{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:10:53Z","timestamp":1788844253045,"version":"build-2803163510"},"reference-count":69,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017170","name":"Thailand Science Research and Innovation","doi-asserted-by":"crossref","award":["MED6901128b"],"award-info":[{"award-number":["MED6901128b"]}],"id":[{"id":"10.13039\/501100017170","id-type":"DOI","asserted-by":"crossref"}]},{"award":["MED6901128b"],"award-info":[{"award-number":["MED6901128b"]}],"id":[{"id":"https:\/\/ror.org\/000025p04","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Science, Research and Innovation Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Enterococcus species are important causes of healthcare-associated infections, particularly multidrug-resistant (MDR) and vancomycin-resistant enterococci (VRE). This study characterized antimicrobial susceptibility, biofilm formation, genomic features, and molecular epidemiology of clinical Enterococcus isolates from southern Thailand. Methods: Forty clinical isolates, comprising E. faecalis (n = 22) and E. faecium (n = 18), were characterized by antimicrobial susceptibility testing, biofilm assays, and whole-genome sequencing. Results: All isolates were susceptible to linezolid and oritavancin, whereas non-susceptibility to ampicillin, fosfomycin, vancomycin, and daptomycin was 60.0%, 57.5%, 12.5%, and 5.0%, respectively. High-level gentamicin resistance and MDR occurred in 37.5% and 22.5%, respectively. Strong biofilm formation predominated in E. faecalis (86.4%), whereas 94.4% of E. faecium were weak producers. ST6 and ST17 predominated in E. faecalis and E. faecium, respectively. All five VRE isolates were E. faecium ST17 or ST262 and carried vanA. High-level ampicillin-resistant E. faecium harbored the PBP5 S466\u2032 insertion and multiple C-terminal substitutions. To our knowledge, this is the first report in Thailand of both daptomycin-resistant E. faecium and resistance-associated LiaS T120A and LiaR W73C substitutions. Closely related isolates within E. faecalis ST6 and E. faecium VRE ST17, ST117, and ST262 showed spatiotemporal patterns consistent with potential epidemiological linkage or lineage persistence. Three novel STs were identified, with E. faecium ST3096 exhibiting high-level ampicillin resistance, fosfomycin resistance, and reduced daptomycin susceptibility. Conclusions: These findings reveal emerging resistant lineages and spatiotemporal patterns of genomic relatedness, supporting continued genomic surveillance of clinical enterococci in Thailand.<\/jats:p>","DOI":"10.3390\/antibiotics15090867","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:53:28Z","timestamp":1788789208000},"page":"867","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genomic Epidemiology, Antimicrobial Resistance, and Virulence of Clinical Enterococcus Isolates from Hat Yai, Thailand: Genomic Relatedness and Lineage Persistence"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7350-4234","authenticated-orcid":false,"given":"Wajeeorn","family":"Ouancharee","sequence":"first","affiliation":[{"name":"Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Sareenee","family":"Saleah","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9541-3224","authenticated-orcid":false,"given":"Rattanaruji","family":"Pomwised","sequence":"additional","affiliation":[{"name":"Division of Biological Science, Faculty of Science, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6999-5534","authenticated-orcid":false,"given":"Arnon","family":"Chukamnerd","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Science, King Mongkut\u2019s University of Technology Thonburi, Bangkok 10140, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-7561","authenticated-orcid":false,"given":"Komwit","family":"Surachat","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"given":"Rosesathorn","family":"Soontarach","sequence":"additional","affiliation":[{"name":"Department of Science, Technology and Innovation, Faculty of Science, Chulabhorn Royal Academy, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0063-7787","authenticated-orcid":false,"given":"Kamonnut","family":"Singkhamanan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3116-2518","authenticated-orcid":false,"given":"Sarunyou","family":"Chusri","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"},{"name":"Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e00058-18","DOI":"10.1128\/CMR.00058-18","article-title":"The Enterococcus: A model of adaptability to its environment","volume":"32","author":"Rice","year":"2019","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jgar.2025.01.016","article-title":"Vancomycin-resistant Enterococcus faecium: A current perspective on resilience, adaptation, and the urgent need for novel strategies","volume":"41","author":"Novais","year":"2025","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e0012123","DOI":"10.1128\/cmr.00121-23","article-title":"Non-faecium non-faecalis enterococci: A review of clinical