Outbreak of vancomycin-resistant Enterococcus faecium ST1133 in paediatric patients with acute lymphoblastic leukaemia from southern Brazil.

Autor: Vasconcelos TM; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil., Mesa D; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil., Rodrigues LS; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil., Medeiros Dos Santos É; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil; Hospital Pequeno Príncipe (HPP), Curitiba, Paraná, Brazil., Krul D; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil., Siqueira AC; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil., de Abreu RBV; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil., Motta FA; Hospital Pequeno Príncipe (HPP), Curitiba, Paraná, Brazil., Conte D; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil., Dalla-Costa LM; Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil. Electronic address: lmdallacosta@gmail.com.
Jazyk: angličtina
Zdroj: Journal of global antimicrobial resistance [J Glob Antimicrob Resist] 2024 Mar; Vol. 36, pp. 41-44. Date of Electronic Publication: 2023 Nov 23.
DOI: 10.1016/j.jgar.2023.11.005
Abstrakt: Objectives: We aimed to investigate an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in paediatric patients from Hospital Pequeno Príncipe. The susceptibility profile was determined, and whole-genome sequencing (WGS) was used to analyse the genetic context of the strains.
Methods: Five VREfm isolates were recovered from sterile sites and surveillance cultures of two paediatric patients with acute lymphoblastic leukaemia. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and the minimum inhibitory concentration (MIC) was assessed according to the European Committee for Antimicrobial Susceptibility Testing (EUCAST). WGS was performed to analyse the genetic context of virulence and resistance genes, and in silico multilocus sequence typing was performed to identify the sequence typing of the strains.
Results: High-level vancomycin resistance was observed in all isolates (≥256 mg/L). WGS revealed the presence of mobile genetic elements, such as plasmids (rep 2 , rep 11a , rep US15 , rep 17 , and rep 18a ), insertion sequences, and phages. Multiple resistance genes (aac(6')-aph(2"), dfrG, ermB, and vanA) and virulence genes (acm and efaAfm) were identified. All the isolates were assigned to ST117 (ST1133 - via a novel MLST), an important epidemic lineage associated with nosocomial infections and outbreaks.
Conclusion: Our results show that the ST117 (ST1133) VREfm isolates are circulating in paediatric patients, which raises a great concern. The development of new drugs as well as the implementation of an antimicrobial stewardship program are necessary for their correct management, limiting the spread of resistance in oncohematological patients.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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