Emergence of vanA Enterococcus faecium in Denmark, 2005-15

Anette M Hammerum; Sharmin Baig; Yasmin Kamel; Louise Roer; Mette Pinholt; Heidi Gumpert; Barbara Holzknecht; Bent Røder; Ulrik S Justesen; Jurgita Samulioniené; Mona Kjærsgaard; Claus Østergaard; Anette Holm; Esad Dzajic; Turid Snekloth Søndergaard; Shahin Gaini; Petra Edquist; Erik Alm; Berit Lilje; Henrik Westh; Marc Stegger; Henrik Hasman

doi:10.1093/jac/dkx138

Emergence of vanA Enterococcus faecium in Denmark, 2005-15

Anette M Hammerum, Sharmin Baig, Yasmin Kamel, Louise Roer, Mette Pinholt, Heidi Gumpert, Barbara Holzknecht, Bent Røder, Ulrik S Justesen, Jurgita Samulioniené, Mona Kjærsgaard, Claus Østergaard, Anette Holm, Esad Dzajic, Turid Snekloth Søndergaard, Shahin Gaini, Petra Edquist, Erik Alm, Berit Lilje, Henrik WesthMarc Stegger, Henrik Hasman

Department of Clinical Medicine

28 Citations (Scopus)

Abstract

Objectives: To describe the changing epidemiology of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in clinical samples in Denmark 2005-15 according to species and van type, and, furthermore, to investigate the genetic relatedness of the clinical E. faecium isolates from 2015.

Methods: During 2005-14, all clinical VRE isolates were tested for the presence of vanA/B/C genes by PCR. In 2015, all clinical VRE isolates were whole-genome sequenced. From the WGS data, the presence of van genes and MLST STs were extracted in silico . Core-genome MLST (cgMLST) analysis was performed for the vancomycin-resistant E. faecium isolates.

Results: During 2005-15, 1043 vanA E. faecium , 25 vanB E. faecium , 4 vanA E. faecalis and 28 vanB E. faecalis were detected. The number of VRE was <50 isolates/year until 2012 to > 200 isolates/year in 2013-15. In 2015, 368 vanA E. faecium and 1 vanB E. faecium were detected along with 1 vanA E. faecalis and 1 vanB E. faecalis . cgMLST subdivided the 368 vanA E. faecium isolates into 33 cluster types (CTs), whereas the vanB E. faecium isolate belonged to a different CT. ST203-CT859 was most prevalent (51%), followed by ST80-CT14 (22%), ST117-CT24 (6%), ST80-CT866 (4%) and ST80-CT860 (2%). Comparison with the cgMLST.org database, previous studies and personal communications with neighbouring countries revealed that the novel cluster ST203-CT859 emerged in December 2014 and spread to the south of Sweden and the Faroe Islands during 2015.

Conclusions: VRE increased in Denmark during 2005-15 due to the emergence of several vanA E. faecium clones.

Original language	English
Journal	Journal of Antimicrobial Chemotherapy
Volume	72
Issue number	8
Pages (from-to)	2184-2190
ISSN	0305-7453
DOIs	https://doi.org/10.1093/jac/dkx138
Publication status	Published - 1 Aug 2017

Keywords

Bacterial Proteins/genetics
Carbon-Oxygen Ligases/genetics
DNA, Bacterial/genetics
Denmark/epidemiology
Enterococcus faecium/genetics
Gram-Positive Bacterial Infections/epidemiology
Humans
Multilocus Sequence Typing
Polymerase Chain Reaction
Sequence Analysis, DNA
Vancomycin-Resistant Enterococci/genetics

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Hammerum, A. M., Baig, S., Kamel, Y., Roer, L., Pinholt, M., Gumpert, H., Holzknecht, B., Røder, B., Justesen, U. S., Samulioniené, J., Kjærsgaard, M., Østergaard, C., Holm, A., Dzajic, E., Søndergaard, T. S., Gaini, S., Edquist, P., Alm, E., Lilje, B., ... Hasman, H. (2017). Emergence of vanA Enterococcus faecium in Denmark, 2005-15. Journal of Antimicrobial Chemotherapy, 72(8), 2184-2190. https://doi.org/10.1093/jac/dkx138

