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In the context of the global action plan to reduce the dissemination of antibiotic resistances it is of utmost importance to understand the population structure of resistant endemic bacterial lineages and to elucidate how bacteria acquire certain resistance determinants. Vancomycin resistant enterococci represent one such example of a prominent nosocomial pathogen on which nation-wide population analyses on prevalent lineages are scarce and data on how the bacteria acquire resistance, especially of the  vanB  genotype, are still under debate. With respect to Germany, an increased prevalence of VRE was noted in recent years. Here, invasive infections caused by sequence type ST192 VRE are often associated with the  vanB -type resistance determinant. Hence, we analyzed 49  vanB -positive and  vanB -negative  E. faecium  isolates by means of whole genome sequencing. Our studies revealed a distinct population structure and that spread of the Tn 1549 - vanB -type resistance involves exchange of large chromosomal fragments between  vanB -positive and  vanB -negative enterococci rather than independent acquisition events.  In vitro  filter-mating experiments support the hypothesis and suggest the presence of certain target sequences as a limiting factor for dissemination of the  vanB  element. Thus, the present study provides a better understanding of how enterococci emerge into successful multidrug-resistant nosocomial pathogens.

Population structure and acquisition of the vanB resistance determinant in German clinical isolates of Enterococcus faecium ST192