manifestations, virulence factors, and antimicrobial resistance","volume":"37","author":"Mullally","year":"2024","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1038\/s41579-024-01054-w","article-title":"ESKAPE pathogens: Antimicrobial resistance, epidemiology, clinical impact and therapeutics","volume":"22","author":"Miller","year":"2024","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.idc.2020.08.004","article-title":"Resistance in vancomycin-resistant enterococci","volume":"34","author":"Miller","year":"2020","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s13756-020-00770-1","article-title":"Enterococcus faecium: From microbiological insights to practical recommendations for infection control and diagnostics","volume":"9","author":"Zhou","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S1473-3099(25)00118-5","article-title":"The WHO Bacterial Priority Pathogens List 2024: A prioritisation study to guide research, development, and public health strategies against antimicrobial resistance","volume":"25","author":"Sati","year":"2025","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jgar.2025.12.018","article-title":"In vitro activity of vancomycin and other commonly used antibiotics against clinical isolates of Enterococcus faecalis and Enterococcus faecium: Data from the antimicrobial testing leadership and surveillance (ATLAS) program from 2019 to 2023","volume":"46","author":"Liu","year":"2026","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e0005922","DOI":"10.1128\/cmr.00059-22","article-title":"Therapeutics for vancomycin-resistant enterococcal bloodstream infections","volume":"36","author":"Cairns","year":"2023","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4268","DOI":"10.1038\/s41467-023-39966-5","article-title":"Molecular basis of beta-lactam antibiotic resistance of ESKAPE bacterium E. faecium penicillin binding protein PBP5","volume":"14","author":"Hunashal","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6797","DOI":"10.1021\/acs.biochem.8b01072","article-title":"Two mutations commonly associated with daptomycin resistance in Enterococcus faecium LiaS(T120A) and LiaR(W73C) appear to function epistatically in LiaFSR signaling","volume":"57","author":"Davlieva","year":"2018","journal-title":"Biochemistry"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Gargis, A.S., Spicer, L.M., Kent, A.G., Zhu, W., Campbell, D., McAllister, G., Ewing, T.O., Albrecht, V., Stevens, V.A., and Sheth, M. (2021). Sentinel surveillance reveals emerging daptomycin-resistant ST736 Enterococcus faecium and multiple mechanisms of linezolid resistance in enterococci in the United States. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.807398"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1038\/s41579-018-0107-z","article-title":"Biofilm-associated infection by enterococci","volume":"17","author":"Chong","year":"2019","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s10123-023-00441-2","article-title":"Molecular characterization and biofilm formation ability of Enterococcus faecium and Enterococcus faecalis bloodstream isolates from a Chinese tertiary hospital in Beijing","volume":"27","author":"Yang","year":"2024","journal-title":"Int. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e0171623","DOI":"10.1128\/aac.01716-23","article-title":"Genomic analysis of inter-hospital transmission of vancomycin-resistant Enterococcus faecium sequence type 80 isolated during an outbreak in Hiroshima, Japan","volume":"68","author":"Segawa","year":"2024","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jhin.2024.06.002","article-title":"Protracted transmission and persistence of ST80 vancomycin-resistant Enterococcus faecium clonal complex types CT2933, CT2932 and CT1916 in a large Irish hospital: A 39-month whole-genome sequencing study","volume":"151","author":"Kavanagh","year":"2024","journal-title":"J. Hosp. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e11478","DOI":"10.7717\/peerj.11478","article-title":"Molecular epidemiology of vancomycin-resistant Enterococcus faecium clinical isolates in a tertiary care hospital in southern Thailand: A retrospective study","volume":"9","author":"Saengsuwan","year":"2021","journal-title":"PeerJ"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chopjitt, P., Boueroy, P., Jenjaroenpun, P., Wongsurawat, T., Hatrongjit, R., Kerdsin, A., and Sunthamala, N. (2024). Genomic characterization of vancomycin-resistant Enterococcus faecium clonal complex 17 isolated from urine in tertiary hospitals in Northeastern Thailand. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1278835"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Chopjitt, P., Kansaen, R., Chaisaeng, S., Phongchaiwasin, S., Boueroy, P., Jenjaroenpun, P., Wongsurawat, T., Kerdsin, A., and Sunthamala, N. (2025). High-risk VREfm clones and resistance determinants in a Thai hospital. Antibiotics, 14.","DOI":"10.3390\/antibiotics14030229"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e21354","DOI":"10.7717\/peerj.21354","article-title":"Comparative genomics of hospital-associated vancomycin-resistant Enterococcus faecium from regional tertiary hospitals in Thailand","volume":"14","author":"Sittiyuno","year":"2026","journal-title":"PeerJ"},{"key":"ref_21","first-page":"494","article-title":"Epidemiology and control of the first reported vancomycin-resistant enterococcus outbreak at a tertiary-care hospital in Bangkok, Thailand","volume":"47","author":"Chotiprasitsakul","year":"2016","journal-title":"Southeast Asian J. Trop. Med. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.jgar.2025.07.024","article-title":"Genotypic and phenotypic characterization of vancomycin-resistant Enterococcus faecium from clinical and surveillance samples in northern Thailand","volume":"44","author":"Nokkhiao","year":"2025","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2001628","DOI":"10.2807\/1560-7917.ES.2021.26.45.2001628","article-title":"Hospital-acquired infections caused by enterococci: A systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020","volume":"26","author":"Brinkwirth","year":"2021","journal-title":"Euro Surveill."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wangprapa, P., Nagy-Szakal, D., Wells, H.L., Fidler, G., Sangtian, M., Panmontha, W., Bunlungsup, S., Techasathit, W., Couto-Rodriguez, M., and Danko, D.C. (2026). Analytical validation of a metagenomic next-generation diagnostic platform for urinary tract infection in a Thai tertiary hospital setting: A BI-Biotia UTI cohort study. Front. Cell. Infect. Microbiol., 16.","DOI":"10.3389\/fcimb.2026.1751074"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wongsuk, T., Homkaew, A., Oonanant, W., Phumisantiphong, U., Nutalai, D., Utaranark, P., and Boonsilp, S. (2026). Molecular insights into antimicrobial resistance and virulence in hospital-associated of vancomycin-resistant Enterococcus faecium isolates in a tertiary hospital in Bangkok Thailand. PLoS ONE, 21.","DOI":"10.1371\/journal.pone.0343967"},{"key":"ref_26","first-page":"001573","article-title":"Global epidemiological insights on the antimicrobial resistance of Enterococcus faecium and a genomic analysis framework","volume":"11","author":"Lee","year":"2025","journal-title":"Microb. Genom."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Radford-Smith, D.E., and Anthony, D.C. (2025). Vancomycin-Resistant E. faecium: Addressing Global and Clinical Challenges. Antibiotics, 14.","DOI":"10.3390\/antibiotics14050522"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4948","DOI":"10.1128\/jb.178.16.4948-4957.1996","article-title":"Structure of the low-affinity penicillin-binding protein 5 PBP5fm in wild-type and highly penicillin-resistant strains of Enterococcus faecium","volume":"178","author":"Zorzi","year":"1996","journal-title":"J. Bacteriol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e0119621","DOI":"10.1128\/AAC.01196-21","article-title":"Prediction of antimicrobial resistance in clinical Enterococcus faecium isolates using a rules-based analysis of whole-genome sequences","volume":"66","author":"Anahtar","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3028","DOI":"10.1128\/AAC.48.8.3028-3032.2004","article-title":"Impact of specific pbp5 mutations on expression of beta-lactam resistance in Enterococcus faecium","volume":"48","author":"Rice","year":"2004","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Novais, C., Tedim, A.P., Lanza, V.F., Freitas, A.R., Silveira, E., Escada, R., Roberts, A.P., Al-Haroni, M., Baquero, F., and Peixe, L. (2016). Co-diversification of Enterococcus faecium core genomes and PBP5: Evidences of pbp5 horizontal transfer. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.01581"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e00291-19","DOI":"10.1128\/AAC.00291-19","article-title":"Prospective observational study of the clinical prognoses of patients with bloodstream infections caused by ampicillin-susceptible but penicillin-resistant Enterococcus faecalis","volume":"63","author":"Kim","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lazzaro, L.M., Cassisi, M., Stefani, S., and Campanile, F. (2022). Impact of PBP4 alterations on beta-lactam resistance and ceftobiprole non-susceptibility among Enterococcus faecalis clinical isolates. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.816657"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Seyedolmohadesin, M., Kouhzad, M., Gotz, F., Ashkani, M., Aminzadeh, S., and Bostanghadiri, N. (2024). Emergence of lineage ST150 and linezolid resistance in Enterococcus faecalis: A molecular epidemiology study of UTIs in Tehran, Iran. Front. Microbiol., 15.","DOI":"10.3389\/fmicb.2024.1464691"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jiac.2015.09.003","article-title":"High-level aminoglycoside resistance in Enterococcus faecalis and Enterococcus faecium causing invasive infection: Twelve-year surveillance in the Minami Ibaraki Area","volume":"22","author":"Osuka","year":"2016","journal-title":"J. Infect. Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e0106725","DOI":"10.1128\/spectrum.01067-25","article-title":"Epidemiology, clinical characteristics, and outcome of enterococcal bloodstream infections in critically ill patients in China: A single-center retrospective 10-year analysis","volume":"13","author":"Jin","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1093\/jac\/dkab071","article-title":"Emergence of aac(6\u2032)-Ie-aph(2\u2033)-Ia-positive enterococci with non-high-level gentamicin resistance mediated by IS1216V: Adaptation to decreased aminoglycoside usage in Taiwan","volume":"76","author":"Chen","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1128\/AAC.32.10.1528","article-title":"High-level resistance to gentamicin in clinical isolates of Streptococcus (Enterococcus) faecium","volume":"32","author":"Eliopoulos","year":"1988","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jgar.2019.08.006","article-title":"Molecular mechanisms and epidemiology of fosfomycin resistance in enterococci isolated from patients at a teaching hospital in China, 2013\u20132016","volume":"20","author":"Zhang","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e0121724","DOI":"10.1128\/spectrum.01217-24","article-title":"Antimicrobial resistance, virulence gene profiles, and molecular epidemiology of enterococcal isolates from patients with urinary tract infections in Shanghai, China","volume":"13","author":"Wu","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"ref_41","unstructured":"National Steering Committee on Antimicrobial Resistance of Thailand (2020). Thailand\u2019s One Health Report on Antimicrobial Consumption and Antimicrobial Resistance in 2018."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Xin, L., Xu, X., Shi, Q., Han, R., Wang, J., Guo, Y., and Hu, F. (2022). High prevalence and overexpression of fosfomycin-resistant gene fosX in Enterococcus faecium from China. Front. Microbiol., 13.","DOI":"10.3389\/fmicb.2022.900185"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1007\/s40121-023-00881-3","article-title":"Characterization of a tigecycline-, linezolid- and vancomycin-resistant clinical Enteroccoccus faecium isolate, carrying vanA and vanB genes","volume":"12","author":"Wardal","year":"2023","journal-title":"Infect. Dis. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jgar.2026.07.018","article-title":"Fosfomycin non-susceptibility in Enterococcus faecium from Taiwan: Evaluation of testing methods and resistance determinants","volume":"50","author":"Peng","year":"2026","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4527","DOI":"10.1128\/AAC.02686-14","article-title":"Whole-genome analyses of Enterococcus faecium isolates with diverse daptomycin MICs","volume":"58","author":"Diaz","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4354","DOI":"10.1128\/AAC.00509-12","article-title":"Correlation between mutations in liaFSR of Enterococcus faecium and MIC of daptomycin: Revisiting daptomycin breakpoints","volume":"56","author":"Munita","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Santimaleeworagun, W., Changpradub, D., Thunyaharn, S., and Hemapanpairoa, J. (2019). Optimizing the dosing regimens of daptomycin based on the susceptible dose-dependent breakpoint against vancomycin-resistant enterococci infection. Antibiotics, 8.","DOI":"10.3390\/antibiotics8040245"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1093\/ofid\/ofy344","article-title":"Temporal and geographic variation in antimicrobial susceptibility and resistance patterns of enterococci: Results from the SENTRY antimicrobial surveillance program, 1997\u20132016","volume":"6","author":"Pfaller","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e0166721","DOI":"10.1128\/AAC.01667-21","article-title":"Activity of oritavancin against Gram-positive pathogens causing bloodstream infections in the United States over 10 years: Focus on drug-resistant enterococcal subsets (2010\u20132019)","volume":"66","author":"Carvalhaes","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"15063","DOI":"10.1038\/s41598-026-51663-z","article-title":"Cationic biocide susceptibility and tolerance-associated genes in clinical, environmental, and commensal Enterococcus isolates","volume":"16","author":"Eldahshan","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_51","first-page":"125","article-title":"Vancomycin-resistant enterococci isolated in tertiary care in Southern Thailand: Prevalence and characterization of biofilm formation","volume":"31","author":"Saengsuwan","year":"2023","journal-title":"Rev. Romana Med. Lab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"11204","DOI":"10.1038\/s41598-019-47602-w","article-title":"Biofilm formation capacity and presence of virulence factors among commensal Enterococcus spp. from wild birds","volume":"9","author":"Hauschild","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/j.1574-6968.2006.00112.x","article-title":"Relationship between biofilm formation, the enterococcal surface protein (Esp) and gelatinase in clinical isolates of Enterococcus faecalis and Enterococcus faecium","volume":"256","author":"Creti","year":"2006","journal-title":"FEMS Microbiol. Lett."