{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:51:29Z","timestamp":1786117889317,"version":"build-2736575974"},"reference-count":42,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology of Taiwan","doi-asserted-by":"crossref","award":["MOST110-2320-B-037-020 and MOST111-2320-B-037-025"],"award-info":[{"award-number":["MOST110-2320-B-037-020 and MOST111-2320-B-037-025"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC112-2320-B-037-030-MY3"],"award-info":[{"award-number":["NSTC112-2320-B-037-030-MY3"]}],"id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","award":["KMU-TB114001 and KMU-TB114001-2"],"award-info":[{"award-number":["KMU-TB114001 and KMU-TB114001-2"]}],"id":[{"id":"10.13039\/501100004694","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Enterococcus faecium<\/jats:italic>\n                      has become a major nosocomial pathogen, primarily driven by its ability to acquire mobile genetic elements carrying antimicrobial resistance or metabolic traits. Our previous study identified a megaplasmid conferring a high-level gentamicin resistance (HLGR), which can undergo recombination between intact and IS\n                      <jats:italic toggle=\"yes\">1216V<\/jats:italic>\n                      -disrupted\n                      <jats:italic toggle=\"yes\">aac(6\u2032)-Ie-aph(2\u2033)-Ia<\/jats:italic>\n                      genes, resulting in a non-HLGR phenotype. In this study, we further characterized the RepA_N-type megaplasmid in sequence type (ST)17 and ST78\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      and examined its distribution among 465 isolates collected between 2011 and 2020 in Taiwan. Both sublineages carried gene clusters associated with carbohydrate utilization, albeit with differences in repertoires. Loss of the RepA_N megaplasmid in ST17 isolate E37 impaired growth on sucrose, confirming its contribution to carbohydrate metabolism. Screening of clinical isolates showed that\n                      <jats:italic toggle=\"yes\">repA_N<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">scrB<\/jats:italic>\n                      (sucrose utilization) genes were highly prevalent (90.8% and 85.8%, respectively) in the 10 years, whereas IS\n                      <jats:italic toggle=\"yes\">1216V<\/jats:italic>\n                      -inserted\n                      <jats:italic toggle=\"yes\">aac(6\u2032)-Ie-aph(2\u2033)-Ia<\/jats:italic>\n                      decreased over time (84.6% in 2011 and 55.7% in 2020), paralleling a decline in HLGR rates (57.7% in 2011 and 45.9% in 2020). Among the 465\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      isolates, ST17 and ST78, both belonging to clonal complex 17, were the most dominant sublineages. The expansion of ST78 vancomycin-resistant\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      since 2015 corresponded with the emergence of type III IS\n                      <jats:italic toggle=\"yes\">1216V<\/jats:italic>\n                      -inserted\n                      <jats:italic toggle=\"yes\">aac(6\u2032)-Ie-aph(2\u2033)-Ia<\/jats:italic>\n                      , while ST17, mainly carrying type II IS\n                      <jats:italic toggle=\"yes\">1216V<\/jats:italic>\n                      insertion, remained stable throughout the decade. Collectively, these results indicate that the RepA_N-type megaplasmid was widely disseminated and may enhance metabolic adaptability in\n                      <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                      , supporting its persistence in clinical environments.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        <jats:italic toggle=\"yes\">Enterococcus faecium<\/jats:italic>\n                        is a major hospital-associated pathogen with high genomic plasticity. This study characterized a widespread RepA_N-type megaplasmid, which conferred both high-level gentamicin resistance and enhanced carbohydrate utilization. The co-selection of antimicrobial resistance and metabolic adaptability on a single mobile genetic element may underlie the evolutionary success of dominant clinical lineages such as sequence type (ST)17 and ST78 in Taiwan. These findings provide a framework for understanding how plasmids contribute to the persistence and spread of\n                        <jats:italic toggle=\"yes\">E. faecium<\/jats:italic>\n                        in healthcare settings.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.03793-25","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:04:12Z","timestamp":1784034252000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Widespread dissemination of the RepA_N-type megaplasmid conferring a carbohydrate utilization advantage in clonal complex 17\n                    <i>Enterococcus faecium<\/i>\n                    in Taiwan"],"prefix":"10.1128","volume":"14","author":[{"given":"Yi-Jing","family":"Chen","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03gk81f96","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Medicine, College of Medicine, Kaohsiung Medical University","place":["Kaohsiung, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/03gk81f96","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University","place":["Kaohsiung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiao-Ching","family":"Peng","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03gk81f96","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Medicine, College of Medicine, Kaohsiung Medical University","place":["Kaohsiung, Taiwan"]},{"id":[{"id":"https:\/\/ror.org\/03gk81f96","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Microbiology and 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