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Antimicrobial-resistant enterococci pose a serious public health threat, particularly vancomycin-resistant enterococci (VRE), for which treatment options are limited. The Centers for Disease Control and Prevention\u2019s Division of Healthcare Quality Promotion Sentinel Surveillance system conducted surveillance from 2018 to 2019 to evaluate antimicrobial susceptibility profiles and molecular epidemiology of 205\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      and 180\n                      <jats:italic>E. faecium<\/jats:italic>\n                      clinical isolates collected from nine geographically diverse sites in the United States. Whole genome sequencing revealed diverse genetic lineages, with no single sequence type accounting for more than 15% of\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      or\n                      <jats:italic>E. faecium<\/jats:italic>\n                      . Phylogenetic analysis distinguished\n                      <jats:italic>E. faecium<\/jats:italic>\n                      from 19\n                      <jats:italic>E. lactis<\/jats:italic>\n                      (previously known as\n                      <jats:italic>E. faecium<\/jats:italic>\n                      clade B). Resistance to vancomycin was 78.3% among\n                      <jats:italic>E. faecium<\/jats:italic>\n                      , 7.8% among\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      , and did not occur among\n                      <jats:italic>E. lactis<\/jats:italic>\n                      isolates. Resistance to daptomycin and linezolid was rare:\n                      <jats:italic>E. faecium<\/jats:italic>\n                      (5.6%, 0.6%, respectively),\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      (2%, 2%), and\n                      <jats:italic>E. lactis<\/jats:italic>\n                      (5.3%, 0%). All VRE harbored the\n                      <jats:italic>vanA<\/jats:italic>\n                      gene. Three of the seven isolates that were not susceptible to linezolid harbored\n                      <jats:italic>optrA<\/jats:italic>\n                      , one chromosomally located and two on linear plasmids that shared a conserved backbone with other multidrug-resistant conjugative linear plasmids. One of these isolates contained\n                      <jats:italic>optrA<\/jats:italic>\n                      and\n                      <jats:italic>vanA<\/jats:italic>\n                      co-localized on the linear plasmid. By screening all enterococci, 20% of\n                      <jats:italic>E. faecium<\/jats:italic>\n                      were predicted to harbor linear plasmids, whereas none were predicted among\n                      <jats:italic>E. faecalis<\/jats:italic>\n                      or\n                      <jats:italic>E. lactis<\/jats:italic>\n                      . Continued surveillance is needed to assess the future emergence and spread of antimicrobial resistance by linear plasmids and other mechanisms.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        This work confirms prior reports of\n                        <jats:italic>E. faecium<\/jats:italic>\n                        showing higher levels of resistance to more antibiotics than\n                        <jats:italic>E. faecalis<\/jats:italic>\n                        and identifies that diverse sequence types are contributing to enterococcal infections in the United States. All VRE harbored the\n                        <jats:italic>vanA<\/jats:italic>\n                        gene. We present the first report of the linezolid resistance gene\n                        <jats:italic>optrA<\/jats:italic>\n                        on linear plasmids in the United States, one of which co-carried a\n                        <jats:italic>vanA<\/jats:italic>\n                        cassette. Additional studies integrating epidemiological, antimicrobial susceptibility, and genomic methods to characterize mechanisms of resistance, including the role of linear plasmids, will be critical to understanding the changing landscape of enterococci in the United States.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/aac.00591-24","type":"journal-article","created":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T09:02:11Z","timestamp":1728982931000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":15,"title":["Sentinel Surveillance reveals phylogenetic diversity and detection of linear plasmids harboring\n                    <i>vanA<\/i>\n                    and\n                    <i>optrA<\/i>\n                    among enterococci collected in the United 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