The first investigation of a nosocomial outbreak caused by ST80 vancomycin-resistant Enterococci faecium in China

Vancomycin-resistant Enterococci faecium (VREfm) in one of the most challenging multidrug-resistant pathogens posing great threats to public health. E. faecium clonal complex 17 (CC17) is the leading cause of hospital acquired infections worldwide [ [1] Lee T. Pang S. Abraham S. Coombs G.W. Antimicrobial-resistant CC17 Enterococcus faecium: The past, the present and the future. J Glob Antimicrob Resist. 2019; 16: 36-47https://doi.org/10.1016/j.jgar.2018.08.016 Crossref PubMed Scopus (90) Google Scholar ]. Since the early 2010s, a novel clone, sequence type 80 (ST80) belonged to CC17, gradually became one of the predominant clinical clones in Europe and Australia, accounting for 40%-67.1% of VREfm isolates [ 2 Pinholt M. Bayliss S.C. Gumpert H. Worning P. Jensen V.V.S. Pedersen M. et al. WGS of 1058 Enterococcus faecium from Copenhagen, Denmark, reveals rapid clonal expansion of vancomycin-resistant clone ST80 combined with widespread dissemination of a vanA-containing plasmid and acquisition of a heterogeneous accessory genome. J Antimicrob Chemother. 2019; 74: 1776-1785https://doi.org/10.1093/jac/dkz118 Crossref Scopus (26) Google Scholar , 3 Pratama R. Beukers A.G. McIver C.J. Keighley C.L. Taylor P.C. van Hal S.J. A vanA vancomycin-resistant Enterococcus faecium ST80 outbreak resulting from a single importation event. J Antimicrob Chemother. 2021; 77: 31-37https://doi.org/10.1093/jac/dkab379 Crossref Scopus (2) Google Scholar , 4 Egan S.A. Kavanagh N.L. Shore A.C. Mollerup S. Samaniego Castruita J.A. O'Connell B. et al. Genomic analysis of 600 vancomycin-resistant Enterococcus faecium reveals a high prevalence of ST80 and spread of similar vanA regions via IS1216E and plasmid transfer in diverse genetic lineages in Ireland. J Antimicrob Chemother. 2022; 77: 320-330https://doi.org/10.1093/jac/dkab393 Crossref Scopus (4) Google Scholar , 5 Rodriguez-Lucas C. Fernandez J. Raya C. Bahamonde A. Quiroga A. Munoz R. et al. Establishment and Persistence of Glycopeptide-Resistant Enterococcus faecium ST80 and ST117 Clones Within a Health Care Facility Located in a Low-Prevalence Geographical Region. Microb Drug Resist. 2022; 28: 217-221https://doi.org/10.1089/mdr.2021.0171 Crossref Scopus (4) Google Scholar ]. Among these expansion, single importation or outbreak event play foundation roles [ [3] Pratama R. Beukers A.G. McIver C.J. Keighley C.L. Taylor P.C. van Hal S.J. A vanA vancomycin-resistant Enterococcus faecium ST80 outbreak resulting from a single importation event. J Antimicrob Chemother. 2021; 77: 31-37https://doi.org/10.1093/jac/dkab379 Crossref Scopus (2) Google Scholar , [4] Egan S.A. Kavanagh N.L. Shore A.C. Mollerup S. Samaniego Castruita J.A. O'Connell B. et al. Genomic analysis of 600 vancomycin-resistant Enterococcus faecium reveals a high prevalence of ST80 and spread of similar vanA regions via IS1216E and plasmid transfer in diverse genetic lineages in Ireland. J Antimicrob Chemother. 2022; 77: 320-330https://doi.org/10.1093/jac/dkab393 Crossref Scopus (4) Google Scholar ]. In Asia, few studies report ST80 [ [1] Lee T. Pang S. Abraham S. Coombs G.W. Antimicrobial-resistant CC17 Enterococcus faecium: The past, the present and the future. J Glob Antimicrob Resist. 2019; 16: 36-47https://doi.org/10.1016/j.jgar.2018.08.016 Crossref PubMed Scopus (90) Google Scholar ], though ST80 can be identified from the genome data in public databases. ST78 VREfm are predominant in China, while ST80 isolates are report clinically in rare frequency [ [6] Liu S. Li Y. He Z. Wang Y. Wang J. Jin D. A molecular study regarding the spread of vanA vancomycin-resistant Enterococcus faecium in a tertiary hospital in China. Journal of Global Antimicrobial Resistance. 2022; 31: 270-278https://doi.org/10.1016/j.jgar.2022.10.010 Crossref Scopus (3) Google Scholar , [7] Zhou W. Zhou H. Sun Y. Gao S. Zhang Y. Cao X. et al. Characterization of clinical enterococci isolates, focusing on the vancomycin-resistant enterococci in a tertiary hospital in China: based on the data from 2013 to 2018. BMC Infect Dis. 2020; 20: 356https://doi.org/10.1186/s12879-020-05078-4 Crossref Scopus (15) Google Scholar ]. The nosocomial transmission and their clinical significance of VREfm ST80 in China is still unclear.