Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study
Background: The emerging ST80 vancomycin-resistant Enterococcus faecium (VREfm) lineage, linked to the increases of clinical infections in China and Japan, raises concerns about environmental transmission. Hospital wastewater systems are recognized reservoirs for antimicrobial-resistant bacteria, bu...
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Elsevier
2025-06-01
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| Series: | International Journal of Medical Microbiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1438422125000141 |
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| author | Liling Zhang Minxuan Su Shaowei Meng Xuan Zhang Hao Wu Meina Wu Xiaojun Ao Xiaoyue Zhang Jiehao Lin Shijia Yu Yuqi Hong Xiucheng Zeng Shuyi Huang Yuxin Zhang Bangjie Yang Ni Zhang Yueting Jiang Lingqing Xu Zhongde Zhang Cha Chen Cong Shen |
| author_facet | Liling Zhang Minxuan Su Shaowei Meng Xuan Zhang Hao Wu Meina Wu Xiaojun Ao Xiaoyue Zhang Jiehao Lin Shijia Yu Yuqi Hong Xiucheng Zeng Shuyi Huang Yuxin Zhang Bangjie Yang Ni Zhang Yueting Jiang Lingqing Xu Zhongde Zhang Cha Chen Cong Shen |
| author_sort | Liling Zhang |
| collection | DOAJ |
| description | Background: The emerging ST80 vancomycin-resistant Enterococcus faecium (VREfm) lineage, linked to the increases of clinical infections in China and Japan, raises concerns about environmental transmission. Hospital wastewater systems are recognized reservoirs for antimicrobial-resistant bacteria, but their role in disseminating ST80 VREfm remains unclear. This study investigates VREfm prevalence in hospital wastewater and genomic links between patients and hospital wastewater. Methods: From December 2023 to May 2024, a total of 262 wastewater samples were collected from three hospitals in Guangzhou, China. VREfm was identified using vancomycin-supplemented media. Antimicrobial susceptibility was assessed using the broth dilution method. Ninety-five patient-derived VREfm genomes in the same hospitals were included. Whole-genome sequencing and bioinformatic analysis were performed to reveal genomic characterizations and genetic transmission links. Results: VREfm was detected in 54.6 % (143/262) of samples. All isolates carried vanA, with 25.9 % (37/143) co-harboring vanA and vanM. The dominant ST80 lineage (43.4 %, n = 62) was linked to recent regional prevalence. A novel sequence type ST2460, belonging to CC17, emerged as the second most prevalent (27.2 %, n = 39). ST80 isolates exhibited enriched antimicrobial resistance genes, correlating with multidrug resistance phenotypes and high resistance rates. Genomic analysis revealed that 95.7 % (132/138) of ST80 isolates from wastewater and patients exhibited close genetic relatedness (median of SNP = 19, IQR: 14–23) and were linked within cross-source transmission networks, supported by the high similarity of a shared p23VRE019-like plasmid. Conclusions: Hospital wastewater is a critical reservoir for high-risk VREfm clones, particularly the outbreak-associated ST80 lineage. The persistence of VREfm in effluents and evidence of cross-source transmission underscores the urgent need for enhanced environmental surveillance. Integrated strategies addressing environmental reservoirs are essential to combat the growing threat of VREfm. |
| format | Article |
| id | doaj-art-7190ac1b6878499cb4fd8a942f5daf10 |
| institution | Kabale University |
| issn | 1438-4221 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | International Journal of Medical Microbiology |
| spelling | doaj-art-7190ac1b6878499cb4fd8a942f5daf102025-08-20T03:45:30ZengElsevierInternational Journal of Medical Microbiology1438-42212025-06-0131915165810.1016/j.ijmm.2025.151658Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological studyLiling Zhang0Minxuan Su1Shaowei Meng2Xuan Zhang3Hao Wu4Meina Wu5Xiaojun Ao6Xiaoyue Zhang7Jiehao Lin8Shijia Yu9Yuqi Hong10Xiucheng Zeng11Shuyi Huang12Yuxin Zhang13Bangjie Yang14Ni Zhang15Yueting Jiang16Lingqing Xu17Zhongde Zhang18Cha Chen19Cong Shen20The Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine/Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine/Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine/Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaDepartment of Otolaryngology, Hospital of Honghe State Affiliated to Kunming Medical University, Southern Central Hospital of Yunnan Province, Mengzi, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaClinical