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The aim of this study is to characterize the factors related to peptidoglycan metabolism in isogenic hVISA/VISA ST100 strains. Recently, we reported the increase in IS 256 transposition in invasive hVISA ST100 clinical strains isolated from the same patient (D1 and D2) before and after vancomycin treatment and two laboratory VISA mutants (D23C9 and D2P11) selected from D2 in independent experiments. High performance liquid chromatography-mass spectrometry (HPLC-MS) analysis of peptidoglycan muropeptides showed increased proportion of monomeric muropeptides and a concomitant decrease in the proportion of tetrameric muropeptide in D2 and derived mutants when compared to the original strain D1. In addition, strain D2 and its derived mutants showed an increase in cell wall thickness with increased pbp 2 gene expression. The VISA phenotype was not stable in D2P11 and showed a reduced autolysis profile. On the other hand, the mutant D23C9 differentiates from D2 and D2P11 in the autolysis profile, and pbp 4 transcription profile. D2-derived mutants exhibited differences in the susceptibility to other antimicrobials. Our results highlight the possibility of selection of different VISA phenotypes from a single hVISA-ST100 genetic background.

A metagenomic approach and network analysis was used to investigate the wide-spectrum profiles of antibiotic resistance genes (ARGs) and their co-occurrence patterns in 50 samples from 10 typical environments. In total, 260 ARG subtypes belonging to 18 ARG types were detected with an abundance range of 5.4 × 10 −6 –2.2 × 10 −1 copy of ARG per copy of 16S-rRNA gene. The trend of the total ARG abundances in environments matched well with the levels of anthropogenic impacts on these environments. From the less impacted environments to the seriously impacted environments, the total ARG abundances increased up to three orders of magnitude, that is, from 3.2 × 10 −3 to 3.1 × 10 0 copy of ARG per copy of 16S-rRNA gene. The abundant ARGs were associated with aminoglycoside, bacitracin, β-lactam, chloramphenicol, macrolide-lincosamide-streptogramin, quinolone, sulphonamide and tetracycline, in agreement with the antibiotics extensively used in human medicine or veterinary medicine/promoters. The widespread occurrences and abundance variation trend of vancomycin resistance genes in different environments might imply the spread of vancomycin resistance genes because of the selective pressure resulting from vancomycin use. The simultaneous enrichment of 12 ARG types in adult chicken faeces suggests the coselection of multiple ARGs in this production system. Non-metric multidimensional scaling analysis revealed that samples belonging to the same environment generally possessed similar ARG compositions. Based on the co-occurrence pattern revealed by network analysis, tet M and aminoglycoside resistance protein, the hubs of the ARG network, are proposed to be indicators to quantitatively estimate the abundance of 23 other co-occurring ARG subtypes by power functions.

Vancomycin is a glycopeptide antibiotic used for the treatment of Gram-positive bacterial infections. Traditionally, it has been used as a drug of last resort; however, clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) strains with decreased susceptibility to vancomycin (vancomycin intermediate-resistant S. aureus [VISA]) and more recently with high-level vancomycin resistance (vancomycin-resistant S. aureus [VRSA]) have been described in the clinical literature. The rare VRSA strains carry transposon Tn1546, acquired from vancomycin-resistant Enterococcus faecalis, which is known to alter cell wall structure and metabolism, but the resistance mechanisms in VISA isolates are less well defined. Herein, we review selected mechanistic aspects of resistance in VISA and summarize biochemical studies on cell wall synthesis in a VRSA strain. Finally, we recapitulate a model that integrates common mechanistic features of VRSA and VISA strains and is consistent with the mode of action of vancomycin.

The roots of antibiotic resistance Antibiotic resistance is thought to have evolved long before naturally occurring antibiotics and their derivatives were used to treat human disease, but direct evidence for genes that encode resistance has been lacking. Now, an ancient vancomycin-resistance gene has been recovered from 30,000-year-old samples of Siberian permafrost, and the three-dimensional structure of its product has been compared with that of its modern counterpart. There are minor structural differences between the ancient and modern versions, but the differences are not reflected in enzyme function. The discovery of antibiotics more than 70 years ago initiated a period of drug innovation and implementation in human and animal health and agriculture. These discoveries were tempered in all cases by the emergence of resistant microbes 1 , 2 . This history has been interpreted to mean that antibiotic resistance in pathogenic bacteria is a modern phenomenon; this view is reinforced by the fact that collections of microbes that predate the antibiotic era are highly susceptible to antibiotics 3 . Here we report targeted metagenomic analyses of rigorously authenticated ancient DNA from 30,000-year-old Beringian permafrost sediments and the identification of a highly diverse collection of genes encoding resistance to β-lactam, tetracycline and glycopeptide antibiotics. Structure and function studies on the complete vancomycin resistance element VanA confirmed its similarity to modern variants. These results show conclusively that antibiotic resistance is a natural phenomenon that predates the modern selective pressure of clinical antibiotic use.

