Dissemination of Verona Integron-encoded Metallo-β-lactamase among clinical and environmental Enterobacteriaceae isolates in Ontario, Canada
Philipp Köhler, Nathalie Tijet, Hyunjin Cindy Kim, Jennie Johnstone, Tom Edge, Samir N. Patel, Christine Seah, Barbara Willey, Brenda L. Coleman, Karen Green, Irene Armstrong, Kevin Katz, Matthew Muller, Jeff Powis, Susan M. Poutanen, David Richardson, Alicia Sarabia, Andrew E. Simor, Allison McGeer, Roberto G. Melano, The Toronto Invasive Bacterial Diseases Network (TIBDN), Agron Plevneshi, Wallis Rudnick, Frances Jamieson, Barbara Yaffe, Larissa Matukas, James M. Downey, Wayne L. Gold, Sharon Walmsley, Mahin Baqi, Mary Vearncombe, Abdelbaset Belhaj, Ian Kitai, Danny Z. Chen, Eileen de Villa, Hani L. N. Dick, Nataly Farshait, K. Lee, Sigmund Krajden, Michael Lingley, Reena Lovinsky, David Rose, Sharon O’Grady, Anne Opavsky, Krystyna Ostrowska, Astrid Petrich, Susan E. Richardson, Neil Rau, Daniel Ricciuto, Valérie Sales, Deborah Yamamura
Abstract
Abstract Surveillance data from Southern Ontario show that a majority of Verona Integron-encoded Metallo-β-lactamase (VIM)-producing Enterobacteriaceae are locally acquired. To better understand the local epidemiology, we analysed clinical and environmental bla VIM -positive Enterobacteriaceae from the area. Clinical samples were collected within the Toronto Invasive Bacterial Diseases Network (2010–2016); environmental water samples were collected in 2015. We gathered patient information on place of residence and hospital admissions prior to the diagnosis. Patients with and without plausible source of acquisition were compared regarding risk exposures. Microbiological isolates underwent whole-genome sequencing (WGS); bla VIM carrying plasmids were characterized. We identified 15 patients, thereof 11 with bla VIM-1 -positive Enterobacter hormaechei within two genetic clusters based on WGS. Whereas no obvious epidemiologic link was identified among cluster I patients, those in cluster II were connected to a hospital outbreak. Except for patients with probable acquisition abroad, we did not identify any further risk exposures. Two bla VIM-1 -positive E. hormaechei from environmental waters matched with the clinical clusters; plasmid sequencing suggested a common ancestor plasmid for the two clusters. These data show that both clonal spread and horizontal gene transfer are drivers of the dissemination of bla VIM-1 -carrying Enterobacter hormaechei in hospitals and the aquatic environment in Southern Ontario, Canada.