Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022

Anette M. Hammerum; Kasper Thystrup Karstensen; Louise Roer; Hülya Kaya; Mikkel Lindegaard; Lone Jannok Porsbo; Anne Kjerulf; Mette Pinholt; Barbara Juliane Holzknecht; Peder Worning; Karen Leth Nielsen; Sanne Grønvall Kjær Hansen; Marianne Clausen; Turid S. Søndergaard; Esad Dzajic; Claus Østergaard; Mikala Wang; Kristoffer Koch; Henrik Hasman

doi:10.2807/1560-7917.ES.2024.29.23.2300633

Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022

Anette M. Hammerum^*, Kasper Thystrup Karstensen, Louise Roer, Hülya Kaya, Mikkel Lindegaard, Lone Jannok Porsbo, Anne Kjerulf, Mette Pinholt, Barbara Juliane Holzknecht, Peder Worning, Karen Leth Nielsen, Sanne Grønvall Kjær Hansen, Marianne Clausen, Turid S. Søndergaard, Esad Dzajic, Claus Østergaard, Mikala Wang, Kristoffer Koch, Henrik Hasman

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

4 Citationer (Scopus)

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Abstract

What did you want to address in this study and why?

Vancomycin is an antibiotic used to treat serious infections caused by multidrug-resistant bacteria. Vancomycin-resistant enterococci (VRE) are bacteria that can cause infections there are difficult to treat; they have become more frequent in Denmark and Europe in the last decade. Infections with VRE enterococci can be treated with another antibiotic: linezolid. We wanted to investigate how many vancomycin-resistant Enterococci were also resistant to linezolid.

What have we learnt from this study?

Detections of VRE in Denmark have increased from 520 isolates in 2015 to 827 isolates in 2022. During those years, the highest number of VRE occurred in the Capital Region of Denmark. From 2019 to 2022, VRE and VVE in this region decreased, but VRE increased in the Zealand Region, Central Denmark Region and North Denmark Region. Only 1% of the vancomycin-resistant enterococci were also resistant to linezolid.

What are the implications of your findings for public health?

The increase in VRE is of concern because this can lead to an increase in the use of other antimicrobial agents i.e. linezolid or daptomycin. Moreover, finding VRE that are also resistant to linezolid, even though the numbers are low, is a concern because the treatment options for such infections are very limited.

Originalsprog	Engelsk
Tidsskrift	Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
Vol/bind	29
Udgave nummer	23
Antal sider	11
ISSN	1025-496X
DOI	https://doi.org/10.2807/1560-7917.ES.2024.29.23.2300633
Status	Udgivet - 2024

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10.2807/1560-7917.ES.2024.29.23.2300633Licens: CC BY

FulltextForlagets udgivne version, 741 KBLicens: CC BY

Citationsformater

Hammerum, A. M., Karstensen, K. T., Roer, L., Kaya, H., Lindegaard, M., Porsbo, L. J., Kjerulf, A., Pinholt, M., Holzknecht, B. J., Worning, P., Nielsen, K. L., Hansen, S. G. K., Clausen, M., Søndergaard, T. S., Dzajic, E., Østergaard, C., Wang, M., Koch, K., & Hasman, H. (2024). Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 29(23). https://doi.org/10.2807/1560-7917.ES.2024.29.23.2300633

Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022. / Hammerum, Anette M.; Karstensen, Kasper Thystrup; Roer, Louise; Kaya, Hülya; Lindegaard, Mikkel; Porsbo, Lone Jannok; Kjerulf, Anne; Pinholt, Mette; Holzknecht, Barbara Juliane; Worning, Peder; Nielsen, Karen Leth; Hansen, Sanne Grønvall Kjær; Clausen, Marianne; Søndergaard, Turid S.; Dzajic, Esad; Østergaard, Claus; Wang, Mikala; Koch, Kristoffer; Hasman, Henrik.

