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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 identified 15 patients, thereof 11 with  bla  VIM-1 -positive  Enterobacter hormaechei  within two genetic clusters based on WGS. Whereas no obvious epidemiologic link was identified 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.

Dissemination of Verona Integron-encoded Metallo-β-lactamase among clinical and environmental Enterobacteriaceae isolates in Ontario, Canada