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. 2018 Apr 19;8:6274. doi: 10.1038/s41598-018-24614-6

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© The Author(s) 2018

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Vancomycin-resistant Enterococcus faecium (VREfm) transmission analysis based on single nucleotide polymorphism (SNP) genotypes of Phylogenetic Clade 1 (PC1). (a) Inferred VREfm transmission directions are represented by line connections between patients. Phylogenetic relationship is measured by differences in unique SNPs (numbers above connecting lines) and patristic distances between the isolates (numbers below connecting lines). (b) Correlation of SNP genotype data with epidemiological data revealed likely direction of transmission and potential points of transmission within the hospital. Potential points of transmission of PC1 vanB ST796 VREfm are indicated (pink areas). The Intensive Care Unit (ICU) was identified as the most likely location where transmission of VREfm occurred to patient 16C_RHH005 who presented with clinical symptoms of a urinary tract infection. Additional hospital units where patients from this cluster were located are indicated (yellow areas). Hospital ward abbreviations: ACW, acute cardiac ward; ED, emergency department; GMW, acute general medicine ward; ICU, intensive care unit; MAU, acute medical admissions unit; MSW, acute medical specialties ward; SSW, acute surgical specialties ward.