Characteristics and trends of clinical strains of enterococci resistant to vancomycin and/or linezolid isolated in France, 2006–2022

Introduction – Numerous outbreaks involving vancomycin-resistant enterococci (VRE) have been reported in France and around the world. In addition, the emergence of linezolid-resistant enterococci (LRE) has recently been described. The objective of this study is to describe the main characteristics of VRE and LRE strains isolated in France and received at the National Reference Center for Antibiotic Resistance between 2006 and 2022. Method – All strains received were characterized phenotypically (MALDI-TOF, susceptibility testing, minimum inhibitory concentration – MIC) and genotypically (real-time PCR, whole-genome sequencing). Typing and comparison of ERV strains were performed using various techniques over time (pulsed-field gel electrophoresis, rep-PCR, comparative genomic analysis, or Fourier transform infrared spectroscopy). Results – Of the 7,416 ERV strains received between 2006 and 2022, the vast majority belonged to the species Enterococcus faecium (91.8–98.8%), followed by E. faecalis (0.8–7.9%). The vanA gene was predominant (76.5%), followed by the vanB gene (22.2%). Nearly all E. faecium strains (>95%) belonged to clonal complex (CC) 17. Since 2017, a significant increase in ERL has been observed, linked to the spread in certain regions of epidemic strains exhibiting chromosomal resistance, as well as to the acquisition of plasmid genes (notably optrA and poxtA) by non-clonal strains. Molecular typing has demonstrated that many ERV clones (primarily E. faecium) were sporadic, while certain hyper-epidemic clones (isolated from ≥5 patients) were detected in several different facilities/cities with locoregional spread. Conclusion – The majority of ERV strains circulating in France are E. faecium strains adapted to the hospital environment (CC17) and carrying the vanA operon. There is also an alarming emergence of ERL strains that must be closely monitored.

Author(s): Zouari Asma, Auger Gabriel, Nogues Sophie, Collet Anaïs, Lecourt Maxime, Guérin François, Cattoir Vincent

Publishing year: 2023

Pages: 473-480

Weekly Epidemiological Bulletin, 2023, n° 22-23, p. 473-480

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