In 2015, a marked increase in vancomycin-resistant Enterococcus faecium (VREfm) isolation was detected at the Royal Hobart Hospital, Australia. The primary objective of this work was to examine the dynamics of VREfm transmission using whole genome data mapped to public health surveillance information. Screening and clinical isolates of VREfm from patients were typed for the specific vancomycin-resistance locus present. Of total isolates collected from 2014-2016 (n = 222), 15.3% and 84.7% harboured either the vanA or the vanB vancomycin-resistance locus, respectively. Whole-genome sequencing of 80 isolates was performed in conjunction with single-nucleotide polymorphic (SNP) analysis and in silico multi-locus sequence typing (MLST). Among the isolates sequenced, 5 phylogenetic clades were identified. The largest vanB clade belonged to MLST sequence type ST796 and contained clinical isolates from VREfm infections that clustered closely with isolates from colonised patients. Correlation of VREfm genotypes with spatio-temporal patient movements detected potential points of transmission within the hospital. ST80 emerged as the major vanA sequence type for which the most likely index case of a patient cluster was ascertained from SNP analyses. This work has identified the dominant clones associated with increased VREfm prevalence in a healthcare setting, and their likely direction of transmission.

中文翻译：

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澳大利亚一家医院出现耐万古霉素屎肠球菌：全基因组测序分析。


2015 年，澳大利亚皇家霍巴特医院检测到耐万古霉素屎肠球菌 (VREfm) 分离量显着增加。这项工作的主要目标是使用映射到公共卫生监测信息的全基因组数据来检查 VREfm 传播的动态。对来自患者的 VREfm 进行筛选和临床分离，针对存在的特定万古霉素耐药位点进行分型。在 2014-2016 年收集的总分离株中（n = 222），15.3% 和 84.7% 分别含有 vanA 或 vanB 万古霉素抗性位点。结合单核苷酸多态性 (SNP) 分析和计算机多位点序列分型 (MLST) 对 80 个分离株进行了全基因组测序。在测序的分离株中，鉴定出 5 个系统发育分支。最大的 vanB 分支属于 MLST 序列类型 ST796，包含来自 VREfm 感染的临床分离株，这些分离株与来自定植患者的分离株紧密聚集。 VREfm 基因型与患者时空运动的相关性检测到了医院内潜在的传播点。 ST80 成为主要的 vanA 序列类型，通过 SNP 分析确定了最可能的患者簇索引病例。这项工作确定了与医疗保健环境中 VREfm 患病率增加相关的显性克隆及其可能的传播方向。