Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan

Abstract The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted...

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Autores principales:	Yoshihiro Fujiya, Tetsuya Harada, Yo Sugawara, Yukihiro Akeda, Masako Yasuda, Ayako Masumi, Junichi Hayashi, Nobuhiro Tanimura, Yoshihiro Tsujimoto, Wataru Shibata, Takahiro Yamaguchi, Ryuji Kawahara, Isao Nishi, Shigeyuki Hamada, Kazunori Tomono, Hiroshi Kakeya
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0dab178ca02c4affba3f0dd1a5e1b666
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spelling	oai:doaj.org-article:0dab178ca02c4affba3f0dd1a5e1b6662021-12-02T17:57:15ZTransmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan10.1038/s41598-021-94213-52045-2322https://doaj.org/article/0dab178ca02c4affba3f0dd1a5e1b6662021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94213-5https://doaj.org/toc/2045-2322Abstract The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted biological and genomic analyses of VRE isolates, and assessed the implemented infection control measures. In total, 149 patients harboring VanA-type VRE were identified from April 2017 to October 2019, with 153 vancomycin-resistant Enterococcus faecium isolated being grouped into 31 pulsotypes using pulsed-field gel electrophoresis, wherein six sequence types belonged to clonal complex 17. Epidemic clones varied throughout the outbreak; however, they all carried vanA-plasmids (pIHVA). pIHVA is a linear plasmid, carrying a unique structural Tn1546 containing vanA; it moves between different Enterococcus spp. by genetic rearrangements. VRE infection incidence among patients in the “hot spot” ward correlated with the local VRE colonization prevalence. Local prevalence also correlated with vancomycin usage in the ward. Transmission of a novel transferrable vanA-plasmid among Enterococcus spp. resulted in genomic diversity in VRE in a non-endemic setting. The prevalence of VRE colonization and vancomycin usage at the ward level may serve as VRE cross-transmission indicators in non-intensive care units for outbreak control.Yoshihiro FujiyaTetsuya HaradaYo SugawaraYukihiro AkedaMasako YasudaAyako MasumiJunichi HayashiNobuhiro TanimuraYoshihiro TsujimotoWataru ShibataTakahiro YamaguchiRyuji KawaharaIsao NishiShigeyuki HamadaKazunori TomonoHiroshi KakeyaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Yoshihiro Fujiya Tetsuya Harada Yo Sugawara Yukihiro Akeda Masako Yasuda Ayako Masumi Junichi Hayashi Nobuhiro Tanimura Yoshihiro Tsujimoto Wataru Shibata Takahiro Yamaguchi Ryuji Kawahara Isao Nishi Shigeyuki Hamada Kazunori Tomono Hiroshi Kakeya Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan
description	Abstract The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted biological and genomic analyses of VRE isolates, and assessed the implemented infection control measures. In total, 149 patients harboring VanA-type VRE were identified from April 2017 to October 2019, with 153 vancomycin-resistant Enterococcus faecium isolated being grouped into 31 pulsotypes using pulsed-field gel electrophoresis, wherein six sequence types belonged to clonal complex 17. Epidemic clones varied throughout the outbreak; however, they all carried vanA-plasmids (pIHVA). pIHVA is a linear plasmid, carrying a unique structural Tn1546 containing vanA; it moves between different Enterococcus spp. by genetic rearrangements. VRE infection incidence among patients in the “hot spot” ward correlated with the local VRE colonization prevalence. Local prevalence also correlated with vancomycin usage in the ward. Transmission of a novel transferrable vanA-plasmid among Enterococcus spp. resulted in genomic diversity in VRE in a non-endemic setting. The prevalence of VRE colonization and vancomycin usage at the ward level may serve as VRE cross-transmission indicators in non-intensive care units for outbreak control.
format	article
author	Yoshihiro Fujiya Tetsuya Harada Yo Sugawara Yukihiro Akeda Masako Yasuda Ayako Masumi Junichi Hayashi Nobuhiro Tanimura Yoshihiro Tsujimoto Wataru Shibata Takahiro Yamaguchi Ryuji Kawahara Isao Nishi Shigeyuki Hamada Kazunori Tomono Hiroshi Kakeya
author_facet	Yoshihiro Fujiya Tetsuya Harada Yo Sugawara Yukihiro Akeda Masako Yasuda Ayako Masumi Junichi Hayashi Nobuhiro Tanimura Yoshihiro Tsujimoto Wataru Shibata Takahiro Yamaguchi Ryuji Kawahara Isao Nishi Shigeyuki Hamada Kazunori Tomono Hiroshi Kakeya
author_sort	Yoshihiro Fujiya
title	Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan
title_short	Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan
title_full	Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan
title_fullStr	Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan
title_full_unstemmed	Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan
title_sort	transmission dynamics of a linear vana-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, japan
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/0dab178ca02c4affba3f0dd1a5e1b666
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Transmission dynamics of a linear vanA-plasmid during a nosocomial multiclonal outbreak of vancomycin-resistant enterococci in a non-endemic area, Japan

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