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Vancomycin-resistant enterococci with vanA gene in treated municipal wastewater and their association with human hospital strains.
Sci Total Environ. 2017 Dec 31; 609:633-643.ST

Abstract

Vancomycin-resistant enterococci (VRE) are pathogens of increasing medical importance. In Brno, Czech Republic, we collected 37 samples from the effluent of a wastewater treatment plant (WWTP), 21 surface swabs from hospital settings, and 59 fecal samples from hospitalized patients and staff. Moreover, we collected 284 gull cloacal swabs from the colony situated 35km downstream the WWTP. Samples were cultured selectively. Enterococci were identified using MALDI-TOF MS, phenotypically tested for susceptibility to antibiotics, and by PCR for occurrence of resistance and virulence genes. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to examine genotypic diversity. VRE carrying the vanA gene were found in 32 (86%, n=37) wastewater samples, from which we obtained 49 isolates: Enterococcus faecium (44) and Enterococcus gallinarum (2), Enterococcus casseliflavus (2), and Enterococcus raffinosus (1). From 33 (69%) of 48 inpatient stool samples, we obtained 39 vanA-carrying VRE, which belonged to E. faecium (33 isolates), Enterococcus faecalis (4), and Enterococcus raffinosus (2). Nearly one-third of the samples from hospital surfaces contained VRE with the vanA gene. VRE were not detected among gulls. Sixty-seven (84%, n=80) E. faecium isolates carried virulence genes hyl and/or esp. Virulence of E. faecalis was encoded by gelE, asa1, and cylA genes. A majority of the E. faecium isolates belonged to the clinically important sequence types ST17 (WWTP: 10 isolates; hospital: 4 isolates), ST18 (9;8), and ST78 (5;0). The remaining isolates belonged to ST555 (2;0), ST262 (1;6), ST273 (3;0), ST275 (1;0), ST549 (2;0), ST19 (0;1), ST323 (3;0), and ST884 (7;17). Clinically important enterococci carrying the vanA gene were almost continually detectable in the effluent of the WWTP, indicating insufficient removal of VRE during wastewater treatment and permanent shedding of these antibiotic resistant pathogens into the environment from this source. This represents a risk of their transmission to the environment.

Authors+Show Affiliations

Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic; CEITEC VFU, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic. Electronic address: oravcovav@vfu.cz.Department of Infectious Diseases, University Hospital Brno, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic.Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.CEITEC VFU, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic; Department of Infectious Diseases and Microbiology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.Department of Biology and Wildlife Diseases, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic; CEITEC VFU, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28763660

Citation

Oravcova, Veronika, et al. "Vancomycin-resistant Enterococci With vanA Gene in Treated Municipal Wastewater and Their Association With Human Hospital Strains." The Science of the Total Environment, vol. 609, 2017, pp. 633-643.
Oravcova V, Mihalcin M, Zakova J, et al. Vancomycin-resistant enterococci with vanA gene in treated municipal wastewater and their association with human hospital strains. Sci Total Environ. 2017;609:633-643.
Oravcova, V., Mihalcin, M., Zakova, J., Pospisilova, L., Masarikova, M., & Literak, I. (2017). Vancomycin-resistant enterococci with vanA gene in treated municipal wastewater and their association with human hospital strains. The Science of the Total Environment, 609, 633-643. https://doi.org/10.1016/j.scitotenv.2017.07.121
Oravcova V, et al. Vancomycin-resistant Enterococci With vanA Gene in Treated Municipal Wastewater and Their Association With Human Hospital Strains. Sci Total Environ. 2017 Dec 31;609:633-643. PubMed PMID: 28763660.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vancomycin-resistant enterococci with vanA gene in treated municipal wastewater and their association with human hospital strains. AU - Oravcova,Veronika, AU - Mihalcin,Matus, AU - Zakova,Jana, AU - Pospisilova,Lucie, AU - Masarikova,Martina, AU - Literak,Ivan, Y1 - 2017/07/28/ PY - 2017/03/24/received PY - 2017/07/10/revised PY - 2017/07/13/accepted PY - 2017/8/2/pubmed PY - 2018/8/14/medline PY - 2017/8/2/entrez KW - Antibiotic resistance KW - Clostridium difficile KW - Glycopeptides KW - Gull KW - Hospital KW - Wastewater treatment plant SP - 633 EP - 643 JF - The Science of the total environment JO - Sci. Total Environ. VL - 609 N2 - Vancomycin-resistant enterococci (VRE) are pathogens of increasing medical importance. In Brno, Czech Republic, we collected 37 samples from the effluent of a wastewater treatment plant (WWTP), 21 surface swabs from hospital settings, and 59 fecal samples from hospitalized patients and staff. Moreover, we collected 284 gull cloacal swabs from the colony situated 35km downstream the WWTP. Samples were cultured selectively. Enterococci were identified using MALDI-TOF MS, phenotypically tested for susceptibility to antibiotics, and by PCR for occurrence of resistance and virulence genes. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to examine genotypic diversity. VRE carrying the vanA gene were found in 32 (86%, n=37) wastewater samples, from which we obtained 49 isolates: Enterococcus faecium (44) and Enterococcus gallinarum (2), Enterococcus casseliflavus (2), and Enterococcus raffinosus (1). From 33 (69%) of 48 inpatient stool samples, we obtained 39 vanA-carrying VRE, which belonged to E. faecium (33 isolates), Enterococcus faecalis (4), and Enterococcus raffinosus (2). Nearly one-third of the samples from hospital surfaces contained VRE with the vanA gene. VRE were not detected among gulls. Sixty-seven (84%, n=80) E. faecium isolates carried virulence genes hyl and/or esp. Virulence of E. faecalis was encoded by gelE, asa1, and cylA genes. A majority of the E. faecium isolates belonged to the clinically important sequence types ST17 (WWTP: 10 isolates; hospital: 4 isolates), ST18 (9;8), and ST78 (5;0). The remaining isolates belonged to ST555 (2;0), ST262 (1;6), ST273 (3;0), ST275 (1;0), ST549 (2;0), ST19 (0;1), ST323 (3;0), and ST884 (7;17). Clinically important enterococci carrying the vanA gene were almost continually detectable in the effluent of the WWTP, indicating insufficient removal of VRE during wastewater treatment and permanent shedding of these antibiotic resistant pathogens into the environment from this source. This represents a risk of their transmission to the environment. SN - 1879-1026 UR - https://www.unboundmedicine.com/medline/citation/28763660/Vancomycin_resistant_enterococci_with_vanA_gene_in_treated_municipal_wastewater_and_their_association_with_human_hospital_strains_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0048-9697(17)31824-7 DB - PRIME DP - Unbound Medicine ER -