Whole Genome Sequencing (WGS) has seen growing utilisation as a tool to shape infection prevention and control measures. One of its anticipated uses is in the regional prospective surveillance of vancomycin-resistant Enterococcus faecium (VREfm), though the effectiveness of this application is currently unestablished. A recent study was embarked upon to evaluate the potential of routine centralised multicentre WGS in identifying and examining the transmission of VREfm within and amongst healthcare facilities.
Samples from VREfm isolates, taken from patients in five different hospitals in the Netherlands over a span of one year, underwent whole genome sequencing and were typed with core genome multilocus sequence typing (cgMLST). The sequence data were then synced with the specific patients’ admission data from the year leading up to their first positive VREfm culture. This allowed the researchers to determine the transmission events within and amongst the hospitals by merging the sequence data with the epidemiological data.
Out of the 57 VREfm isolates detected over the study period, it was found that approximately two-thirds (38/57 or 66.7%) could be grouped with at least one other isolate. With the definitions in use, it was possible to establish intra-hospital transmission in nearly all cases (37 out of 38) and inter-hospital transmission in a minority of cases (3 out of 38). Notably, this approach assisted in detecting a multicenter outbreak and two local outbreaks.
The study concludes that habitual whole genome sequencing of VRE can effectively assist in identifying and tracing outbreaks, and in delineating them. Integrating this method into a centralised surveillance system that spans across collaborative healthcare networks helps unveil the intricate dynamics of VRE transmission within and between hospitals, thereby empowering infection control strategies.
The research was conducted diligently, abiding by all relevant ethical guidelines. There were no conflicts of interest reported by the authors, and the necessary approvals for the study were attained from the regional medical ethics committee METC Brabant (NW2023-35). Moreover, every necessary patient and participant consent was attained and recorded appropriately. All the whole genome sequencing reads-files used for this research have been made available in the ENA database (study accession number PRJEB96955).
Source: https://www.medrxiv.org/content/10.1101/2025.10.02.25337224v1