{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T11:05:22Z","timestamp":1781175922192,"version":"3.54.1"},"posted":{"date-parts":[[2024,8,3]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":63,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T00:00:00Z","timestamp":1722643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,8,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>\n                  Vancomycin-resistant\n                  <jats:italic>Enterococcus faecium<\/jats:italic>\n                  (VREfm) is a prevalent healthcare-acquired pathogen. Gastrointestinal colonization can lead to difficult-to-treat bloodstream infections with high mortality rates. Prior studies have investigated VREfm population structure within healthcare centers. However, little is known about how and why hospital-adapted VREfm populations change over time. We sequenced 710 healthcare-associated VREfm clinical isolates from 2017-2022 from a large tertiary care center as part of the Enhanced Detection System for Healthcare-Associated Transmission (EDS-HAT) program. Although the VREfm population in our center was polyclonal, 46% of isolates formed genetically related clusters, suggesting a high transmission rate. We compared our collection to 15,631 publicly available VREfm genomes spanning 20 years. Our findings describe a drastic shift in lineage replacement within nosocomial VREfm populations at both the local and global level. Functional and genomic analysis revealed, antimicrobial peptide, bacteriocin T8 may be a driving feature of strain emergence and persistence in the hospital setting.\n                <\/jats:p>\n                <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    This study shows local and global lineage replacement of vancomycin-resistant\n                    <jats:italic>Enterococcus faecium<\/jats:italic>\n                    . Bacteriocin T8 is enriched in emergent lineages and provides a strong competitive advantage\n                    <jats:italic>in vitro<\/jats:italic>\n                    and\n                    <jats:italic>in vivo<\/jats:italic>\n                    .\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.08.01.24311290","type":"posted-content","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T04:21:03Z","timestamp":1722831663000},"source":"Crossref","is-referenced-by-count":3,"title":["Bacteriocin production facilitates nosocomial emergence of vancomycin-resistant\n                  <i>Enterococcus faecium<\/i>"],"prefix":"10.64898","author":[{"given":"Emma G.","family":"Mills","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander B.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa P.","family":"Griffith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine","family":"Hewlett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora","family":"Pless","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J.","family":"Sundermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3787-2705","authenticated-orcid":false,"given":"Lee H.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P.","family":"Zackular","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7284-0103","authenticated-orcid":false,"given":"Daria","family":"Van Tyne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2024080607250483000_2024.08.01.24311290v1.1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro2761"},{"key":"2024080607250483000_2024.08.01.24311290v1.2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI43918"},{"key":"2024080607250483000_2024.08.01.24311290v1.3","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01316-06"},{"key":"2024080607250483000_2024.08.01.24311290v1.4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-6-200309160-00011"},{"key":"2024080607250483000_2024.08.01.24311290v1.5","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-micro-091213-113003"},{"key":"2024080607250483000_2024.08.01.24311290v1.6","first-page":"e00670","article-title":"Last Bacteria Standing: VREfm Persistence in the Hospitalized Gut","volume":"13","year":"2022","journal-title":"mBio"},{"key":"2024080607250483000_2024.08.01.24311290v1.7","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1917130117"},{"key":"2024080607250483000_2024.08.01.24311290v1.8","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.96.12.6908"},{"key":"2024080607250483000_2024.08.01.24311290v1.9","doi-asserted-by":"crossref","unstructured":"Correa-Martinez, C. 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