title: Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex.
abstract: Vancomycin-resistant enterococci (VRE) have caused hospital outbreaks worldwide, and the vancomycin-resistance gene (vanA) has crossed genus boundaries to methicillin-resistant Staphylococcus aureus. Spread of VRE, therefore, represents an immediate threat for patient care and creates a reservoir of mobile resistance genes for other, more virulent pathogens. Evolutionary genetics, population structure, and geographic distribution of 411 VRE and vancomycin-susceptible Enterococcus faecium isolates, recovered from human and nonhuman sources and community and hospital reservoirs in 5 continents, identified a genetic lineage of E. faecium (complex-17) that has spread globally. This lineage is characterized by 1) ampicillin resistance, 2) a pathogenicity island, and 3) an association with hospital outbreaks. Complex-17 is an example of cumulative evolutionary processes that improved the relative fitness of bacteria in hospital environments. Preventing further spread of this epidemic E. faecium subpopulation is critical, and efforts should focus on the early disclosure of ampicillin-resistant complex-17 strains.
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands. r.willems@digd.azu.nl
authors.forename: Rob J L
authors.initials: RJ
authors.lastname: Willems
authors.forename: Janetta
authors.initials: J
authors.lastname: Top
authors.forename: Marga
authors.initials: M
authors.lastname: van Santen
authors.forename: D Ashley
authors.initials: DA
authors.lastname: Robinson
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Coque
authors.forename: Fernando
authors.initials: F
authors.lastname: Baquero
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D000349:Africa / Q000453:epidemiology; D000818:Animals; D001315:Australia / Q000453:epidemiology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism; D002415:Cats; D002417:Cattle; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D004285:Dogs; D016984:Enterococcus faecium / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D005060:Europe / Q000453:epidemiology; D019143:Evolution, Molecular; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D009656:North America / Q000453:epidemiology; D010403:Penicillin Resistance; D011995:Recombination, Genetic; D013020:South America / Q000453:epidemiology; D020713:Vancomycin Resistance
chemical_list: D001426:Bacterial Proteins