TY - JOUR AU - Willems, Rob J.L. AU - Top, Janetta AU - van Santen, Marga AU - Robinson, D. Ashley AU - Coque, Teresa AU - Baquero, Fernando AU - Grundmann, Hajo AU - Bonten, Marc J.M. T1 - Global Spread of Vancomycin-resistant Enterococcus faecium from Distinct Nosocomial Genetic Complex T2 - Emerging Infectious Disease journal PY - 2005 VL - 11 IS - 6 SP - 821 SN - 1080-6059 AB - 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. KW - Keywords: molecular epidemiology KW - Enterococcus faecium KW - Multilocus Sequence Typing KW - Population structure KW - Genetic evolution KW - VRE KW - vancomycin-resistance DO - 10.3201/eid1106.041204 UR - https://wwwnc.cdc.gov/eid/article/11/6/04-1204_article ER - End of Reference