Key Points Enterococci are some of the most versatile organisms found to infect hospitalized patients. The epidemiology of enterococcal infections has evolved since the emergence of these pathogens and has seen the rise of Enterococcus faecium as a nosocomial pathogen with serious clinical implications. The effect of antibiotics on the microbiota of the gastrointestinal tract and subsequent alterations in the regulation of the gut immune system can favour colonization by multidrug-resistant enterococci. Enterococcal genomes are extremely malleable, with the ability to exchange large fragments of chromosomal DNA. In addition, the lack of CRISPR (clustered regularly interspaced short palindromic repeats) elements has a potential role in the adaptation of hospital-associated enterococci. Specific pathogenicity factors contribute to the ability of enterococci to produce disease and/or survive in the gastrointestinal tract of mammals. The major factors include secreted and cell surface-associated determinants. Antibiotic resistance is widespread for the anti-enterococcal antibiotics that are most commonly used in clinical practice, and the mechanisms of resistance for many of these antibiotics are known. These antibiotics include ampicillin, linezolid, daptomycin and quinupristin–dalfopristin, and there is also high-level resistance to aminoglycosides. Such resistances have important therapeutic implications. Arias and Murray discuss the factors that may have contributed to the rise of enterococci as nosocomial pathogens, with an emphasis on the epidemiology and pathogenesis of these species and their mechanisms of resistance to the most relevant anti-enterococcal agents used in clinical practice. The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of Gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci.

We investigated genomic evolution of vancomycin-resistant Enterococcus faecium (VREF) during an outbreak in Shenzhen, China. Whole-genome sequencing revealed 2 sequence type 80 VREF subpopulations diverging through insertion sequence-mediated recombination. One subpopulation acquired more antimicrobial resistance and carbohydrate metabolism genes. Persistent VREF transmission underscores the need for genomic surveillance to curb spread.

Vancomycin-resistant enterococci (VRE) are a major public health concern, yet little is known about their circulation in fish. This study investigated the occurrence, glycopeptide resistance genotypes, virulence characteristics, and sequence types (STs) of VRE isolated from diseased fishes and humans. Isolates were identified using multiplex polymerase chain reaction (PCR) assay and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and tested for antimicrobial susceptibility. VRE isolates were screened for the presence of glycopeptide resistance genes and eight virulence genes. Multilocus sequence typing (MLST) was determined to assess the clonality of VRE isolates from fishes and humans. Among 60 human samples, 20 Enterococcus species isolates (33.33%) including Enterococcus faecalis and Enterococcus faecium (10 of each), were identified. The overall prevalence of E. faecalis was 42.86% (30/70) in Oreochromis niloticus and 48.0% (24/50) in Clarias gariepinus . E. faecium was found in 15.71% (11/70) of Oreochromis niloticus and 14.0% (7/50) of Clarias gariepinus . Over 50% of human isolates were multidrug resistant (MDR) and 30% exhibited an extensive drug resistant (XDR) phenotype. Fish isolates also displayed high MDR (70.83%) and XDR (29.17%) rates. Forty-nine (53.26%; 34 from fish and 15 from human) isolates were VRE including 30 isolates of E. faecalis (VREfs) and 19 isolates of E. faecium (VREfm). The vanA gene was the most frequent among VREfs (83.33%) and VREfm (100%) isolates. The vanB gene was found in 26.67% of VREfs and 15.79% of VREfm. Three out of 10 VREfm (30%) and 2/24 (8.33%) VREfs isolates of fish origin carried both vanA and vanB genes. vanC gene was found in 13.33% (4/30) of VREfs of human and fish origin. One VREfs isolate from human urine carried both vanA and vanC genes. High frequency of the virulence genes  gelE , sprE , asa1 , esp, and cylA were observed;  efa  and ace gene was more associated with VREfs, while hyl  gene was more frequently detected in VREfm. Different combinations of virulence genes suggesting synergistic pathogenic potential. MLST revealed both overlapping and host-specific STs among the examined Enterococcus isolates from humans and fish. Experimental infection of O. niloticus with VREfs and VREfm caused a 100% and 60% mortality rate within 6 days postinfection, respectively with characteristic disease symptoms. The emergence of VRE and the high prevalence of virulence traits could be regarded as an alarming situation. The call for increased infection control and antibiotic stewardship measures is timely and relevant to combat the spread of VRE in fish and humans.

