Major globally disseminated clonal complexes of antimicrobial resistant enterococci associated with infections in cancer patients in Brazil

Occurrence of multidrug‐resistantEnterococcus faeciumisolated from environmental samples

“…On the other hand, E. faecium isolates are important nosocomial pathogens, and resistance to several antimicrobial classes is closely related to a higher mortality rate since therapeutic options have become limited in the treatment of enterococcal infections (Golob et al 2019;Igbinosa and Beshiru 2019). In Brazil, a high prevalence of resistance to fluoroquinolones and erythromycin was described in clinical E. faecium isolates obtained from patients hospitalized in hospitals geographically dispersed (Sacramento et al 2017;Santos et al 2017). Regarding VRE isolates, they emerge as important pathogens worldwide and, in Brazil, after the first report in 1998, many other reports have been described (Dalla Costa et al 1998;Pereira et al 2010).…”

<p>Molecular Characterization Of Vancomycin-Resistant <em>Enterococcus faecalis</em> Among Inpatients At Iranian University Hospitals: Clonal Dissemination Of ST6 And ST422</p>

“…E. faecalis strains identified as ST6 showed similar characteristics to ST6 clones isolated in Portugal and Poland39,40 and were characterized by high-level resistance to aminoglycosides, and vancomycin, but differed from the strains described in Cuba and Spain where they were vancomycin susceptible 12,41. ST6 has been reported worldwide, and it is probably the major lineage in CCA, which is often associated with invasive infections and resistance to multiple drugs, owing to its adaptability to hospital environment as a result of the acquisition of pathogenicity islands and antimicrobial resistance genes by recombination and horizontal gene transfer 14,42,43,44,45. Notably, 6 of the 25 isolates were found to be ST422 (Table 1).…”

Silent clonal spread of vancomycin-resistant Enterococcus faecalis ST6 and ST525 colonizing patients at hospital admission in Natal, Brazil

“…Examples of Efs strains showing the same or similar pulsotypes but clustering in different sequence types have previously been described. 8 ST6 is dispersed worldwide mostly in association with nosocomial infections, whereas ST525 has only been documented in Brazil southeastern regions (VREfs linezolid-resistant infections; https:// pubmlst.org), 4,9 suggesting the dispersion of relevant strains of such lineage in this country. A patient was colonized with both ST525 A and B clones collected 14 months apart.…”

“…10 In summary, patients with a previous history of hospitalization and who had been admitted to different hospitals of Natal were colonized with 2 VREfs clonal lineages with potential to cause infection, one closely related to global ST6-VREfs and the other more region specific (ST525). 4,9 The detection of several Efs strains with the same PFGE type associated with different sequence types (via MLST) highlights both the limited accuracy of these methods to identify identical Efs strains and the need to use methods with a higher resolution to better follow transmission events between patients and institutions. The identification of 2 specific VREfs clones is reminiscent of the emergence of VRE in other regions of Brazil in previous years, where VREfs strains are now being replaced by dominant vancomycin-resistant hospital-associated E. faecium.…”