c Fast and accurate identification and typing of pathogens are essential for effective surveillance and outbreak detection. The current routine procedure is based on a variety of techniques, making the procedure laborious, time-consuming, and expensive. With whole-genome sequencing (WGS) becoming cheaper, it has huge potential in both diagnostics and routine surveillance. The aim of this study was to perform a real-time evaluation of WGS for routine typing and surveillance of verocytotoxin-producing Escherichia coli (VTEC). In Denmark, the Statens Serum Institut (SSI) routinely receives all suspected VTEC isolates. During a 7-week period in the fall of 2012, all incoming isolates were concurrently subjected to WGS using IonTorrent PGM. Real-time bioinformatics analysis was performed using web-tools (www.genomicepidemiology.org) for species determination, multilocus sequence type (MLST) typing, and determination of phylogenetic relationship, and a specific VirulenceFinder for detection of E. coli virulence genes was developed as part of this study. In total, 46 suspected VTEC isolates were characterized in parallel during the study. VirulenceFinder proved successful in detecting virulence genes included in routine typing, explicitly verocytotoxin 1 (vtx1), verocytotoxin 2 (vtx2), and intimin (eae), and also detected additional virulence genes. VirulenceFinder is also a robust method for assigning verocytotoxin (vtx) subtypes. A real-time clustering of isolates in agreement with the epidemiology was established from WGS, enabling discrimination between sporadic and outbreak isolates. Overall, WGS typing produced results faster and at a lower cost than the current routine. Therefore, WGS typing is a superior alternative to conventional typing strategies. This approach may also be applied to typing and surveillance of other pathogens.
Bacterial pathogens still pose a major threat to public health, and in order to limit their spread and prevent infectious disease outbreaks, accurate and rapid diagnostics and classification of isolates are of great importance. In current routine practice, isolation and identification are mostly performed at clinical microbiological laboratories, and verification and further characterization are performed for a few selected pathogens at national, or regional, reference laboratories, using a variety of species-specific methods. Typing and surveillance of bacterial pathogens rely mainly on well-established, standardized phenotypic and molecular typing methods, such as serotyping and pulsed-field gel electrophoresis (PFGE) (1, 2). However, to obtain sufficient discrimination between isolates, it is typically necessary to combine typing results from several different typing techniques, both phenotypic and genotypic. As a result, it is laborious, time-consuming, and expensive to perform proper typing for surveillance and outbreak detection.As the cost of whole-genome sequencing (WGS) has decreased and benchtop sequencing machines enable fast turnaround, it has become increasingly attractive...