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We report the emergence of vancomycin resistance in a patient colonized with a vanA-containing, vanRS-negative isolate of Enterococcus faecium which was initially vancomycin susceptible. This is a previously undescribed mechanism of drug resistance with diagnostic and therapeutic implications.

Vancomycin-Variable Enterococcus faecium: In Vivo Emergence of Vancomycin Resistance in a Vancomycin-Susceptible Isolate