{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:31:53Z","timestamp":1791919913563,"version":"4.3.4"},"reference-count":90,"publisher":"Microbiology Society","issue":"12","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007137","name":"Helse Nord RHF","doi-asserted-by":"crossref","award":["HNF1362-17"],"award-info":[{"award-number":["HNF1362-17"]}],"id":[{"id":"10.13039\/501100007137","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,19]]},"abstract":"Between 2010 and 2015 the incidence of vancomycin-resistant \n \n Enterococcus faecium<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> (VREfm<\/jats:italic>) in Norway increased dramatically. Hence, we selected (1) a random subset of vancomycin-resistant enterococci (VRE) from the Norwegian Surveillance System for Communicable Diseases (2010\u201315; n<\/jats:italic>=239) and (2) Norwegian vancomycin-susceptible \n \n E. faecium<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> (VSEfm<\/jats:italic>) bacteraemia isolates from the national surveillance system for antimicrobial resistance in microbes (2008 and 2014; n<\/jats:italic>=261) for further analysis. Whole-genome sequences were collected for population structure, van<\/jats:italic> gene cluster, mobile genetic element and virulome analysis, as well as antimicrobial susceptibility testing. Comparative genomic and phylogeographical analyses were performed with complete genomes of global \n \n E. faecium<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> strains from the National Center for Biotechnology Information (NCBI) (1946\u20132022; n<\/jats:italic>=272). All Norwegian VREfm<\/jats:italic> and most of the VSEfm<\/jats:italic> clustered with global hospital-associated sequence types (STs) in the phylogenetic subclade A1. The vanB2<\/jats:italic> subtype carried by chromosomal Tn1549<\/jats:italic> integrative conjugative elements was the dominant van<\/jats:italic> type. The major Norwegian VREfm<\/jats:italic> cluster types (CTs) were in accordance with concurrent European CTs. The dominant vanB<\/jats:italic>-type VREfm<\/jats:italic> CTs, ST192-CT3\/26 and ST117-CT24, were mostly linked to a single hospital in Norway where the clones spread after independent chromosomal acquisition of Tn1549<\/jats:italic>. The less prevalent vanA<\/jats:italic> VRE were associated with more diverse CTs and vanA<\/jats:italic> carrying Inc18 or RepA_N plasmids with toxin\u2013antitoxin systems. Only 5\u200a% of the Norwegian VRE were Enterococcus faecalis,<\/jats:italic> all of which contained vanB<\/jats:italic>. The Norwegian VREfm<\/jats:italic> and VSEfm<\/jats:italic> isolates harboured CT-specific virulence factor (VF) profiles supporting biofilm formation and colonization. The dominant VREfm<\/jats:italic> CTs in general hosted more virulence determinants than VSEfm<\/jats:italic>. The phylogenetic clade B VSEfm<\/jats:italic> isolates (n<\/jats:italic>=21),<\/jats:italic> recently classified as \n \n Enterococcus lactis<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic>, harboured fewer VFs than \n \n E. faecium<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> in general, and particularly subclade A1 isolates. In conclusion, the population structure of Norwegian \n \n E. faecium<\/jats:ext-link>\n <\/jats:named-content>\n <\/jats:italic> isolates mirrors the globally prevalent clones and particularly concurrent European VREfm<\/jats:italic>\/VSEfm<\/jats:italic> CTs. Novel chromosomal acquisition of vanB2<\/jats:italic> on Tn1549<\/jats:italic> from the gut microbiota, however, formed a single major hospital VREfm<\/jats:italic> outbreak. Dominant VREfm<\/jats:italic> CTs contained more VFs than VSEfm<\/jats:italic>.<\/jats:p>","DOI":"10.1099\/mgen.0.001160","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T16:18:36Z","timestamp":1703002716000},"source":"Crossref","is-referenced-by-count":14,"title":["The population structure of vancomycin-resistant and -susceptible Enterococcus faecium in a low-prevalence antimicrobial resistance setting is highly influenced by circulating global hospital-associated clones"],"prefix":"10.1099","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0395-120X","authenticated-orcid":false,"given":"Mushtaq","family":"AL Rubaye","sequence":"first","affiliation":[{"name":"Research group for Host\u2013Microbe Interactions, Department of Medical Biology, UiT The Arctic University of Norway, Troms\u00f8, 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