An investigation of the prevalence and molecular epidemiology of vancomycin-resistant Enterococcus faecium in Irish hospitals using whole-genome sequencing

Vancomycin-resistant Enterococcus faecium (VREfm) is an antibiotic-resistant bacterium that causes serious infections among patients in hospitals. Ireland has the highest level of VREfm causing life-threatening bloodstream infections (BSIs) in Europe but little is known about how it has emerged and spread here or the genetic relationships between VREfm in Irish hospitals. This is partly because scientific methods to accurately investigate this have not been available until recently. Currently, only a small proportion of patients in Irish hospitals are routinely tested for rectal carriage of VREfm (i.e. those deemed to be at-risk of VREfm infections). Patients found to be VREfm-positive patients are isolated in separate rooms/wards, which incurs extensive healthcare costs. This study aims to investigate how commonly patients in an entire large Irish hospital carry VREfm and to examine the genetic characteristics of VREfm from Irish hospitals using state-of-the-art laboratory techniques i.e. whole-genome sequencing (WGS), that examine the entire genetic content of VREfm. Patients on all wards of St. James's Hospital Dublin will be tested for VREfm as part of routine hospital rectal screening and frequently touched hospital surfaces and air will also be tested for VREfm. VREfm identified in six additional Irish hospitals from routine testing of patients will also be included in the study as well as VREfm from BSIs from all hospitals involved. For the purposes of comparison, vancomycin-susceptible E. faecium (VSEfm), that are more readily treatable with antibiotics than VREfm, will also be investigated from BSIs from all hospitals as VSEfm can develop into VREfm following exposure to antibiotics. This detailed comparison of the genomes of all VREfm/VSEfm, will, for the first time, provide accurate information on how VREfm have emerged and spread in Irish hospitals. This information will be used to update national procedures for testing patients for VREfm in order to reduce patient infections.

Award Date
27 June 2019
Award Value
Principal Investigator
Professor David Coleman
Host Institution
Dublin Dental University Hospital
Investigator Led Projects