Clade-specific evolution and genome plasticity underlying antimicrobial resistance in Enterococcus faecium

Area of Science:

• Microbiology
• Genomics
• Public Health

Background:

• Enterococcus faecium, a commensal organism, has emerged as a leading multidrug-resistant (MDR) hospital-acquired pathogen.
• Its rapid adaptation is driven by genomic plasticity, horizontal gene transfer, and selective antibiotic pressures.
• Hospital-acquired clones, like clonal complex 17, are enriched with antibiotic resistance genes and virulence factors.

Purpose of the Study:

• To review the evolutionary history, genomic diversity, resistance mechanisms, and global trends of MDR Enterococcus faecium.
• To examine the clinical and public health significance of MDR E. faecium within a One Health framework.
• To highlight strategies for combating MDR E. faecium, including genomic surveillance and novel therapies.

Main Methods:

• Comparative genome studies analysis.
• Literature review of evolutionary history and resistance mechanisms.
• Analysis of global resistance trends and One Health perspectives.

Main Results:

• Hospital-acquired E. faecium clones exhibit significant enrichment of antibiotic resistance genes and virulence factors.
• Resistance extends to critical antibiotics including penicillin, vancomycin, linezolid, and daptomycin.
• E. faecium poses a significant threat due to restricted therapeutic options and increased mortality/morbidity.

Conclusions:

• MDR E. faecium evolution into a hospital pathogen is a critical global public health concern.
• Integrated genomic surveillance, novel therapies, and enhanced antimicrobial stewardship are crucial for control.
• A One Health approach, considering human, animal, and environmental reservoirs, is essential.