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.2147\/IDR.S305167","article-title":"Phenotype-genotype correlations and distribution of key virulence factors in Enterococcus faecalis isolated from patients with urinary tract infections","volume":"14","author":"Hashem","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/apm.12336","article-title":"Spread of an Enterococcus faecalis sequence type 6 (CC2) clone in patients undergoing selective decontamination of the digestive tract","volume":"123","author":"Girbau","year":"2015","journal-title":"APMIS"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"938937","DOI":"10.1155\/2013\/938937","article-title":"High genetic diversity of Enterococcus faecium and Enterococcus faecalis clinical isolates by pulsed-field gel electrophoresis and multilocus sequence typing from a hospital in Malaysia","volume":"2013","author":"Weng","year":"2013","journal-title":"Biomed. Res. Int."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.eimc.2016.02.020","article-title":"Persistence of a ST6 clone of Enterococcus faecalis genotype vanB2 in two Hospitals in Aragon (Spain)","volume":"35","author":"Alonso","year":"2017","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1038\/s41467-021-21749-5","article-title":"Apparent nosocomial adaptation of Enterococcus faecalis predates the modern hospital era","volume":"12","author":"Pontinen","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1093\/jac\/dkr545","article-title":"Clonal outbreak of ST17 multidrug-resistant Enterococcus faecium harbouring an Inc18-like::Tn1546 plasmid in a haemo-oncology ward of a Spanish hospital","volume":"67","author":"Valdezate","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Lisotto, P., Couto, N., Rosema, S., Lokate, M., Zhou, X., Bathoorn, E., Harmsen, H.J.M., Friedrich, A.W., Rossen, J.W.A., and Chlebowicz-Fliss, M.A. (2021). Molecular characterisation of vancomycin-resistant Enterococcus faecium isolates belonging to the lineage ST117\/CT24 causing hospital outbreaks. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.728356"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1038\/s44259-023-00017-0","article-title":"Integration of vanHAX downstream of a ribosomal RNA operon restores vancomycin resistance in a susceptible Enterococcus faecium strain","volume":"2","author":"McInnes","year":"2024","journal-title":"npj Antimicrob. Resist."},{"key":"ref_62","unstructured":"CLSI (2025). Performance Standards for Antimicrobial Susceptibility Testing, Clinical and Laboratory Standards Institute. [35th ed.]. CLSI Supplement M100."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/j.1600-0463.2007.apm_630.x","article-title":"Quantification of biofilm in microtiter plates: Overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci","volume":"115","author":"Stepanovic","year":"2007","journal-title":"APMIS"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1128\/aem.46.3.549-552.1983","article-title":"Simple and rapid method for isolating large plasmid DNA from lactic streptococci","volume":"46","author":"Anderson","year":"1983","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/0471142727.mb0204s56","article-title":"Preparation of genomic DNA from bacteria","volume":"56","author":"Wilson","year":"2001","journal-title":"Curr. Protoc. Mol. Biol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"8365","DOI":"10.1038\/srep08365","article-title":"RASTtk: A modular and extensible implementation of the RAST algorithm for building custom annotation pipelines and annotating batches of genomes","volume":"5","author":"Brettin","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"D678","DOI":"10.1093\/nar\/gkac1003","article-title":"Introducing the Bacterial and Viral Bioinformatics Resource Center (BV-BRC): A resource combining PATRIC, IRD and ViPR","volume":"51","author":"Olson","year":"2023","journal-title":"Nucleic Acids Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1128\/JCM.42.6.2548-2557.2004","article-title":"Serological and genetic diversity of capsular polysaccharides in Enterococcus faecalis","volume":"42","author":"Hufnagel","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Wang, G., Yu, F., Lin, H., Murugesan, K., Huang, W., Hoss, A.G., Dhand, A., Lee, L.Y., Zhuge, J., and Yin, C. (2018). Evolution and mutations predisposing to daptomycin resistance in vancomycin-resistant Enterococcus faecium ST736 strains. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0209785"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/9\/867\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:29:56Z","timestamp":1788841796000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/9\/867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,6]]},"references-count":69,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["antibiotics15090867"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15090867","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,6]]}}}