Emerging Infectious Disease ISSN: 1080-6059

Epidemic and Nonepidemic Multidrug-Resistant Enterococcus faecium

Helen L. Leavis*†, Rob J.L. Willems†, Janetta Top†, Emile Spalburg†, Ellen M. Mascini*, Ad C. Fluit*, Andy Hoepelman*, Albert J. de Neeling†, and Marc J.M. Bonten*

Author affiliations: *University Medical Center Utrecht, Utrecht, the Netherlands; †National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands

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Figure 3

Hypothetical evolutionary scheme for Enterococcus faecium genotypes and phenotypes from an ancestral E. faecium type. Open slices indicate esp-negative, ampicillin-susceptible, and vancomycin-susceptible. Closed slices indicate esp-positive, ampicillin-resistant, and vancomycin-resistant. Numbers indicate the number of strains. Arrows indicate the putative evolutionary direction. Clin-Inf, clinical infectious; Clin-Surv, clinical survey; Comm-Surv, community survey. a, dominant genogroup (A,C) f

Figure 3. Hypothetical evolutionary scheme for Enterococcus faecium genotypes and phenotypes from an ancestral E. faecium type. Open slices indicate esp-negative, ampicillin-susceptible, and vancomycin-susceptible. Closed slices indicate esp-positive, ampicillin-resistant, and vancomycin-resistant. Numbers indicate the number of strains. Arrows indicate the putative evolutionary direction. Clin-Inf, clinical infectious; Clin-Surv, clinical survey; Comm-Surv, community survey. ^a, dominant genogroup (A,C) for vancomycin-resistant enterococci and dominant cluster (2,3,4) for vancomycin-susceptible enterococci. ^b, clinical relevant strains (“yes”) are the total of epidemic and clinical infectious isolates, clinical nonrelevant strains (“no”) are the total of clinical and community survey isolates.

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