A Multicentre Hospital Outbreak in Sweden Caused by Introduction of a vanB2 Transposon into a Stably Maintained pRUM-Plasmid in an Enterococcus faecium ST192 Clone

Sivertsen, Audun; Billström, Hanna; Melefors, Öjar; Liljequist, B. Olsson; Wisell, Karin Tegmark; Ullberg, Måns; Özenci, Volkan; Sundsfjord, Arnfinn; Hegstad, Kristin

doi:10.1371/journal.pone.0103274

Cited by 33 publications

(20 citation statements)

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“…rep 17/pRUM was the single most dominating replicon type among the selected E. faecium strains. This is consistent with previous reports, which also link the axe-txe TA-loci to this replicon type [ 17 , 21 , 41 , 48 , 81 ]. Both the axe and the txe targets (457 and 458) hybridized to 15/20 E. faecium strains, while none of the E. faecalis strains were positive (p < 0.0001).…”

Section: Resultssupporting

confidence: 94%

“…This might reflect higher plasmid content in the selected STs, but may also be due to the higher number of rep targets included in the array. We suppose the factual number of plasmids to be lower than the identified rep genes since multi replicon plasmids and plasmid remnants in the core chromosome are known for many bacteria including enterococci [ 21 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

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Investigating the mobilome in clinically important lineages of Enterococcus faecium and Enterococcus faecalis

et al. 2015

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BackgroundThe success of Enterococcus faecium and E. faecalis evolving as multi-resistant nosocomial pathogens is associated with their ability to acquire and share adaptive traits, including antimicrobial resistance genes encoded by mobile genetic elements (MGEs). Here, we investigate this mobilome in successful hospital associated genetic lineages, E. faecium sequence type (ST)17 (n=10) and ST78 (n=10), E. faecalis ST6 (n=10) and ST40 (n=10) by DNA microarray analyses.ResultsThe hybridization patterns of 272 representative targets including plasmid backbones (n=85), transposable elements (n=85), resistance determinants (n=67), prophages (n=29) and clustered regularly interspaced short palindromic repeats (CRISPR)-cas sequences (n=6) separated the strains according to species, and for E. faecalis also according to STs. RCR-, Rep_3-, RepA_N- and Inc18-family plasmids were highly prevalent and with the exception of Rep_3, evenly distributed between the species. There was a considerable difference in the replicon profile, with rep17/pRUM, rep2/pRE25, rep14/EFNP1 and rep20/pLG1 dominating in E. faecium and rep9/pCF10, rep2/pRE25 and rep7 in E. faecalis strains. We observed an overall high correlation between the presence and absence of genes coding for resistance towards antibiotics, metals, biocides and their corresponding MGEs as well as their phenotypic antimicrobial susceptibility pattern. Although most IS families were represented in both E. faecalis and E. faecium, specific IS elements within these families were distributed in only one species. The prevalence of IS256-, IS3-, ISL3-, IS200/IS605-, IS110-, IS982- and IS4-transposases was significantly higher in E. faecium than E. faecalis, and that of IS110-, IS982- and IS1182-transposases in E. faecalis ST6 compared to ST40. Notably, the transposases of IS981, ISEfm1 and IS1678 that have only been reported in few enterococcal isolates were well represented in the E. faecium strains. E. faecalis ST40 strains harboured possible functional CRISPR-Cas systems, and still resistance and prophage sequences were generally well represented.ConclusionsThe targeted MGEs were highly prevalent among the selected STs, underlining their potential importance in the evolution of hospital-adapted lineages of enterococci. Although the propensity of inter-species horizontal gene transfer (HGT) must be emphasized, the considerable species-specificity of these MGEs indicates a separate vertical evolution of MGEs within each species, and for E. faecalis within each ST.Electronic supplementary materialThe online version of this article (doi:10.1186/s12864-015-1407-6) contains supplementary material, which is available to authorized users.