Hammerum, AM, Baig, S, Kamel, Y, Roer, L, Pinholt, M, Gumpert, H, Holzknecht, B, Røder, B, Justesen, US, Samulioniené, J, Kjærsgaard, M, Østergaard, C, Holm, A, Dzajic, E, Søndergaard, TS, Gaini, S, Edquist, P, Alm, E, Lilje, B, Westh, H, Stegger, M & Hasman, H 2017, 'Emergence of vanA Enterococcus faecium in Denmark, 2005-15', Journal of Antimicrobial Chemotherapy, vol. 72, no. 8, pp. 2184-2190. https://doi.org/10.1093/jac/dkx138

@article{35e21bbde98e487f9f4743525a41aa6c,

title = "Emergence of vanA Enterococcus faecium in Denmark, 2005-15",

abstract = "Objectives: To describe the changing epidemiology of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in clinical samples in Denmark 2005-15 according to species and van type, and, furthermore, to investigate the genetic relatedness of the clinical E. faecium isolates from 2015.Methods: During 2005-14, all clinical VRE isolates were tested for the presence of vanA/B/C genes by PCR. In 2015, all clinical VRE isolates were whole-genome sequenced. From the WGS data, the presence of van genes and MLST STs were extracted in silico . Core-genome MLST (cgMLST) analysis was performed for the vancomycin-resistant E. faecium isolates.Results: During 2005-15, 1043 vanA E. faecium , 25 vanB E. faecium , 4 vanA E. faecalis and 28 vanB E. faecalis were detected. The number of VRE was <50 isolates/year until 2012 to > 200 isolates/year in 2013-15. In 2015, 368 vanA E. faecium and 1 vanB E. faecium were detected along with 1 vanA E. faecalis and 1 vanB E. faecalis . cgMLST subdivided the 368 vanA E. faecium isolates into 33 cluster types (CTs), whereas the vanB E. faecium isolate belonged to a different CT. ST203-CT859 was most prevalent (51%), followed by ST80-CT14 (22%), ST117-CT24 (6%), ST80-CT866 (4%) and ST80-CT860 (2%). Comparison with the cgMLST.org database, previous studies and personal communications with neighbouring countries revealed that the novel cluster ST203-CT859 emerged in December 2014 and spread to the south of Sweden and the Faroe Islands during 2015.Conclusions: VRE increased in Denmark during 2005-15 due to the emergence of several vanA E. faecium clones.",

keywords = "Bacterial Proteins/genetics, Carbon-Oxygen Ligases/genetics, DNA, Bacterial/genetics, Denmark/epidemiology, Enterococcus faecium/genetics, Gram-Positive Bacterial Infections/epidemiology, Humans, Multilocus Sequence Typing, Polymerase Chain Reaction, Sequence Analysis, DNA, Vancomycin-Resistant Enterococci/genetics",

author = "Hammerum, {Anette M} and Sharmin Baig and Yasmin Kamel and Louise Roer and Mette Pinholt and Heidi Gumpert and Barbara Holzknecht and Bent R{\o}der and Justesen, {Ulrik S} and Jurgita Samulionien{\'e} and Mona Kj{\ae}rsgaard and Claus {\O}stergaard and Anette Holm and Esad Dzajic and S{\o}ndergaard, {Turid Snekloth} and Shahin Gaini and Petra Edquist and Erik Alm and Berit Lilje and Henrik Westh and Marc Stegger and Henrik Hasman",

note = "{\textcopyright} The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: [email protected].",

