{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:29:43Z","timestamp":1777922983231,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:00:00Z","timestamp":1603843200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:p>\n                    The purpose of the study was to investigate the molecular characteristics and genetic relatedness of the first reported cases of vancomycin-resistant enterococci (VRE) from the Tripoli Medical Center, Libya. In total, 43 VRE isolates were obtained from various clinical sites throughout the years 2013\u20132014, including 40\n                    <jats:italic toggle=\"yes\">vanA<\/jats:italic>\n                    -type and 2\n                    <jats:italic toggle=\"yes\">vanB-<\/jats:italic>\n                    type vancomycin-resistant\n                    <jats:italic toggle=\"yes\">Enterococcus faecium<\/jats:italic>\n                    isolates and 1\n                    <jats:italic toggle=\"yes\">vanC1<\/jats:italic>\n                    -type\n                    <jats:italic toggle=\"yes\">Enterococcus gallinarum<\/jats:italic>\n                    . Of the 42\n                    <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                    , 19 isolates were subjected to whole genome sequencing. Core genome multilocus sequence typing (cgMLST) analysis revealed three sequence clusters (SCs) of clonally related isolates, which were linked to different hospital wards. The first two VRE isolates, isolated early 2013 from patients in the medical intensive care unit, were grouped in SC1 (MLST [ST] 78,\n                    <jats:italic toggle=\"yes\">vanB<\/jats:italic>\n                    ) and differed in only 3 of 1423 cgMLST alleles. The SC2 (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200916, special care baby unit, neonatal intensive care unit, pediatric surgery ward, and oncology ward) and SC3 (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u20091, antenatal ward) were all ST80\n                    <jats:italic toggle=\"yes\">vanA-<\/jats:italic>\n                    VRE, but the single SC3 isolate differed in 233 alleles compared with SC2. Within SC2, isolates differed in 1\u201323 alleles. Comparison with a larger database of\n                    <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                    strains indicated that all isolates clustered within the previously defined hospital clade A1. A combination of Resfinder and mlplasmid analysis identified the presence of resistance genes on different plasmid predicted genetic elements among different SCs. In conclusion, this study documents the first isolates causing outbreaks with VRE in the Libyan health care system. Further surveillance efforts using molecular typing methods to monitor spread of multidrug-resistant bacteria in the Libyan health care system are urgently needed.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2019.0095","type":"journal-article","created":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T09:58:49Z","timestamp":1584439129000},"page":"1390-1398","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Whole Genome Sequence Analysis of the First Vancomycin-Resistant\n                    <i>Enterococcus faecium<\/i>\n                    Isolates from a Libyan Hospital in Tripoli"],"prefix":"10.1177","volume":"26","author":[{"given":"Mohamed O.","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asma K.","family":"Elramalli","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Tripoli Medical Center, Tripoli, Libya."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith E.","family":"Baptiste","sequence":"additional","affiliation":[{"name":"Department of Veterinary Medicine, Danish Medicines Agency, Copenhagen, Denmark."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Daw","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Tripoli, Libya."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulaziz","family":"Zorgani","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Tripoli, Tripoli, Libya."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, UMCU, Utrecht, The Netherlands."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rob J.L.","family":"Willems","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, UMCU, Utrecht, The Netherlands."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janetta","family":"Top","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, UMCU, Utrecht, The Netherlands."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,10,28]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2017.04.027"},{"key":"e_1_3_4_3_2","unstructured":"Lebreton F. 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