The purpose of the study was to investigate the molecular characteristics and genetic relatedness of the first reported cases of vancomycin-resistant enterococci (VRE) from the Tripoli Medical Center, Libya. In total, 43 VRE isolates were obtained from various clinical sites throughout the years 2013–2014, including 40 vanA-type and 2 vanB-type vancomycin-resistant Enterococcus faecium isolates and 1 vanC1-type Enterococcus gallinarum. Of the 42 E. faecium, 19 isolates were subjected to whole genome sequencing. Core genome multilocus sequence typing (cgMLST) analysis revealed three sequence clusters (SCs) of clonally related isolates, which were linked to different hospital wards. The first two VRE isolates, isolated early 2013 from patients in the medical intensive care unit, were grouped in SC1 (MLST [ST] 78, vanB) and differed in only 3 of 1423 cgMLST alleles. The SC2 (n = 16, special care baby unit, neonatal intensive care unit, pediatric surgery ward, and oncology ward) and SC3 (n = 1, antenatal ward) were all ST80 vanA-VRE, but the single SC3 isolate differed in 233 alleles compared with SC2. Within SC2, isolates differed in 1–23 alleles. Comparison with a larger database of E. faecium strains indicated that all isolates clustered within the previously defined hospital clade A1. A combination of Resfinder and mlplasmid analysis identified the presence of resistance genes on different plasmid predicted genetic elements among different SCs. In conclusion, this study documents the first isolates causing outbreaks with VRE in the Libyan health care system. Further surveillance efforts using molecular typing methods to monitor spread of multidrug-resistant bacteria in the Libyan health care system are urgently needed.

中文翻译：

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的黎波里利比亚医院首株耐万古霉素粪肠球菌全基因组序列分析

该研究的目的是调查利比亚的黎波里医疗中心首例报告的耐万古霉素肠球菌 (VRE) 病例的分子特征和遗传相关性。在 2013-2014 年期间，总共从不同临床地点获得了 43 株 VRE 分离株，包括 40株vanA型和 2株 vanB型耐万古霉素屎肠球菌和 1 株vanC1型鸡肠球菌。42 E. faecium, 19 个分离株进行了全基因组测序。核心基因组多位点序列分型 (cgMLST) 分析揭示了与不同医院病房相关的克隆相关分离株的三个序列簇 (SC)。前两个 VRE 分离株是 2013 年初从医疗重症监护病房的患者中分离出来的，被归入 SC1（MLST [ST] 78，vanB），并且在 1423 个 cgMLST 等位基因中只有 3 个不同。SC2（n  = 16，特护婴儿病房，新生儿重症监护病房，小儿外科病房和肿瘤病房）和SC3（n  = 1，产前病房）均为ST80 vanA- VRE，但单一SC3分离株在233等位基因与 SC2 相比。在 SC2 中，分离株在 1-23 个等位基因上存在差异。与更大的数据库的比较E. faecium菌株表明所有分离株都聚集在先前定义的医院进化枝 A1 内。Resfinder 和 mlplasmid 分析的组合确定了不同 SCs 中不同质粒预测遗传元件上抗性基因的存在。总之，这项研究记录了利比亚卫生保健系统中第一个导致 VRE 暴发的分离株。迫切需要使用分子分型方法进一步监测利比亚卫生保健系统中耐多药细菌的传播。