FIG 4.

International phylogenies confirm that three major tetM-positive RT078 clades are present across continents. (A) Map of Western Europe. The regions of England and The Netherlands from which the genomes included in panel B originated are highlighted (in black and pink, respectively). (B) Time-scaled RT078 phylogeny constructed using genomes of clinical isolates from England (Oxfordshire and Leeds), supplemented with genomes from the Netherlands (human isolates [clinical or farmer] and pig isolates [30]). Branch colors are as described for the map in panel A. The presence of the three predominant ribosomal protection protein (RPP) tetM alleles (tetM 10, 16, and 19) is indicated by the colored bars to the right of the tree. The gray shaded block over the region corresponding to the period prior to 1990 indicates that the region is not scaled identically for different phylogenies and should not be used for comparisons. (C) Map highlighting the regions in North America and Western Europe from which the genomes included in panel D originated. (D) Time-scaled RT078 phylogeny constructed using genomes of clinical isolates from England supplemented with clinical isolates from North America and Europe (distinct from the isolates used as described for panel B) from two clinical trials of the drug fidaxomicin (Table S1) (33, 34).