This study emphasizes the importance of infection control measures to limit transmission of VREfm between patients. However, the diversity of the VREfm isolates points to the fact that other important factors may also affect the VREfm increase in Denmark. Finally, WGS is suitable for typing of VREfm and has replaced PFGE for typing of VREfm in Denmark.
We describe clonal shifts in
vanA Enterococcus faecium
isolates from clinical samples obtained from patients in Denmark from 2015 to the first quarter (Q1) of 2019. During Q1 2019, the vancomycin-variable enterococci (VVE) ST1421-CT1134
vanA E. faecium
became the most dominant
vanA E. faecium
clone and has spread to all five regions in Denmark. Among 174
E. faecium
isolates with
vanA, vanB
or vanA/
vanB
genes in Q1 2019, 44% belonged to this type.
Objectives: During the last decades several methicillin-resistant Staphylococcus aureus (MRSA) clones with the capability of global spread have emerged in the community. Here, we have investigated a large collection of clinical isolates belonging to MRSA clone t304/ST6, which has emerged in many European countries over the last years, in order to retrace its phylogeny and its spread. Methods: We characterized 466 ST6 isolates from Denmark (n ¼ 354), France (n ¼ 10), Norway (n ¼ 24), Sweden (n ¼ 27) and the UK (n ¼ 51). All had spa-type t304 (n ¼ 454) or t304-related spa-types (n ¼ 12) and whole genome sequencing (WGS) was carried out on Illumina Miseq or Hiseq with 100e300 bp reads. cgMLST was performed using Ridom SeqSphere. Results: A minimum spanning tree (MST) of all 466 isolates showed one large cluster including 182 isolates collected only from Denmark and related to a long-term neonatal outbreak in Copenhagen. This cluster contrasted with numerous small clusters, including the remaining Danish isolates and isolates from the other countries that interspersed throughout the tree. Most isolates were Panton-Valentine leukocidin (PVL) negative (95%) and harboured SCCmec IVa. One genome was closed using Oxford Nanopore technology and Illumina MiSeq. It contained a plasmid of 19.769 bp including the blaZ gene. A similar plasmid was found in 78% of all isolates. Discussion: t304/ST6 is a successful emerging clone and the fact that isolates from five countries are interspersed throughout the MST indicates a common origin. This clone is commonly described in the Middle East and its emergence in Europe coincides with influx of refugees from the Syrian Civil War.
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