In addition to an overall rise in vancomycin-resistant Enterococcus faecium (VREfm), an increase in certain strain types marked by sequence type (ST) and cluster type (CT) has been reported in Germany over the past few years. Outbreak analyses at Charité - Universitätsmedizin Berlin revealed the frequent occurrence of VREfm ST117 CT71 isolates in 2017 and 2018. To investigate whether ST117 CT71 have emerged in recent years or whether these strains have been circulating for a longer time, we retrospectively analyzed non-outbreak strains that occurred between 2008 and 2018 to identify frequent STs and CTs. In total, 120 VREfm isolates obtained from clinical and surveillance cultures from the years 2008, 2013, 2015, and 2018 were analyzed. Thirty isolates per year comprising the first 7–8 non-outbreak isolates of each quarter of the respective year were sequenced using whole genome sequencing. MLST and cgMLST were determined as well as resistance genes and virulence factors. Risk factors for VREfm ST117 were analyzed in a multivariable analysis with patient characteristics as possible confounders. The percentage of VREfm of type ST117 increased from 17% in 2008 to 57% in 2018 (p = 0.012). In 2008, vanA genotype accounted for 80% of all ST117 isolates compared to 6% in 2018. VanB CT71 first appeared in 2018 and predominated over all other ST117 at 43% (p < 0.0001). The set of resistance genes (msrC, efmA, erm(B), dfrG, aac(6′)-Ii, gyrA, parC and pbp5) and virulence factors (acm, esp, hylEfm, ecbA and sgrA) in CT71 was also found in other ST117 non-CT71 strains, mainly in CT36. The study population did not differ among the different calendar years analyzed in terms of age, gender, length of stay, or ward type (each p > 0.2). This study revealed an increase in ST117 strains from 2008 to 2018, accompanied by a shift toward CT71 strains with the vanB genotype in 2018. We did not detect resistance or virulence traits in CT71 that could confer survival advantage compared to other CTs among ST117 strains. To date, it is not clear why ST117 and in particular strain type ST117 CT71 predominates over other strains.

中文翻译：

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Charité-Universitätsmedizin柏林大学增加的耐万古霉素粪肠球菌ST117 CT71菌株，2008年至2018年。

在过去几年中，除了耐万古霉素的粪肠球菌（VREfm）总体增加外，还报道了某些以序列类型（ST）和簇类型（CT）标记的菌株类型的增加。Charité-柏林大学医学院的暴发分析表明，2017年和2018年VREfm ST117 CT71分离株频繁发生。为调查ST117 CT71是否在最近几年出现或这些菌株传播时间较长，我们回顾性分析了非暴发菌株在2008年至2018年之间进行，以识别频繁的ST和CT。总共分析了从2008年，2013年，2015年和2018年的临床和监测培养物中获得的120种VREfm分离株。使用全基因组测序，每年对30个分离株（包括相应年份的每个季度的前7-8个非暴发分离株）进行测序。确定了MLST和cgMLST以及抗性基因和毒力因子。对VREfm ST117的危险因素进行了多变量分析，以患者特征为可能的混杂因素。ST117型VREfm的百分比从2008年的17％增加到2018年的57％（p = 0.012）。在2008年，vanA基因型占所有ST117分离株的80％，而在2018年为6％。VanBCT71首次出现于2018年，占所有其他ST117分离株的43％（p <0.0001）。还发现了CT71中的抗性基因集（msrC，efmA，erm（B），dfrG，aac（6'）-Ii，gyrA，parC和pbp5）和毒力因子（acm，esp，hylEfm，ecbA和sgrA）。在其他ST117非CT71菌株中，主要在CT36中。在年龄，性别，住院时间或病房类型方面，不同年龄段的研究人群没有差异（每个p> 0.2）。这项研究显示，从2008年到2018年，ST117菌株有所增加，并于2018年转向具有vanB基因型的CT71菌株。与ST117菌株中的其他CT相比，我们没有检测到CT71的耐药性或毒力性状与其他CT相比具有生存优势。迄今为止，尚不清楚为什么ST117，特别是ST117 CT71型菌株比其他菌株占主导地位。与ST117菌株中的其他CT相比，我们未在CT71中检测到抗药性或毒力特性，这些特性可能赋予存活优势。迄今为止，尚不清楚为什么ST117，特别是ST117 CT71型菌株比其他菌株占主导地位。与ST117菌株中的其他CT相比，我们未在CT71中检测到抗药性或毒力特性，这些特性可能赋予存活优势。迄今为止，尚不清楚为什么ST117，尤其是ST117 CT71型菌株比其他菌株占优势。