Multilevel population genetic analysis of<i>vanA</i>and<i>vanB Enterococcus faecium</i>causing nosocomial outbreaks in 27 countries (1986–2012)

Abstract

Both strains and plasmids contributed to the spread and persistence of vancomycin resistance among E. faecium. Horizontal gene transfer events among genetic elements from different clonal lineages (same or different species) result in chimeras with different stability and host range, complicating the surveillance of epidemic plasmids.