1 Vol.:(0123456789) Scientifc Reports | (2020) 10:18580 | https://doi.org/10.1038/s41598-020-75247-7 www.nature.com/scientificreports Dissemination of Verona Integron‑encoded Metallo‑β‑lactamase among clinical and environmental Enterobacteriaceae isolates in Ontario, Canada Philipp Kohler 1 , Nathalie Tijet 2 , Hyunjin C. Kim 1,3 , Jennie Johnstone 1 , Tom Edge 4,5 , Samir N. Patel 2,3 , Christine Seah 2 , Barbara Willey 1 , Brenda Coleman 1 , Karen Green 1 , Irene Armstrong 1,6 , Kevin Katz 3,7 , Matthew P. Muller 8 , Jef Powis 9 , Susan M. Poutanen 1,10 , David Richardson 11 , Alicia Sarabia 12 , Andrew Simor 3,13 , Allison McGeer 1,3 , Roberto G. Melano 2,3* & The Toronto Invasive Bacterial Diseases Network (TIBDN) * Surveillance data from Southern Ontario show that a majority of Verona Integron‑encoded Metallo‑ β‑lactamase (VIM)‑producing Enterobacteriaceae are locally acquired. To better understand the local epidemiology, we analysed clinical and environmental bla VIM ‑positive Enterobacteriaceae from the area. Clinical samples were collected within the Toronto Invasive Bacterial Diseases Network (2010– 2016); environmental water samples were collected in 2015. We gathered patient information on place of residence and hospital admissions prior to the diagnosis. Patients with and without plausible source of acquisition were compared regarding risk exposures. Microbiological isolates underwent whole‑ genome sequencing (WGS); bla VIM carrying plasmids were characterized. We identifed 15 patients, thereof 11 with bla VIM‑1 ‑positive Enterobacter hormaechei within two genetic clusters based on WGS. Whereas no obvious epidemiologic link was identifed among cluster I patients, those in cluster II were connected to a hospital outbreak. Except for patients with probable acquisition abroad, we did not identify any further risk exposures. Two bla VIM‑1 ‑positive E. hormaechei from environmental waters matched with the clinical clusters; plasmid sequencing suggested a common ancestor plasmid for the two clusters. These data show that both clonal spread and horizontal gene transfer are drivers of the dissemination of bla VIM‑1 ‑carrying Enterobacter hormaechei in hospitals and the aquatic environment in Southern Ontario, Canada. Te global dissemination of metallo-β-lactamases (MBLs) constitutes a severe threat to modern healthcare. MBLs exhibit a broad hydrolytic spectrum, which inactivates many currently used β-lactams. Te Verona Inte- gron-encoded Metallo-β-lactamase (VIM) is among the most common MBLs causing human infection 1 . Over the last decade this carbapenemase has become a serious health threat in healthcare institutions in countries such as Greece, Italy, and Spain 2–4 . It has been associated with outbreaks of hospital acquired infections due to Pseudomonas aeruginosa and Enterobacteriaceae, and has been found in both sewage and surface water in many OPEN 1 Sinai Health System, Toronto, ON, Canada. 2 Public Health Ontario Laboratory, Toronto, ON, Canada. 3 University of Toronto, Toronto, ON, Canada. 4 Environment and Climate Change Canada, Burlington, ON, Canada. 5 McMaster University, Hamilton, ON, Canada. 6 Toronto Public Health, Toronto, ON, Canada. 7 North York General Hospital, Toronto, ON, Canada. 8 St. Michael’s Hospital, Toronto, ON, Canada. 9 Michael Garron Hospital, Toronto, ON, Canada. 10 University Health Network, Toronto, ON, Canada. 11 William Osler Health System, Brampton, ON, Canada. 12 Trillium Health Partners, Toronto, ON, Canada. 13 Sunnybrook Health Sciences Centre, Toronto, ON, Canada. * A list of authors and their afliations appears at the end of the paper. * email: roberto.melano@ oahpp.ca