Laboratory, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaClinical Laboratory, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaThe Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, ChinaThe Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Correspondence to: State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Neihuanxi Road, Guangzhou 510080, China.The Second Clinical Medical College, Guangzhou University of Chinese Medicine, State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; State Key Laboratory of Dampness Syndrome of Chinese Medicine/Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, China; Correspondence to: State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Dade Road, Guangzhou 510080, China.Background: The emerging ST80 vancomycin-resistant Enterococcus faecium (VREfm) lineage, linked to the increases of clinical infections in China and Japan, raises concerns about environmental transmission. Hospital wastewater systems are recognized reservoirs for antimicrobial-resistant bacteria, but their role in disseminating ST80 VREfm remains unclear. This study investigates VREfm prevalence in hospital wastewater and genomic links between patients and hospital wastewater. Methods: From December 2023 to May 2024, a total of 262 wastewater samples were collected from three hospitals in Guangzhou, China. VREfm was identified using vancomycin-supplemented media. Antimicrobial susceptibility was assessed using the broth dilution method. Ninety-five patient-derived VREfm genomes in the same hospitals were included. Whole-genome sequencing and bioinformatic analysis were performed to reveal genomic characterizations and genetic transmission links. Results: VREfm was detected in 54.6 % (143/262) of samples. All isolates carried vanA, with 25.9 % (37/143) co-harboring vanA and vanM. The dominant ST80 lineage (43.4 %, n = 62) was linked to recent regional prevalence. A novel sequence type ST2460, belonging to CC17, emerged as the second most prevalent (27.2 %, n = 39). ST80 isolates exhibited enriched antimicrobial resistance genes, correlating with multidrug resistance phenotypes and high resistance rates. Genomic analysis revealed that 95.7 % (132/138) of ST80 isolates from wastewater and patients exhibited close genetic relatedness (median of SNP = 19, IQR: 14–23) and were linked within cross-source transmission networks, supported by the high similarity of a shared p23VRE019-like plasmid. Conclusions: Hospital wastewater is a critical reservoir for high-risk VREfm clones, particularly the outbreak-associated ST80 lineage. The persistence of VREfm in effluents and evidence of cross-source transmission underscores the urgent need for enhanced environmental surveillance. Integrated strategies addressing environmental reservoirs are essential to combat the growing threat of VREfm.http://www.sciencedirect.com/science/article/pii/S1438422125000141Enterococcus faeciumVancomycinHospital wastewaterMolecular epidemiologyWhole-genome sequencingTransmission |
| spellingShingle | Liling Zhang Minxuan Su Shaowei Meng Xuan Zhang Hao Wu Meina Wu Xiaojun Ao Xiaoyue Zhang Jiehao Lin Shijia Yu Yuqi Hong Xiucheng Zeng Shuyi Huang Yuxin Zhang Bangjie Yang Ni Zhang Yueting Jiang Lingqing Xu Zhongde Zhang Cha Chen Cong Shen Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study International Journal of Medical Microbiology Enterococcus faecium Vancomycin Hospital wastewater Molecular epidemiology Whole-genome sequencing Transmission |
| title | Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study |
| title_full | Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study |
| title_fullStr | Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study |
| title_full_unstemmed | Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study |
| title_short | Occurrence of vanA/vanM-positive vancomycin-resistant Enterococcus faecium in hospital wastewater associated with clinical infections in Guangzhou, China: A genomic epidemiological study |
| title_sort | occurrence of vana vanm positive vancomycin resistant enterococcus faecium in hospital wastewater associated with clinical infections in guangzhou china a genomic epidemiological study |
| topic | Enterococcus faecium Vancomycin Hospital wastewater Molecular epidemiology Whole-genome sequencing Transmission |
| url | http://www.sciencedirect.com/science/article/pii/S1438422125000141 |
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