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In total, 517 <jats:italic>Enterococcus<\/jats:italic> spp. isolates were obtained from raw and treated sewage from five sewage treatment plants (STPs) over three sampling occasions, with <jats:italic>Enterococcus faecium<\/jats:italic> as the most prevalent (<jats:italic>n<\/jats:italic>\u2009=\u2009492) species. <jats:italic>E. faecium<\/jats:italic> strains (<jats:italic>n<\/jats:italic>\u2009=\u2009307) obtained from the influent samples, showed the highest resistance against quinupristin\/dalfopristin (67.8%). We observed reduced susceptibility to erythromycin (30.6%) and tetracycline (6.2%) in these strains. <jats:italic>E. faecium<\/jats:italic> strains (<jats:italic>n<\/jats:italic>\u2009=\u2009185) obtained from the effluent samples showed highest resistance against quinupristin\/dalfopristin (68.1%) and reduced susceptibility to erythromycin (24.9%) and tetracycline (8.6%). We did not detect resistance against last\u2010resort antibiotics, such as linezolid, vancomycin, and tigecycline in any of the strains. Multidrug\u2010resistant (MDR) <jats:italic>E. faecium<\/jats:italic> strains were detected in both influent (2.3%) and effluent (2.2%) samples. Whole genome sequencing of the <jats:italic>Enterococcus<\/jats:italic> spp. strains (<jats:italic>n<\/jats:italic>\u2009=\u200925) showed the presence of several antibiotic resistance genes, conferring resistance against aminoglycosides, tetracyclines, and macrolides, as well as several virulence genes and plasmid replicons. Two sequenced MDR strains from the effluents belonged to the hospital\u2010associated clonal complex 17 and carried multiple virulence genes. Our study demonstrates that clinically relevant MDR <jats:italic>Enterococcus<\/jats:italic> spp. strains are entering the marine environment through treated sewage.<\/jats:p>","DOI":"10.1002\/mbo3.1397","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T11:39:34Z","timestamp":1709638774000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Multidrug\u2010resistant <i>Enterococcus faecium<\/i> strains enter the Norwegian marine environment through treated sewage"],"prefix":"10.1002","volume":"13","author":[{"given":"Vera","family":"Radisic","sequence":"first","affiliation":[{"name":"Department of Contaminants and Biohazards Institute of Marine Research (IMR)  Bergen Norway"},{"name":"Department of Biological Sciences University of Bergen (UiB)  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didrik H.","family":"Grevskott","sequence":"additional","affiliation":[{"name":"Department of Contaminants and Biohazards Institute of Marine Research (IMR)  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadja","family":"Junghardt","sequence":"additional","affiliation":[{"name":"Department of Contaminants and Biohazards Institute of Marine Research (IMR)  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise","family":"\u00d8vre\u00e5s","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences University of Bergen (UiB)  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2955-3402","authenticated-orcid":false,"given":"Nachiket P.","family":"Marathe","sequence":"additional","affiliation":[{"name":"Department of Contaminants and Biohazards Institute of Marine Research (IMR)  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0732-8893(00)00130-9"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkz935"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro2761"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/cmb.2012.0021"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2015.05.091"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11033-022-07627-3"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaa345"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1128\/jb.188.8.2875-2884.2006"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00023-12"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02412-14"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/03079450701589167"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1750-3841.13523"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmni.2022.100977"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1099\/ijs.0.054171-0"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02686-14"},{"key":"e_1_2_11_17_1","unstructured":"ECDC. 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