year = "2017",

month = aug,

day = "1",

doi = "10.1093/jac/dkx138",

language = "English",

volume = "72",

pages = "2184--2190",

journal = "Journal of Antimicrobial Chemotherapy",

issn = "0305-7453",

publisher = "Oxford University Press",

number = "8",

}

TY - JOUR

T1 - Emergence of vanA Enterococcus faecium in Denmark, 2005-15

AU - Hammerum, Anette M

AU - Baig, Sharmin

AU - Kamel, Yasmin

AU - Roer, Louise

AU - Pinholt, Mette

AU - Gumpert, Heidi

AU - Holzknecht, Barbara

AU - Røder, Bent

AU - Justesen, Ulrik S

AU - Samulioniené, Jurgita

AU - Kjærsgaard, Mona

AU - Østergaard, Claus

AU - Holm, Anette

AU - Dzajic, Esad

AU - Søndergaard, Turid Snekloth

AU - Gaini, Shahin

AU - Edquist, Petra

AU - Alm, Erik

AU - Lilje, Berit

AU - Westh, Henrik

AU - Stegger, Marc

AU - Hasman, Henrik

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Objectives: To describe the changing epidemiology of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in clinical samples in Denmark 2005-15 according to species and van type, and, furthermore, to investigate the genetic relatedness of the clinical E. faecium isolates from 2015.Methods: During 2005-14, all clinical VRE isolates were tested for the presence of vanA/B/C genes by PCR. In 2015, all clinical VRE isolates were whole-genome sequenced. From the WGS data, the presence of van genes and MLST STs were extracted in silico . Core-genome MLST (cgMLST) analysis was performed for the vancomycin-resistant E. faecium isolates.Results: During 2005-15, 1043 vanA E. faecium , 25 vanB E. faecium , 4 vanA E. faecalis and 28 vanB E. faecalis were detected. The number of VRE was <50 isolates/year until 2012 to > 200 isolates/year in 2013-15. In 2015, 368 vanA E. faecium and 1 vanB E. faecium were detected along with 1 vanA E. faecalis and 1 vanB E. faecalis . cgMLST subdivided the 368 vanA E. faecium isolates into 33 cluster types (CTs), whereas the vanB E. faecium isolate belonged to a different CT. ST203-CT859 was most prevalent (51%), followed by ST80-CT14 (22%), ST117-CT24 (6%), ST80-CT866 (4%) and ST80-CT860 (2%). Comparison with the cgMLST.org database, previous studies and personal communications with neighbouring countries revealed that the novel cluster ST203-CT859 emerged in December 2014 and spread to the south of Sweden and the Faroe Islands during 2015.Conclusions: VRE increased in Denmark during 2005-15 due to the emergence of several vanA E. faecium clones.

AB - Objectives: To describe the changing epidemiology of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in clinical samples in Denmark 2005-15 according to species and van type, and, furthermore, to investigate the genetic relatedness of the clinical E. faecium isolates from 2015.Methods: During 2005-14, all clinical VRE isolates were tested for the presence of vanA/B/C genes by PCR. In 2015, all clinical VRE isolates were whole-genome sequenced. From the WGS data, the presence of van genes and MLST STs were extracted in silico . Core-genome MLST (cgMLST) analysis was performed for the vancomycin-resistant E. faecium isolates.Results: During 2005-15, 1043 vanA E. faecium , 25 vanB E. faecium , 4 vanA E. faecalis and 28 vanB E. faecalis were detected. The number of VRE was <50 isolates/year until 2012 to > 200 isolates/year in 2013-15. In 2015, 368 vanA E. faecium and 1 vanB E. faecium were detected along with 1 vanA E. faecalis and 1 vanB E. faecalis . cgMLST subdivided the 368 vanA E. faecium isolates into 33 cluster types (CTs), whereas the vanB E. faecium isolate belonged to a different CT. ST203-CT859 was most prevalent (51%), followed by ST80-CT14 (22%), ST117-CT24 (6%), ST80-CT866 (4%) and ST80-CT860 (2%). Comparison with the cgMLST.org database, previous studies and personal communications with neighbouring countries revealed that the novel cluster ST203-CT859 emerged in December 2014 and spread to the south of Sweden and the Faroe Islands during 2015.Conclusions: VRE increased in Denmark during 2005-15 due to the emergence of several vanA E. faecium clones.

KW - Bacterial Proteins/genetics

KW - Carbon-Oxygen Ligases/genetics

KW - DNA, Bacterial/genetics

KW - Denmark/epidemiology

KW - Enterococcus faecium/genetics

KW - Gram-Positive Bacterial Infections/epidemiology

KW - Humans

KW - Multilocus Sequence Typing

KW - Polymerase Chain Reaction

KW - Sequence Analysis, DNA

KW - Vancomycin-Resistant Enterococci/genetics

U2 - 10.1093/jac/dkx138

DO - 10.1093/jac/dkx138

M3 - Journal article

C2 - 28541565

SN - 0305-7453

VL - 72

SP - 2184

EP - 2190

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

IS - 8

ER -

Emergence of vanA Enterococcus faecium in Denmark, 2005-15

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Keywords

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