{"entity": "publication", "iuid": "8a39ed8268da427f9f955b67ecc803bf", "timestamp": "2026-03-16T23:59:51.140Z", "links": {"self": {"href": "https://publications.scilifelab.se/publication/8a39ed8268da427f9f955b67ecc803bf.json"}, "display": {"href": "https://publications.scilifelab.se/publication/8a39ed8268da427f9f955b67ecc803bf"}}, "title": "A multicentre hospital outbreak in Sweden caused by introduction of a vanB2 transposon into a stably maintained pRUM-plasmid in an Enterococcus faecium ST192 clone.", "authors": [{"family": "Sivertsen", "given": "Audun", "initials": "A"}, {"family": "Billstr\u00f6m", "given": "Hanna", "initials": "H"}, {"family": "Melefors", "given": "\u00d6jar", "initials": "\u00d6"}, {"family": "Liljequist", "given": "Barbro Olsson", "initials": "BO"}, {"family": "Wisell", "given": "Karin Tegmark", "initials": "KT"}, {"family": "Ullberg", "given": "M\u00e5ns", "initials": "M"}, {"family": "\u00d6zenci", "given": "Volkan", "initials": "V"}, {"family": "Sundsfjord", "given": "Arnfinn", "initials": "A"}, {"family": "Hegstad", "given": "Kristin", "initials": "K"}], "type": "journal article", "published": "2014-08-25", "journal": {"volume": "9", "issn": "1932-6203", "issue": "8", "pages": "e103274", "title": "PLoS ONE", "issn-l": "1932-6203"}, "abstract": "The clonal dissemination of VanB-type vancomycin-resistant Enterococcus faecium (VREfm) strains in three Swedish hospitals between 2007 and 2011 prompted further analysis to reveal the possible origin and molecular characteristics of the outbreak strain. A representative subset of VREfm isolates (n\u200a=\u200a18) and vancomycin-susceptible E. faecium (VSEfm, n\u200a=\u200a2) reflecting the spread in time and location was approached by an array of methods including: selective whole genome sequencing (WGS; n\u200a=\u200a3), multi locus sequence typing (MLST), antimicrobial susceptibility testing, virulence gene profiling, identification of mobile genetic elements conferring glycopeptide resistance and their ability to support glycopeptide resistance transfer. In addition, a single VREfm strain with an unrelated PFGE pattern collected prior to the outbreak was examined by WGS. MLST revealed a predominance of ST192, belonging to a hospital adapted high-risk lineage harbouring several known virulence determinants (n\u226510). The VREfm outbreak strain was resistant to ampicillin, gentamicin, ciprofloxacin and vancomycin, and susceptible to teicoplanin. Consistently, a vanB2-subtype as part of Tn1549/Tn5382 with a unique genetic signature was identified in the VREfm outbreak strains. Moreover, Southern blot hybridisation analyses of PFGE separated S1 nuclease-restricted total DNAs and filter mating experiments showed that vanB2-Tn1549/Tn5382 was located in a 70-kb sized rep17/pRUM plasmid readily transferable between E. faecium. This plasmid contained an axe-txe toxin-antitoxin module associated with stable maintenance. The two clonally related VSEfm harboured a 40 kb rep17/pRUM plasmid absent of the 30 kb vanB2-Tn1549/Tn5382 gene complex. Otherwise, these two isolates were similar to the VREfm outbreak strain in virulence- and resistance profile. In conclusion, our observations support that the origin of the multicentre outbreak was caused by an introduction of vanB2-Tn1549/Tn5382 into a rep17/pRUM plasmid harboured in a pre-existing high-risk E. faecium ST192 clone. The subsequent dissemination of VREfm to other centres was primarily caused by clonal spread rather than plasmid transfer to pre-existing high-risk clones.", "doi": "10.1371/journal.pone.0103274", "pmid": "25153894", "labels": {"National Genomics Infrastructure": null, "NGI Stockholm (Genomics Applications)": null, "NGI Stockholm (Genomics Production)": null}, "xrefs": [{"db": "pii", "key": "PONE-D-14-06782"}, {"db": "pmc", "key": "PMC4143159"}], "notes": [], "created": "2017-05-04T14:58:57.820Z", "modified": "2020-01-21T13:56:03.523Z"}