Defining the Role of the Environment in the Emergence and Persistence of vanA Vancomycin-Resistant Enterococcus (VRE) in an Intensive Care Unit: A Molecular Epidemiological Study

Lee, AS; White, E; Monahan, LG; Jensen, SO; Chan, R; Van Hal, SJ

Defining the Role of the Environment in the Emergence and Persistence of vanA Vancomycin-Resistant Enterococcus (VRE) in an Intensive Care Unit: A Molecular Epidemiological Study

Lee, AS White, E Monahan, LG

Jensen, SO Chan, R Van Hal, SJ

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Publication Type:: Journal Article
Citation:: Infection Control and Hospital Epidemiology, 2018, 39 (6), pp. 668 - 675
Issue Date:: 2018-06-01

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Field	Value	Language
dc.contributor.author	Lee, AS	en_US
dc.contributor.author	White, E	en_US
dc.contributor.author	Monahan, LG https://orcid.org/0000-0003-2933-9000	en_US
dc.contributor.author	Jensen, SO	en_US
dc.contributor.author	Chan, R	en_US
dc.contributor.author	Van Hal, SJ	en_US
dc.date.available	2020-05-25T19:23:23Z
dc.date.issued	2018-06-01	en_US
dc.identifier.citation	Infection Control and Hospital Epidemiology, 2018, 39 (6), pp. 668 - 675	en_US
dc.identifier.issn	0899-823X	en_US
dc.identifier.uri	http://hdl.handle.net/10453/124090
dc.description.abstract	© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To describe the transmission dynamics of the emergence and persistence of vanA vancomycin-resistant enterococcus (VRE) in an intensive care unit (ICU) using whole-genome sequencing of patient and environmental isolates.DESIGN Retrospective cohort study.SETTING ICU in a tertiary referral center.PARTICIPANTS Patients admitted to the ICU over an 11-month period.METHODS VanA VRE isolated from patients (n=31) were sequenced using the Illumina MiSeq platform. Environmental samples from bed spaces, equipment, and waste rooms were collected. All vanA VRE-positive environmental samples (n=14) were also sequenced. Data were collected regarding patient ward and bed movements.RESULTS The 31 patient vanA VRE isolates were from screening (n=19), urine (n=4), bloodstream (n=3), skin/wound (n=3), and intra-abdominal (n=2) sources. The phylogeny from sequencing data confirmed several VRE clusters, with 1 group accounting for 38 of 45 isolates (84%). Within this cluster, cross-transmission was extensive and complex across the ICU. Directionality indicated that colonized patients contaminated environmental sites. Similarly, environmental sources not only led to patient colonization but also to infection. Notably, shared equipment acted as a conduit for transmission between different ICU areas. Infected patients, however, were not linked to further VRE transmission.CONCLUSIONS Genomic sequencing confirmed a predominantly clonal outbreak of VRE with complex transmission dynamics. The environmental reservoir, particularly from shared equipment, played a key role in ongoing VRE spread. This study provides evidence to support the use of multifaceted strategies, with an emphasis on measures to reduce bacterial burden in the environment, for successful VRE control.	en_US
dc.relation.ispartof	Infection Control and Hospital Epidemiology	en_US
dc.relation.isbasedon	10.1017/ice.2018.29	en_US
dc.subject.classification	Epidemiology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Gram-Positive Bacterial Infections	en_US
dc.subject.mesh	Cross Infection	en_US
dc.subject.mesh	Carbon-Oxygen Ligases	en_US
dc.subject.mesh	Bacterial Proteins	en_US
dc.subject.mesh	Anti-Bacterial Agents	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Sequence Analysis	en_US
dc.subject.mesh	Disease Outbreaks	en_US
dc.subject.mesh	Equipment Contamination	en_US
dc.subject.mesh	Infection Control	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Intensive Care Units	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Molecular Epidemiology	en_US
dc.subject.mesh	Tertiary Care Centers	en_US
dc.subject.mesh	Vancomycin-Resistant Enterococci	en_US
dc.title	Defining the Role of the Environment in the Emergence and Persistence of vanA Vancomycin-Resistant Enterococcus (VRE) in an Intensive Care Unit: A Molecular Epidemiological Study	en_US
dc.type	Journal Article
utslib.citation.volume	6	en_US
utslib.citation.volume	39	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Strength - ithree - Institute of Infection, Immunity and Innovation
utslib.copyright.status	open_access
pubs.issue	6	en_US
pubs.publication-status	Published	en_US
pubs.volume	39	en_US

Abstract:

© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. OBJECTIVE To describe the transmission dynamics of the emergence and persistence of vanA vancomycin-resistant enterococcus (VRE) in an intensive care unit (ICU) using whole-genome sequencing of patient and environmental isolates.DESIGN Retrospective cohort study.SETTING ICU in a tertiary referral center.PARTICIPANTS Patients admitted to the ICU over an 11-month period.METHODS VanA VRE isolated from patients (n=31) were sequenced using the Illumina MiSeq platform. Environmental samples from bed spaces, equipment, and waste rooms were collected. All vanA VRE-positive environmental samples (n=14) were also sequenced. Data were collected regarding patient ward and bed movements.RESULTS The 31 patient vanA VRE isolates were from screening (n=19), urine (n=4), bloodstream (n=3), skin/wound (n=3), and intra-abdominal (n=2) sources. The phylogeny from sequencing data confirmed several VRE clusters, with 1 group accounting for 38 of 45 isolates (84%). Within this cluster, cross-transmission was extensive and complex across the ICU. Directionality indicated that colonized patients contaminated environmental sites. Similarly, environmental sources not only led to patient colonization but also to infection. Notably, shared equipment acted as a conduit for transmission between different ICU areas. Infected patients, however, were not linked to further VRE transmission.CONCLUSIONS Genomic sequencing confirmed a predominantly clonal outbreak of VRE with complex transmission dynamics. The environmental reservoir, particularly from shared equipment, played a key role in ongoing VRE spread. This study provides evidence to support the use of multifaceted strategies, with an emphasis on measures to reduce bacterial burden in the environment, for successful VRE control.

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http://hdl.handle.net/10453/124090