Origin and transmission of carbapenemase-producing Enterobacterales and vancomycin-resistant Enterococci in hospitalized patients: a genomic and epidemiological analysis.

Background: Antimicrobial resistance is an emergent threat, with Carbapenemase-Producing Enterobacterales (CPE) and Vancomycin-Resistant Enterococcus (VRE) posing substantial challenges. We investigated CPE/VRE acquisition and spread in hospitalized patients by analysing resistance genes and microbiomes using whole genome sequencing (WGS) and exploring epidemiological and clinical risk factors.

Methods: This retrospective study included patients from the infectious disease department of a tertiary hospital. Stool samples were collected weekly, together with clinical and epidemiological information. Those in which CPE/VRE was isolated underwent WGS to evaluate the presence of resistance genes. Microbiome analysis was performed at admission and discharge. WGS was also performed for all positive samples collected within the hospital during the study period.

Results: Of the 102 participants, 16 (15.7%) had CPE/VRE at admission. Key risk factors for harbouring CPE/VRE at admission included recent hospitalization, surgery, and antibiotic use. The first week of hospitalization was critical for acquiring CPE/VRE, with dementia, central or urinary catheters, and carbapenem use being significant risk factors. CPE/VRE acquired post-admission shared resistance genes with circulating hospital strains, whereas those present at admission featured novel genes such as bla and optrA. Microbiome analysis revealed significant differences in species abundance and reduced diversity at discharge.

Conclusions: The probability of having CPE/VRE at admission to the infectious diseases department was high. Stringent infection control measures are essential for preventing CPE/VRE spread and the introduction of novel resistance genes.