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Title: Detection of vancomycin-resistant Enterococcus faecium hospital-adapted lineages in municipal wastewater treatment plants indicates widespread distribution and release into the environment
Authors: Theodore Gouliouris
Kathy E. Raven
Danesh Moradigaravand
Catherine Ludden
Francesc Coll
Beth Blane
Plamena Naydenova
Carolyne Horner
Nicholas M. Brown
Jukka Corander
Direk Limmathurotsakul
Julian Parkhill
Sharon J. Peacock
London School of Hygiene & Tropical Medicine
University of Cambridge
Addenbrooke's Hospital
Mahidol University
Universitetet i Oslo
Wellcome Sanger Institute
British Society for Antimicrobial Chemotherapy
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 1-Apr-2019
Citation: Genome Research. Vol.29, No.4 (2019), 626-634
Abstract: © 2019 Gouliouris et al. Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of healthcare-associated infection. Reservoirs of VREfm are largely assumed to be nosocomial although there is a paucity of data on alternative sources. Here, we describe an integrated epidemiological and genomic analysis of E. faecium associated with bloodstream infection and isolated from wastewater. Treated and untreated wastewater from 20 municipal treatment plants in the East of England, United Kingdom was obtained and cultured to isolate E. faecium, ampicillin-resistant E. faecium (AREfm), and VREfm. VREfm was isolated from all 20 treatment plants and was released into the environment by 17/20 plants, the exceptions using terminal ultraviolet light disinfection. Median log 10 counts of AREfm and VREfm in untreated wastewater from 10 plants in direct receipt of hospital sewage were significantly higher than 10 plants that were not. We sequenced and compared the genomes of 423 isolates from wastewater with 187 isolates associated with bloodstream infection at five hospitals in the East of England. Among 481 E. faecium isolates belonging to the hospital-adapted clade, we observed genetic intermixing between wastewater and bloodstream infection, with highly related isolates shared between a major teaching hospital in the East of England and 9/20 plants. We detected 28 antibiotic resistance genes in the hospital-adapted clade, of which 23 were represented in bloodstream, hospital sewage, and municipal wastewater isolates. We conclude that our findings are consistent with widespread distribution of hospital-adapted VREfm beyond acute healthcare settings with extensive release of VREfm into the environment in the East of England.
ISSN: 15495469
Appears in Collections:Scopus 2019

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