST80-CT14 vanA, ST117-CT24 vanA, ST203-CT859 vanA, ST1421-CT1134 vanA (VVE cluster), ST80-CT1064 vanA/vanB, ST117-CT36 vanB and ST80-CT2406 vanB. We detected 35 linezolid vancomycin-resistant E. faecium and eight linezolid-resistant VVEfm.ConclusionFrom 2015 to 2022, the numbers of VRE and VVE increased. The spread of the VVE cluster ST1421-CT1134 vanA E. faecium in Denmark is a concern, especially since VVE diagnostics are challenging. The finding of LVRE, although in small numbers, ia also a concern, as treatment options are limited.
摘要：
背景万古霉素耐药肠球菌(VRE)在丹麦和欧洲呈上升趋势。利奈唑胺和万古霉素耐药肠球菌（LVRE）令人担忧，因为治疗选择有限。万古霉素可变肠球菌（VVE）带有vanA基因复合物，但在表型上对万古霉素敏感。目的是描述2015年至2022年间丹麦VRE和VVE的克隆变化，并调查VRE和VVE之间的基因型利奈唑胺抗性。方法对2015年至2022年4090例丹麦临床VRE和VVE分离株进行全基因组测序。我们从测序数据中提取万古霉素抗性基因和序列类型（STs），并对屎肠球菌进行核心基因组多位点序列分型（cgMLST）分析。测试所有分离株是否存在编码利奈唑胺抗性的突变或基因。结果99%的VRE和VVE分离株为屎肠球菌。从2015年到2019年，91.1%的VRE和VVE是vanAE.faecium。在2020年，vanB屎肠球菌的数量增加到509个VRE和VVE分离株中的254个。在2015年至2022年之间，七个屎肠球菌簇占主导地位：ST80-CT14vanA，ST117-CT24vanA,ST203-CT859vanA,ST1421-CT1134vanA(VVE集群),ST80-CT1064vanA/vanB,ST117-CT36vanB和ST80-CT2406vanB。我们检测到35种利奈唑胺耐万古霉素的屎肠球菌和8种利奈唑胺耐药的VVEfm。结论从2015年到2022年，VRE和VVE的数量有所增加。VVE簇ST1421-CT1134vanAE.faecium在丹麦的传播令人担忧，尤其是VVE诊断具有挑战性。LVRE的发现,虽然数量很少，我也很担心，因为治疗选择有限。
