Randomized trial reveals within-patient diversity and transmission of vancomycin-resistant Enterococcus faecium, indicating improved detection of transmission events.
Key Points
To assess the within-patient diversity and transmission dynamics of vancomycin-resistant Enterococcus faecium using culture-enriched metagenomic sequencing.
Applied culture-enriched metagenomic sequencing to matched GI tract and blood VREfm populations from 35 patients.
Samples collected ≤14 days apart from patients with positive VREfm blood cultures between 2020 and 2025.
Compared 70 metagenomic VREfm populations to 470 contemporary clinical isolate genomes for transmission assessment.
Identified 19 putative transmission clusters, including 6 clusters with multi-strain populations.
GI tract populations showed greater diversity compared to bloodstream populations, with multi-strain colonization in five patients.
Variant analysis suggested distinct environment-specific pressures between GI tract and bloodstream environments.