Genomic comparison of VRE isolates.

<p><b>(A)</b> Conserved sequence blocks generated by HarvestTools 1.1.2 to construct the phylogenetic tree. <b>(B)</b> A second phylogeny was performed on more closely related strains, to refine the Recipient-Donor clade. Isolates with the hypervariable groupings shown in <b>(C)</b> share the same color in both phylogenies. <b>(C)</b> A 40kb interval from the donor strain spanning the hypervariable chromosomal locus was extracted and homologous sequence blocks were obtained from each isolate. Each colored block corresponds to syntenic interval between strains, and isolates are grouped by primary syntenic block order. The red recipient block (outlined in black) corresponds to a mobile element gene insertion of an IS<i>1251</i>-like element. The corresponding genes in the Recipient genomic interval are shown below.</p

Agarose gel showing SmaI digestion patterns of strains via PFGE.

<p><b>(A)</b> PFGE gel of VRE 5, 6, 7, VRE Recipient and VRE Donor isolates with ramped pulse times of 2s to 28s to resolve higher-molecular weight fragments. <b>(B)</b> Same as A but with ramped pulse times of 2s to 7s to resolve low-molecular weight fragments. Asterisks (*) indicate missing or variable DNA band sizes among isolates. Arrows indicate the corresponding higher resolution DNA band area in panel B relative to panel A. </p

Genomic confirmation of vancomycin-resistant <i>Enterococcus</i> transmission from deceased donor to liver transplant recipient

<div><p>In a liver transplant recipient with vancomycin-resistant <i>Enterococcus</i> (VRE) surgical site and bloodstream infection, a combination of pulsed-field gel electrophoresis, multilocus sequence typing, and whole genome sequencing identified that donor and recipient VRE isolates were highly similar when compared to time-matched hospital isolates. Comparison of <i>de novo</i> assembled isolate genomes was highly suggestive of transplant transmission rather than hospital-acquired transmission and also identified subtle internal rearrangements between donor and recipient missed by other genomic approaches. Given the improved resolution, whole-genome assembly of pathogen genomes is likely to become an essential tool for investigation of potential organ transplant transmissions.</p></div