The evolution of during the modern antibiotic era has been delineated by distinct strain emergence events, many of which include acquisition of antibiotic resistance. The relative high burden of methicillin-resistant (MRSA) in healthcare and community settings is a major concern worldwide. Vancomycin, a glycopeptide antibiotic that inhibits cell wall biosynthesis, remains a drug of choice for treatment of severe MRSA infections. strains exhibiting increased resistance to vancomycin, known as vancomycin intermediate-resistant (VISA) (MIC = 4-8 µg/mL), were discovered in the 1990s. The molecular basis of resistance in VISA is polygenic and involves stepwise mutations in genes encoding molecules predominantly involved in cell envelope biosynthesis. isolates with complete resistance to vancomycin (MIC ≥ 16 µg/mL) are termed vancomycin-resistant (VRSA)-they were first reported in the U.S. in 2002. Resistance in VRSA is conferred by the gene and operon, which is present on a plasmid. Although treatment of VRSA infections is challenging, the total number of human VRSA infections to date is limited (14 in the U.S.). By comparison, the burden of VISA is relatively high and the molecular mechanisms of resistance are less well-defined. VISA are associated with persistent infections, vancomycin treatment failure, and poor clinical outcomes. Here, we review in brief progress made toward understanding the acquisition of antibiotic resistance in , with an emphasis on the molecular mechanisms underlying vancomycin resistance.

Human infections with methicillin-resistant Staphylococcus aureus (MRSA) are commonly treated with vancomycin, and strains with decreased susceptibility, designated as vancomycin-intermediate S. aureus (VISA), are associated with treatment failure. Here, we profiled the phenotypic, mutational, and transcriptional landscape of 10 VISA strains adapted by laboratory evolution from one common MRSA ancestor, the USA300 strain JE2. Using functional and independent component analysis, we found that: 1) despite the common genetic background and environmental conditions, the mutational landscape diverged between evolved strains and included mutations previously associated with vancomycin resistance (in vraT, graS, vraFG, walKR, and rpoBCD) as well as novel adaptive mutations (SAUSA300_RS04225, ssaA, pitAR, and sagB); 2) the first wave of mutations affected transcriptional regulators and the second affected genes involved in membrane biosynthesis; 3) expression profiles were predominantly strain-specific except for sceD and lukG, which were the only two genes significantly differentially expressed in all clones; 4) three independent virulence systems (φSa3, SaeR, and T7SS) featured as the most transcriptionally perturbed gene sets across clones; 5) there was a striking variation in oxacillin susceptibility across the evolved lineages (from a 10-fold increase to a 63-fold decrease) that also arose in clinical MRSA isolates exposed to vancomycin and correlated with susceptibility to teichoic acid inhibitors; and 6) constitutive expression of the VraR regulon explained cross-susceptibility, while mutations in walK were associated with cross-resistance. Our results show that adaptation to vancomycin involves a surprising breadth of mutational and transcriptional pathways that affect antibiotic susceptibility and possibly the clinical outcome of infections.

Enterococci are common human commensals but can cause severe infections in immunocompromised patients. Enterococcus faecium is a notable example, capable of acquiring resistance to multiple antibiotics, including the critically important drug vancomycin. Such strains, known as vancomycin-resistant E. faecium (VRE), are routinely detected in clinical laboratories using phenotypic assays. However, some isolates carry vancomycin resistance genes yet remain phenotypically susceptible; these are termed vancomycin variable enterococci (VVE). Because phenotypic assays may fail to identify VVE, patients treated with glycopeptides risk developing undetected VRE infections. VVE have been reported in Scandinavia and Japan, but their prevalence in the Netherlands remains largely unknown. To address this gap, two large Dutch clinical microbiology laboratories collaborated to screen enterococcal isolates for vancomycin resistance genes using molecular assays. Among 477 isolates tested, six carried van genes while remaining vancomycin-susceptible. Three of these subsequently developed vancomycin resistance in vitro . All three were Enterococcus faecium ST117 strains carrying a chromosomal vanB2 operon, likely linked to the same outbreak. Genomic analysis revealed three mutations in the van operon regulator proteins: vanR (T189K) and vanS (G253C, L282V). We conclude that: (1) VVE are present in the Dutch population and may spread between patients; (2) VVE can develop into VRE upon vancomycin exposure; (3) specific mutations in regulatory proteins may underlie this phenotype; and (4) diagnostic policies should balance the low prevalence of VVE against their potential to cause severe complications, using sensitive molecular tests when appropriate. Our findings emphasize the importance of surveillance in revealing hidden threats and guiding clinical microbiology strategies, particularly with respect to VVE as precursors of VRE.