Genomic characterisation of vancomycin-resistant Enterococcus faecium with Tn1546-plasmid rep17 in obstetrics and gynaecology settings in Algeria.

Enterococcus faecium is a major global health threat, particularly in high-risk patient groups, and the emergence of vancomycin-resistant strains (VREfm) has severely limited treatment options. Here, we conducted a comprehensive genomic analysis of two clinical vanA-type VREfm isolates. Two VREfm strains were isolated 20 days apart from surgical site infections (SSIs) from two different hospitalised patients in obstetrics and gynaecology departments because of post-operative wound infections. Antibiotic susceptibility profile, whole-genome sequencing (WGS), and bioinformatic analyses were conducted to investigate plasmids, resistome and genomic relatedness with reported E. faecium genomes. Both isolates were identified as ST80 within the clonal complex CC17 and revealed close relatedness, since only 8 gSNPs distinguish them. They exhibited multidrug-resistance phenotype mediated by the presence of resistance genes to vancomycin, to aminoglycosides, and to macrolides. The vanA operon was found in a Tn1546 transposon-like element on the rep17 plasmid that also carries locus 3: [ant(6)-sat(4)-aph(3')] raising the possibility of its transfer into a staphylococcal genome, as recently reported. Our study reports genomic attributes of two clinical VREfm ST80 isolates, harbouring a vanA-carrying rep17 plasmid in Algeria highlighting the presence of the epidemic VREfm ST80 clone evolving in healthcare settings.