摘要
      耐万古霉素粪肠球菌（VREfm）是一种机会性病原体，是全球公共和环境卫生的最高优先事项之一。根据“一个健康”方法，我们首次确定了同时从海洋海滩水域、污水处理厂的海底排水口和未经处理污水的海上排放中回收的VREfm的抗生素耐药性和毒力基因，以及序列类型（ST）隶属关系，并将其与克罗地亚地区大学医院的监测VREfm进行比较，以评估其传播的危险性和引入自然环境的途径。重要的是，从废水、沿海海水和医院中回收的VREfm具有相似的毒力、多药耐药性和ST特征，对公共健康构成了重大威胁。所有分离株都携带vanA基因，而一个临床分离株也携带vanC2/C3基因。医院菌株主要携带氨基糖苷类耐药基因aac（6′）-Ie-aph（2〃）-Ia、aph（1〃）-Ib和aph（3〃）-Id，这两个基因在环境分离株中也占主导地位。hyl基因是最普遍的毒力基因。这些分离株属于克隆复合体CC17的10个ST，CC17是一个与医院感染和疫情相关的主要流行病谱系，ST117和ST889在水传播和医院分离株中很常见，表明它们是污水驱动的传播。为了更好地了解所调查的水基质中伴随分类单元的多样性，使用基于Illumina的16S rDNA测序进行了微生物组分类分析，并使用PICRUSt2生物信息学工具预测了它们的抗性特征。另外还鉴定了60个病原菌属，其中弧杆菌属、不动杆菌属、埃希氏志贺菌属、拟杆菌属和假单胞菌属最为丰富，并与过多的抗生素抗性基因和模块有关，为废水排放（包括经处理的废水）的有害影响提供了进一步的证据，应从卫生和技术角度充分解决的自然水生环境问题。
Abstract
Vancomycin-resistant Enterococcus faecium (VREfm) is an opportunistic pathogen among the highest global priorities regarding public and environmental health. Following One Health approach, we determined for the first time the antibiotic resistance and virulence genes, and sequence types (STs) affiliation of VREfm recovered simultaneously from marine beach waters, submarine outfall of a wastewater treatment plant and an offshore discharge of untreated sewage, and compared them with the surveillance VREfm from regional university hospital in Croatia to assess the hazard of their transmission and routes of introduction into the natural environment. Importantly, VREfm recovered from wastewater, coastal bathing waters and hospital shared similar virulence, multidrug resistance, and ST profiles, posing a major public health threat. All isolates carried the vanA gene, while one clinical isolate also possessed the vanC2/C3 gene. The hospital strains largely carried the aminoglycoside-resistance genes aac(6′)-Ie-aph(2″)-Ia, and aph(2″)-Ib and aph(2″)-Id, which were also predominant in the environmental isolates. The hyl gene was the most prevalent virulence gene. The isolates belonged to 10 STs of the clonal complex CC17, a major epidemic lineage associated with hospital infections and outbreaks, with ST117 and ST889 common to waterborne and hospital isolates, pointing to their sewage-driven dissemination.

To gain better insight into the diversity of accompanying taxons in the surveyed water matrices, microbiome taxonomic profiling was carried out using Illumina-based 16S rDNA sequencing and their resistome features predicted using the PICRUSt2 bioinformatics tool. An additional 60 pathogenic bacterial genera were identified, among which Arcobacter, Acinetobacter, Escherichia-Shigella, Bacteroides and Pseudomonas were the most abundant and associated with a plethora of antibiotic resistance genes and modules, providing further evidence of the hazardous effects of wastewater discharges, including the treated ones, on the natural aquatic environment that should be adequately addressed from a sanitary and technological perspective.

https://www.sciencedirect.com/science/article/abs/pii/S0048969722068206