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To substantiate a common genetic background of ciprofloxacin-resistantEnterococcus faecium , 32 ciprofloxacin-resistant (Cipr ) and 31 ciprofloxacin-susceptible (Cips ) isolates from outbreaks, clinical infections, surveillances, and animals from 10 different countries were genotyped by multilocus sequence typing. Additionally, susceptibilities to ampicillin and vancomycin and the presence ofesp were determined and the quinolone resistance-determining regions ofparC ,gyrA ,parB , andgyrE were sequenced. High-level Cipr (MIC ≥ 64 μg/ml) due to point mutations in the quinolone resistance-determining region was unique to a distinct hospital-adapted genetic complex inE. faecium , previously designated CC17. Low-level Cipr (MIC = 4 μg/ml) in non-CC17 strains is not attributable to point mutations in any subunit of the topoisomerase genes, and the mechanism of resistance remains unclear. Acquisition of mutations inparC andgyrA , leading to high-level Cipr , is, in addition to ampicillin resistance and the presence of a putative pathogenicity island, another cumulative step in hospital adaptation of CC17.

journal of clinical microbiology

High-Level Ciprofloxacin Resistance from Point Mutations in gyrA and parC Confined to Global Hospital-Adapted Clonal Lineage CC17 of Enterococcus faecium