---
title: "Enterococcus faecium clade evolution and genome plasticity driving antimicrobial resistance"
id: "pubmed-42579153"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42579153"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42579153/"
doi: "10.1007/s00203-026-05077-0"
published_at: "2026-08-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Enterococcus faecium clade evolution and genome plasticity driving antimicrobial resistance
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42579153
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42579153/)
- **DOI:** [10.1007/s00203-026-05077-0](https://doi.org/10.1007%2Fs00203-026-05077-0)
- **Published At:** 2026-08-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Enterococcus faecium has shifted from a commensal organism to a leading **multidrug resistant** hospital-acquired pathogen with major global public health impact. - Its rapid adaptation is driven by high **genomic plasticity**, extensive **horizontal gene transfer**, and selection from heavy antibiotic use in clinical and non-clinical settings. - Comparative genomic studies identify distinct community-associated and hospital-associated clades; hospital clones, notably **clonal complex 17**, are enriched for antibiotic resistance genes, mobile genetic elements and virulence factors. - The species shows resistance to multiple drug classes, including beta-lactams (penicillin), **vancomycin**, **linezolid**, and **daptomycin**, narrowing therapeutic options and contributing to increased morbidity and mortality. - The review examines evolutionary history, genome diversity, resistance mechanisms, and global resistance trends that underlie the emergence of hospital-adapted E. faecium. - Clinical and public health importance is discussed in a **one health** context: humans, animals and the environment serve as integrated reservoirs for resistant strains and mobile elements. - The authors highlight the need for coordinated measures: integrated **genomic surveillance**, development of novel therapeutic approaches, and strengthened **antimicrobial stewardship** aligned with World Health Organization priorities. - Conflict of interest: authors declare no competing interests. Ethical approval: not applicable.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. * 2 Gujarat Biotechnology Research Centre, Gandhinagar, Gujarat, 382011, India. * 3 Institute of Pharmacy, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. * 4 Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. shruti.chatterjee@nirmauni.ac.in. * PMID: **42579153** * DOI: [ 10.1007/s00203-026-05077-0 ](https://doi.org/10.1007/s00203-026-05077-0) Item in Clipboard Review # Clade-specific evolution and genome plasticity underlying antimicrobial resistance in Enterococcus faecium Krishna Patel et al. Arch Microbiol. 2026. Show details Display options Display options Format Abstract PubMed PMID Arch Microbiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arch+Microbiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Arch+Microbiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42579153/) . 2026 Aug 11;208(11):572. doi: 10.1007/s00203-026-05077-0. ### Authors [Krishna Patel](https://pubmed.ncbi.nlm.nih.gov/?term=Patel+K&cauthor_id=42579153)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42579153/#short-view-affiliation-1 "Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India."), [Monica Chavan](https://pubmed.ncbi.nlm.nih.gov/?term=Chavan+M&cauthor_id=42579153)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42579153/#short-view-affiliation-1 "Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42579153/#short-view-affiliation-2 "Gujarat Biotechnology Research Centre, Gandhinagar, Gujarat, 382011, India."), [Jigna Shah](https://pubmed.ncbi.nlm.nih.gov/?term=Shah+J&cauthor_id=42579153)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42579153/#short-view-affiliation-3 "Institute of Pharmacy, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India."), [Shruti Chatterjee](https://pubmed.ncbi.nlm.nih.gov/?term=Chatterjee+S&cauthor_id=42579153)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42579153/#short-view-affiliation-4 "Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. shruti.chatterjee@nirmauni.ac.in.") ### Affiliations * 1 Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. * 2 Gujarat Biotechnology Research Centre, Gandhinagar, Gujarat, 382011, India. * 3 Institute of Pharmacy, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. * 4 Institute of Science, Nirma University, SG Highway, Ahmedabad, Gujarat, 382478, India. shruti.chatterjee@nirmauni.ac.in. * PMID: **42579153** * DOI: [ 10.1007/s00203-026-05077-0 ](https://doi.org/10.1007/s00203-026-05077-0) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract A commensal organism has transformed into the leading multidrug resistant (MDR) hospital acquired pathogen, with serious implication on global public health. The ability of Enterococcus faecium to rapidly adapt through its great genomic plasticity, horizontal gene transfer and under selective pressures created by heavy antibiotic application both clinically and non-clinically is responsible for the phenomenon. Comparative genome studies have reported the presence of different community acquired and hospital acquired clades; hospital acquired clones being particularly the clonal complex 17 have enriched antibiotic resistant genes, mobile genetic elements, virulence factors. Therapeutic choices are now restricted, while mortality and morbidity increase due to lack of adequate drug targets, resistant to penicillin, vancomycin, linezolid and daptomycin. This review critically discuss the finding about the evolutionary history, diversity of genome, resistant mechanisms and global resistant trends of E. faecium's evolution into the hospital associated strain. The clinical and public health importance of MDR E. faecium is reviewed within the context of one health including the integrated roles of human, animal, and environment as reservoirs. Lastly, the review highlights the importance of integrated genomic surveillance, novel therapy approaches and an enhanced antimicrobial stewardship program according to World Health Organization priorities in the global fight against MDR E. faecium. **Keywords:** Antimicrobial resistance; Horizontal gene transfer; Mobile genetic element; Sequence type; Vancomycin resistant Enterococcus. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: Not applicable. ## References 1. 1. Abdelbary MHH, Senn L, Greub G, Chaillou G, Moulin E, Blanc DS (2019) Whole-genome sequencing revealed independent emergence of vancomycin-resistant Enterococcus faecium causing sequential outbreaks over 3 years in a tertiary care hospital. Eur J Clin Microbiol Infect Dis 38(6):1163–1170. - [DOI](https://doi.org/10.1007/s10096-019-03524-z) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30888549/) 2. 1. Allen F, McInnes RS, van Schaik W, Moran RA (2025) IS1216 drives the evolution of pRUM-like multidrug resistance plasmids in Enterococcus faecium. Microb Genom. - [DOI](https://doi.org/10.1099/mgen.0.001598) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/41406009/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/12711152/) 3. 1. Almeida-Santos AC, Novais C, Peixe L, Freitas AR (2025) Vancomycin-resistant Enterococcus faecium: a current perspective on resilience, adaptation, and the urgent need for novel strategies. J Global Antimicrob Resist 41:233–252. - [DOI](https://doi.org/10.1016/j.jgar.2025.01.016) 4. 1. Arias CA, Murray BE (2012) The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol 10(4):266–278. - [DOI](https://doi.org/10.1038/nrmicro2761) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/22421879/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/3621121/) 5. 1. Arredondo-Alonso S, Top J, McNally A, Puranen S, Pesonen M, Pensar J, Marttinen P, Braat JC, Rogers MRC, van Schaik W, Kaski S, Willems RJL, Corander J, & Schürch AC (2020) Plasmids Shaped the Recent Emergence of the Major Nosocomial Pathogen Enterococcus faecium. MBio, 11(1), 1–17. 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