PMC9372734_01
Timeline of antimicrobial treatment andE. faeciumisolate recovery. Post-operative day and Efm isolate recovery profiles (V, vancomycin; L, linezolid, D, daptomycin; bottom) are shown together with antibacterial and antifungal treatment regimens. Vancomycin-resistant enterococci (VRE) targeted antimicrobials are highlighted in orange and other antimicrobials are presented in light grey. Isolate post-operative day recovery dates are highlighted in blue. Inverted carrots signify that the antimicrobial agent in question was continued throughout the time period in question. Two vertical forward slashes denote time breaks.
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The patient was ultimately transitioned to culture-directed therapy (meropenem, fluconazole, and linezolid) for four weeks (Fig. 1). A detailed course of antimicrobial therapy is outlined in Fig. 1.
Alignment of plasmid 3 from Isolates 4 and 5 to the vancomycin resistance plasmid 3 of Isolate 3. Regions present in Isolate 4 and 5 draft genomes are indicated in purple and green respectively. Identified resistance genes are indicated in black.
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Plasmid 3 (p3) contained a vanA operon (Fig. 2), explaining the observed vancomycin resistance. Table S2), resulting in the loss of multiple resistance genes (Table 2, Fig. 2). This 7.4 kbp deletion was flanked by IS1216 family transposase genes, suggesting that it was located on a mobile element. Interestingly, this sequence was present in a temporally later isolate, Isolate 5 (Fig. 2).