{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:46:17Z","timestamp":1792079177693,"version":"4.4.0"},"reference-count":36,"publisher":"American Society of Tropical Medicine and Hygiene","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,15]]},"abstract":"ABSTRACT.<\/jats:title>\n \n Enterococci are major causes of both community-acquired and healthcare-associated infections. The rapid global dissemination of multidrug-resistant clones poses a major challenge to clinical management and infection control. The aim for the present study was to investigate the prevalence, antimicrobial resistance patterns, virulence genes, and molecular epidemiology of\n Enterococcus<\/jats:italic>\n species isolated from clinical specimens in university hospitals of Sfax, Tunisia. A descriptive, hospital-based, cross-sectional surveillance study was conducted between March 2020 and February 2021. It included all\n Enterococcus<\/jats:italic>\n strains isolated in the Microbiology Department of Habib Bourguiba University Hospital.\n Enterococcus<\/jats:italic>\n isolates were tested for antimicrobial susceptibility in accordance with European Committee on Antimicrobial Susceptibility Testing guidelines. Polymerase chain reaction assays were performed to detect resistance genes (\n vanA, vanB, ermA, ermB, ermC, msrA, mefE, vga, vat, vgb<\/jats:italic>\n ), virulence genes (gelatinase [\n gelE<\/jats:italic>\n ], aggregation substance, enterococcal surface protein [\n esp<\/jats:italic>\n ], cytolysin, hyaluronidase), and the IS16 marker associated with the clonal complex 17 (CC17) lineage. A total of 231\n Enterococcus<\/jats:italic>\n isolates were recovered, including\n Enterococcus faecalis<\/jats:italic>\n (62.3%) and\n Enterococcus faecium<\/jats:italic>\n (34.2%). All\n E. faecalis<\/jats:italic>\n isolates were susceptible to ampicillin, vancomycin, and linezolid; all\n E. faecium<\/jats:italic>\n isolates were resistant to ampicillin, and 7.6% exhibited\n vanA<\/jats:italic>\n -mediated glycopeptide resistance. The\n ermB<\/jats:italic>\n gene was the predominant macrolide resistance determinant. Among\n E. faecium<\/jats:italic>\n ,\n esp<\/jats:italic>\n (74.7%) was the most prevalent virulence gene, whereas\n E. faecalis<\/jats:italic>\n mainly harbored\n gelE<\/jats:italic>\n (78.5%). The IS16 element, characteristic of CC17 clones, was detected in 86.1% of\n E. faecium<\/jats:italic>\n isolates. The present study highlights the emergence of multidrug-resistant\n E. faecium<\/jats:italic>\n strains with molecular features suggestive of CC17 affiliation in hospital settings in Sfax, Tunisia, underscoring the urgent need for stronger infection control and antimicrobial stewardship programs.\n <\/jats:p>","DOI":"10.4269\/ajtmh.26-0005","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:11:18Z","timestamp":1792077078000},"source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial Resistance and Molecular Epidemiology of Enterococcus Species Isolated at the University Hospitals of Sfax, Tunisia"],"prefix":"10.4269","author":[{"given":"Sadok","family":"Bougharriou","sequence":"first","affiliation":[{"name":"Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senda","family":"Mezghani Maalej","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hela","family":"Karray Hakim","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Curr Opin Microbiol","first-page":"73","article-title":"The multifaceted lifestyle of enterococci: Genetic diversity, ecology and risks for public health","volume":"65","author":"Cattoir","year":"2022"},{"key":"b2","series-title":"Microb Pathog","first-page":"107381","article-title":"Enterococci for human health: A friend or foe?","volume":"201","author":"Wang","year":"2025"},{"issue":"4","key":"b3","series-title":"Indian J Med Microbiol","first-page":"301","article-title":"Review of virulence factors of enterococcus: An emerging nosocomial pathogen","volume":"27","author":"Upadhyaya","year":"2009"},{"issue":"4","key":"b4","series-title":"Nat Rev Microbiol","first-page":"266","article-title":"The rise of the Enterococcus: Beyond vancomycin resistance","volume":"10","author":"Arias","year":"2012"},{"issue":"2","key":"b5","series-title":"China CDC Wkly","first-page":"17","article-title":"Antimicrobial-resistant evolution and global spread of Enterococcus faecium clonal complex (CC) 17: Progressive change from gut colonization to hospital-adapted pathogen","volume":"4","author":"Peng","year":"2022"},{"issue":"4","key":"b6","series-title":"Clin Microbiol Infect","first-page":"349","article-title":"European recommendations for antimicrobial resistance surveillance","volume":"10","author":"Cornaglia","year":"2004"},{"issue":"5","key":"b7","series-title":"Am J Infect Control","first-page":"309","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008"},{"key":"b8","article-title":"Breakpoint Tables for Interpretation of MICs and Zone Diameters.","year":"2020"},{"issue":"1","key":"b9","series-title":"J Clin Microbiol","first-page":"24","article-title":"Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR","volume":"33","author":"Dutka-Malen","year":"1995"},{"issue":"10","key":"b10","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"755","article-title":"Macrolide resistance phenotypes and genotypes in French clinical isolates of Streptococcus pneumoniae. 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