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Cases of bacteremia caused by vancomycin-resistant  E. faecium  (VRE-fm) increased significantly in Taiwan. The present multicenter surveillance study was performed to reveal the associated epidemiological characteristics. In 2012, 134 non-repetitive VRE-fm isolates were prospectively collected from 12 hospitals in Taiwan. Antimicrobial susceptibility, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and analysis of  van  genes and Tn 1546  structures were investigated. Two isolates carried  van B genes, while all the remaining isolates carried  van A genes. Three isolates demonstrated a specific  van A genotype  - van B phenotype. Nine (6.7%) isolates demonstrated tigecycline resistance, and all were susceptible to daptomycin and linezolid. Molecular typing revealed 58 pulsotypes and 13 sequence types (STs), all belonged to three major lineages 17, 18, and 78. The most frequent STs were ST17 (n = 48, 35.8%), ST414 (n = 22, 16.4%), and ST78 (n = 16, 11.9%). Among the  van A harboring isolates, eight structure types of the Tn 1546 -like element were demonstrated. Type I (a partial deletion in the  orf1  and insertion of IS 1251 -like between the  vanS  -  vanH  genes) and Type II (Type I with an additional insertion of IS 1678  between  orf2  -  vanS  genes) were the most predominant, consisted of 60 (45.5%) and 62 (47.0%) isolates, respectively. The increase of VRE-fm bacteremia in Taiwan may be associated with the inter- and intra-hospital spread of some major STs and horizontal transfer of  van A genes mostly carried on two efficient Tn 1546- like elements. The prevailing ST414 and widespread of the Type II Tn 1546 -like elements are an emerging problem that requires continuous monitoring.

plos one

National Surveillance on Vancomycin-Resistant Enterococcus faecium in Taiwan: Emergence and Widespread of ST414 and a Tn1546-Like Element with Simultaneous Insertion of IS1251-like and IS1678