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Section: Resultssupporting

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Investigating the mobilome in clinically important lineages of Enterococcus faecium and Enterococcus faecalis

et al. 2015

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“…E. faecium ST192 has been recognized as one of three highly prevalent sequence types responsible for causing VRE outbreaks and hospital-associated (HA) bloodstream infections in German hospital patients in recent years 7 . Moreover, emergence of E. faecium ST192 as a dominant clone and belonging to a cluster of HA-strains formerly known as clonal complex 17 (CC17), was reported from Sweden and Korea where outbreaks with these strains were noted 21 22 23 . Interestingly, and opposed to the data of the present study, vancomycin resistance in these strains was mediated by the acquisition of either vanA , as part of the plasmid-associated transposon Tn 1546 , or the vanB -containing Tn 1549 , also of plasmid origin.…”

Section: Discussionmentioning

confidence: 99%

Population structure and acquisition of the vanB resistance determinant in German clinical isolates of Enterococcus faecium ST192

Bender

Kalmbach

Fleige

et al. 2016

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In the context of the global action plan to reduce the dissemination of antibiotic resistances it is of utmost importance to understand the population structure of resistant endemic bacterial lineages and to elucidate how bacteria acquire certain resistance determinants. Vancomycin resistant enterococci represent one such example of a prominent nosocomial pathogen on which nation-wide population analyses on prevalent lineages are scarce and data on how the bacteria acquire resistance, especially of the vanB genotype, are still under debate. With respect to Germany, an increased prevalence of VRE was noted in recent years. Here, invasive infections caused by sequence type ST192 VRE are often associated with the vanB-type resistance determinant. Hence, we analyzed 49 vanB-positive and vanB-negative E. faecium isolates by means of whole genome sequencing. Our studies revealed a distinct population structure and that spread of the Tn1549-vanB-type resistance involves exchange of large chromosomal fragments between vanB-positive and vanB-negative enterococci rather than independent acquisition events. In vitro filter-mating experiments support the hypothesis and suggest the presence of certain target sequences as a limiting factor for dissemination of the vanB element. Thus, the present study provides a better understanding of how enterococci emerge into successful multidrug-resistant nosocomial pathogens.

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“…Outbreaks by VRE strains can possibly arise in hospitals when already well-established vancomycin-sensitive E. faecium strain acquire vancomycin resistance genes via a resistant plasmid (53). The finding of similar VRE bacteria belonging to the same clonal cluster (CC17) was described internationally as well established in hospital environments.…”

Section: Discussionmentioning

confidence: 99%

Anthropogenic antibiotic resistance genes mobilization to the polar regions

Hernández

González‐Acuña

2016

Infection Ecology & Epidemiology

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Anthropogenic influences in the southern polar region have been rare, but lately microorganisms associated with humans have reached Antarctica, possibly from military bases, fishing boats, scientific expeditions, and/or ship-borne tourism. Studies of seawater in areas of human intervention and proximal to fresh penguin feces revealed the presence of Escherichia coli strains least resistant to antibiotics in penguins, whereas E. coli from seawater elsewhere showed resistance to one or more of the following antibiotics: ampicillin, tetracycline, streptomycin, and trim-sulfa. In seawater samples, bacteria were found carrying extended-spectrum β-lactamase (ESBL)-type CTX-M genes in which multilocus sequencing typing (MLST) showed different sequence types (STs), previously reported in humans. In the Arctic, on the contrary, people have been present for a long time, and the presence of antibiotic resistance genes (ARGs) appears to be much more wide-spread than was previously reported. Studies of E coli from Arctic birds (Bering Strait) revealed reduced susceptibility to antibiotics, but one globally spreading clone of E. coli genotype O25b-ST131, carrying genes of ESBL-type CTX-M, was identified. In the few years between sample collections in the same area, differences in resistance pattern were observed, with E. coli from birds showing resistance to a maximum of five different antibiotics. Presence of resistance-type ESBLs (TEM, SHV, and CTX-M) in E. coli and Klebsiella pneumoniae was also confirmed by specified PCR methods. MLST revealed that those bacteria carried STs that connect them to previously described strains in humans. In conclusion, bacteria previously related to humans could be found in relatively pristine environments, and presently human-associated, antibiotic-resistant bacteria have reached a high global level of distribution that they are now found even in the polar regions.

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A Multicentre Hospital Outbreak in Sweden Caused by Introduction of a vanB2 Transposon into a Stably Maintained pRUM-Plasmid in an Enterococcus faecium ST192 Clone

Cited by 33 publications

References 52 publications

Investigating the mobilome in clinically important lineages of Enterococcus faecium and Enterococcus faecalis

Investigating the mobilome in clinically important lineages of Enterococcus faecium and Enterococcus faecalis

Population structure and acquisition of the vanB resistance determinant in German clinical isolates of Enterococcus faecium ST192

Anthropogenic antibiotic resistance genes mobilization to the polar regions

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