{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:18:35Z","timestamp":1788524315932,"version":"build-2803163510"},"reference-count":69,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Urinary tract infections (UTIs), traditionally dominated by Gram-negative pathogens, are increasingly complicated by antimicrobial-resistant\n                      <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                      spp. in hospital settings, particularly during the use of indwelling catheters. This study screened urine samples from 210 catheterized intensive care unit patients at Uppsala University Hospital (June 2020\u2013September 2021), identifying 39 unique PhenePlate\u2122-RF types across\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">E. faecalis<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">E. durans<\/jats:italic>\n                      .\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      isolates showed considerable diversity, primarily within clonal complex 17 (CC17), known for its virulence and antibiotic resistance. We identified multiple lineages and sequence types (STs), such as in patient HWP143, who had isolates from both ST80 and ST22 (an ancestral CC17 lineage). Notably, metabolic adaptations, such as increased L-arabinose metabolism, and shifts in antibiotic resistance were observed. Variations and similarities in plasmid content between individual lineages suggest horizontal gene transfer.\n                      <jats:italic toggle=\"yes\">E. faecalis<\/jats:italic>\n                      isolates exhibited less diversity, but still significant metabolic variability across patients and mixed infections, as seen in patient HWP051, colonized by both ST16 (CC58) and ST287.\n                      <jats:italic toggle=\"yes\">E. durans<\/jats:italic>\n                      , though less common, shared important metabolic traits with\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      and displayed polyclonal characteristics, highlighting its potential role in UTIs and the complexity of enterococcal infections.\n                      <jats:italic toggle=\"yes\">E. durans<\/jats:italic>\n                      was sometimes misidentified, underlining the need for accurate identification methods. This research underscores the importance of understanding genetic and metabolic diversity, plasmid variations, and horizontal gene transfer (HGT) in\n                      <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                      spp., which influence antibiotic resistance, virulence, and ultimately, treatment outcomes.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Our study, performed in Uppsala University Hospital, Sweden, uncovers novel insights into the genetic and metabolic diversity of\n                        <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                        species, focusing on\n                        <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                        ,\n                        <jats:italic toggle=\"yes\">E. faecalis<\/jats:italic>\n                        , and\n                        <jats:italic toggle=\"yes\">E. durans<\/jats:italic>\n                        . Unlike prior studies, which often have focused on single lineages, we reveal multiple clones and lineages within individual catheterized intensive care unit patients, including clones from clonal complex 17 and the emerging sequence type (ST) 192, highlighting notable metabolic adaptations and shifts in antibiotic resistance. The detection of mixed colonization with varied ST types and\n                        <jats:italic toggle=\"yes\">E. durans<\/jats:italic>\n                        misidentification by matrix-assisted laser desorption\/ionization time-of-flight mass spectrometry further emphasizes the challenges in\n                        <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                        species identification. Our findings have significant implications for understanding the complexity of\n                        <jats:italic toggle=\"yes\">Enterococcus<\/jats:italic>\n                        infections, stressing the need to consider genetic and metabolic diversity to improve disease management and treatment outcomes.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.03160-24","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T08:28:14Z","timestamp":1749716894000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["Heterogeneity and metabolic diversity among\n                    <i>Enterococcus<\/i>\n                    species during long-term colonization"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0060-005X","authenticated-orcid":true,"given":"Philip A.","family":"Karlsson","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048a87296","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Biochemistry and Microbiology, Uppsala University","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taoran","family":"Zhang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048a87296","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Biochemistry and Microbiology, Uppsala University","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef D.","family":"J\u00e4rhult","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048a87296","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Sciences, Zoonosis Science Center, Uppsala University","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0328-518X","authenticated-orcid":true,"given":"Enrique","family":"Joffr\u00e9","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048a87296","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Biochemistry and Microbiology, Uppsala University","place":["Uppsala, Sweden"]},{"name":"Department of Microbiology, Tumor and Cell Biology, Karolinska Institute","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4757-1583","authenticated-orcid":true,"given":"Helen","family":"Wang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048a87296","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Biochemistry and Microbiology, Uppsala University","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/1120009X.2017.1380395"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2017.07.014"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro3432"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S234840"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11071815"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1087446"},{"key":"e_1_3_5_8_2","first-page":"E201","article-title":"High frequency of vancomycin resistant Enterococcus faecalis in children: an alarming concern","volume":"57","author":"Sabouni F","year":"2016","unstructured":"Sabouni F, Movahedi Z, Mahmoudi S, Pourakbari B, Keshavarz Valian S, Mamishi S. 2016. 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