{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T15:51:21Z","timestamp":1785167481545,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T00:00:00Z","timestamp":1612483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold><jats:italic>Enterococcus faecalis<\/jats:italic> has been commonly considered as one of the major pathogens of the urinary tract infection (UTI) in human host worldwide, whereas the molecular characteristics of <jats:italic>E. faecalis<\/jats:italic> clinical isolates from the patients with UTI in China remains seldomly reported. This study aimed to investigate the resistance mechanism, molecular characteristics and risk factors of <jats:italic>E. faecalis<\/jats:italic> clinical isolates from patients with UTI in China.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 115 non-duplicated <jats:italic>E. faecalis<\/jats:italic> clinical isolates from patients with UTI were retrospectively collected in a tertiary hospital in China and their clinical data was further analyzed. The linezolid and tedizolid susceptibility were determined by agar dilution. The resistance genes, including <jats:italic>erm<\/jats:italic>(A)<jats:italic>, erm<\/jats:italic>(B)<jats:italic>, erm<\/jats:italic>(C)<jats:italic>, tet<\/jats:italic>(M)<jats:italic>, optrA, cfr, cfr<\/jats:italic>(B), <jats:italic>poxtA<\/jats:italic>, and MLST-based housekeeping genes were investigated by PCR.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In 115 non-duplicated <jats:italic>E. faecalis<\/jats:italic> clinical isolates from the patients with UTI in this hospital setting, the frequency of linezolid or tedizolid-resistant\/intermediate isolates were 22.61 and 13.04%, respectively, and the frequency of linezolid-resistant\/intermediate <jats:italic>E. faecalis<\/jats:italic> clinical isolates carrying with <jats:italic>erm<\/jats:italic>(A) were 86%. Among the five linezolid-resistant <jats:italic>E. faecalis<\/jats:italic> strains found in this study, three <jats:italic>optrA-<\/jats:italic>positive isolates and the other two linezolid-resistant strains were G2576U genetic mutations in the V domain of the 23S rRNA genes. The ST clonality analysis indicated that 31.42% (11\/35) of ST16 <jats:italic>E. faecalis<\/jats:italic> UTI isolates were not susceptible to linezolid. Moreover, the univariable analysis indicated that the high risk factors of linezolid-resistant\/intermediate <jats:italic>E. faecalis<\/jats:italic> infections involved the indwelling catheter, trachea cannula catheter and the carriage of <jats:italic>erm<\/jats:italic>(A) or <jats:italic>optrA<\/jats:italic>. Furthermore, the indwelling catheter and trachea cannula catheter were demonstrated as the independent predictors of linezolid-resistant\/intermediate <jats:italic>E. faecalis<\/jats:italic> strains in patients with UTI by multivariable analysis.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Linezolid-resistant\/intermediate <jats:italic>E. faecalis<\/jats:italic> associated with urinary tract infections of patients in this hospital setting from China might be explained by the high carriage frequency of <jats:italic>optrA<\/jats:italic> genes and moreover, indwelling catheter and trachea cannula should be considered as the independent predictors of linezolid-resistant\/intermediate <jats:italic>E. faecalis<\/jats:italic> infections. The transmission mechanism of linezolid-resistant\/intermediate <jats:italic>E. faecalis<\/jats:italic> in this hospital setting should be further studied.<\/jats:p>","DOI":"10.3389\/fpubh.2021.570650","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T03:38:01Z","timestamp":1612755481000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":28,"title":["Linezolid Resistance in Enterococcus faecalis Associated With Urinary Tract Infections of Patients in a Tertiary Hospitals in China: Resistance Mechanisms, Virulence, and Risk 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