I: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, Bind 29, Nr. 23, 2024.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Hammerum, AM, Karstensen, KT, Roer, L, Kaya, H, Lindegaard, M, Porsbo, LJ, Kjerulf, A, Pinholt, M, Holzknecht, BJ, Worning, P, Nielsen, KL, Hansen, SGK, Clausen, M, Søndergaard, TS, Dzajic, E, Østergaard, C, Wang, M, Koch, K & Hasman, H 2024, 'Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022', Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, bind 29, nr. 23. https://doi.org/10.2807/1560-7917.ES.2024.29.23.2300633

Hammerum AM, Karstensen KT, Roer L, Kaya H, Lindegaard M, Porsbo LJ et al. Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2024;29(23). https://doi.org/10.2807/1560-7917.ES.2024.29.23.2300633

Hammerum, Anette M. ; Karstensen, Kasper Thystrup ; Roer, Louise ; Kaya, Hülya ; Lindegaard, Mikkel ; Porsbo, Lone Jannok ; Kjerulf, Anne ; Pinholt, Mette ; Holzknecht, Barbara Juliane ; Worning, Peder ; Nielsen, Karen Leth ; Hansen, Sanne Grønvall Kjær ; Clausen, Marianne ; Søndergaard, Turid S. ; Dzajic, Esad ; Østergaard, Claus ; Wang, Mikala ; Koch, Kristoffer ; Hasman, Henrik. / Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022. I: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2024 ; Bind 29, Nr. 23.

@article{a960f142ae1a4cdb8cb529afb0729669,

title = "Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022",

abstract = "BackgroundVancomycin-resistant enterococci (VRE) are increasing in Denmark and Europe. Linezolid and vancomycin-resistant enterococci (LVRE) are of concern, as treatment options are limited. Vancomycin-variable enterococci (VVE) harbour the vanA gene complex but are phenotypically vancomycin-susceptible.AimThe aim was to describe clonal shifts for VRE and VVE in Denmark between 2015 and 2022 and to investigate genotypic linezolid resistance among the VRE and VVE.MethodsFrom 2015 to 2022, 4,090 Danish clinical VRE and VVE isolates were whole genome sequenced. We extracted vancomycin resistance genes and sequence types (STs) from the sequencing data and performed core genome multilocus sequence typing (cgMLST) analysis for Enterococcus faecium. All isolates were tested for the presence of mutations or genes encoding linezolid resistance.ResultsIn total 99% of the VRE and VVE isolates were E. faecium. From 2015 through 2019, 91.1% of the VRE and VVE were vanA E. faecium. During 2020, to the number of vanB E. faecium increased to 254 of 509 VRE and VVE isolates. Between 2015 and 2022, seven E. faecium clusters dominated: ST80-CT14 vanA, ST117-CT24 vanA, ST203-CT859 vanA, ST1421-CT1134 vanA (VVE cluster), ST80-CT1064 vanA/vanB, ST117-CT36 vanB and ST80-CT2406 vanB. We detected 35 linezolid vancomycin-resistant E. faecium and eight linezolid-resistant VVEfm.ConclusionFrom 2015 to 2022, the numbers of VRE and VVE increased. The spread of the VVE cluster ST1421-CT1134 vanA E. faecium in Denmark is a concern, especially since VVE diagnostics are challenging. The finding of LVRE, although in small numbers, ia also a concern, as treatment options are limited.",

keywords = ", Enterococcus faecium, cgMLST, Enterococcus faecalis, LRE, LVRE, MLST, VRE, WGS",

author = "Hammerum, {Anette M.} and Karstensen, {Kasper Thystrup} and Louise Roer and H{\"u}lya Kaya and Mikkel Lindegaard and Porsbo, {Lone Jannok} and Anne Kjerulf and Mette Pinholt and Holzknecht, {Barbara Juliane} and Peder Worning and Nielsen, {Karen Leth} and Hansen, {Sanne Gr{\o}nvall Kj{\ae}r} and Marianne Clausen and S{\o}ndergaard, {Turid S.} and Esad Dzajic and Claus {\O}stergaard and Mikala Wang and Kristoffer Koch and Henrik Hasman",

year = "2024",

doi = "10.2807/1560-7917.ES.2024.29.23.2300633",

language = "English",

volume = "29",

journal = "Eurosurveillance",

issn = "1025-496X",

publisher = "Centre Europeen pour la Surveillance Epidemiologique du SIDA",

number = "23",

}

TY - JOUR

T1 - Surveillance of vancomycin-resistant enterococci reveals shift in dominating clusters from vanA to vanB Enterococcus faecium clusters, Denmark, 2015 to 2022

AU - Hammerum, Anette M.

AU - Karstensen, Kasper Thystrup

AU - Roer, Louise

AU - Kaya, Hülya

AU - Lindegaard, Mikkel

AU - Porsbo, Lone Jannok

AU - Kjerulf, Anne

AU - Pinholt, Mette

AU - Holzknecht, Barbara Juliane

AU - Worning, Peder

AU - Nielsen, Karen Leth

AU - Hansen, Sanne Grønvall Kjær

AU - Clausen, Marianne

AU - Søndergaard, Turid S.

AU - Dzajic, Esad

AU - Østergaard, Claus

AU - Wang, Mikala

AU - Koch, Kristoffer

AU - Hasman, Henrik

PY - 2024

Y1 - 2024

N2 - BackgroundVancomycin-resistant enterococci (VRE) are increasing in Denmark and Europe. Linezolid and vancomycin-resistant enterococci (LVRE) are of concern, as treatment options are limited. Vancomycin-variable enterococci (VVE) harbour the vanA gene complex but are phenotypically vancomycin-susceptible.AimThe aim was to describe clonal shifts for VRE and VVE in Denmark between 2015 and 2022 and to investigate genotypic linezolid resistance among the VRE and VVE.MethodsFrom 2015 to 2022, 4,090 Danish clinical VRE and VVE isolates were whole genome sequenced. We extracted vancomycin resistance genes and sequence types (STs) from the sequencing data and performed core genome multilocus sequence typing (cgMLST) analysis for Enterococcus faecium. All isolates were tested for the presence of mutations or genes encoding linezolid resistance.ResultsIn total 99% of the VRE and VVE isolates were E. faecium. From 2015 through 2019, 91.1% of the VRE and VVE were vanA E. faecium. During 2020, to the number of vanB E. faecium increased to 254 of 509 VRE and VVE isolates. Between 2015 and 2022, seven E. faecium clusters dominated: ST80-CT14 vanA, ST117-CT24 vanA, ST203-CT859 vanA, ST1421-CT1134 vanA (VVE cluster), ST80-CT1064 vanA/vanB, ST117-CT36 vanB and ST80-CT2406 vanB. We detected 35 linezolid vancomycin-resistant E. faecium and eight linezolid-resistant VVEfm.ConclusionFrom 2015 to 2022, the numbers of VRE and VVE increased. The spread of the VVE cluster ST1421-CT1134 vanA E. faecium in Denmark is a concern, especially since VVE diagnostics are challenging. The finding of LVRE, although in small numbers, ia also a concern, as treatment options are limited.

AB - BackgroundVancomycin-resistant enterococci (VRE) are increasing in Denmark and Europe. Linezolid and vancomycin-resistant enterococci (LVRE) are of concern, as treatment options are limited. Vancomycin-variable enterococci (VVE) harbour the vanA gene complex but are phenotypically vancomycin-susceptible.AimThe aim was to describe clonal shifts for VRE and VVE in Denmark between 2015 and 2022 and to investigate genotypic linezolid resistance among the VRE and VVE.MethodsFrom 2015 to 2022, 4,090 Danish clinical VRE and VVE isolates were whole genome sequenced. We extracted vancomycin resistance genes and sequence types (STs) from the sequencing data and performed core genome multilocus sequence typing (cgMLST) analysis for Enterococcus faecium. All isolates were tested for the presence of mutations or genes encoding linezolid resistance.ResultsIn total 99% of the VRE and VVE isolates were E. faecium. From 2015 through 2019, 91.1% of the VRE and VVE were vanA E. faecium. During 2020, to the number of vanB E. faecium increased to 254 of 509 VRE and VVE isolates. Between 2015 and 2022, seven E. faecium clusters dominated: ST80-CT14 vanA, ST117-CT24 vanA, ST203-CT859 vanA, ST1421-CT1134 vanA (VVE cluster), ST80-CT1064 vanA/vanB, ST117-CT36 vanB and ST80-CT2406 vanB. We detected 35 linezolid vancomycin-resistant E. faecium and eight linezolid-resistant VVEfm.ConclusionFrom 2015 to 2022, the numbers of VRE and VVE increased. The spread of the VVE cluster ST1421-CT1134 vanA E. faecium in Denmark is a concern, especially since VVE diagnostics are challenging. The finding of LVRE, although in small numbers, ia also a concern, as treatment options are limited.

KW - , Enterococcus faecium

KW - cgMLST

KW - Enterococcus faecalis

KW - LRE

KW - LVRE

KW - MLST

KW - VRE

KW - WGS

U2 - 10.2807/1560-7917.ES.2024.29.23.2300633

DO - 10.2807/1560-7917.ES.2024.29.23.2300633

M3 - Journal article

C2 - 38847117

AN - SCOPUS:85195438560

VL - 29

JO - Eurosurveillance

JF - Eurosurveillance

SN - 1025-496X

IS - 23

ER -