FIG 5.

(A) Phylogenetic maximum likelihood tree of imported strains. The NGS cluster information, as well as the most likely origin of the VREfm, is displayed. Patient identification (ID) numbers are indicated along with (in parentheses) whether patients were transferred from a local hospital (A to Z), from a hospital within Germany (1), or from any other hospital (2). If no information was available, the isolate is marked as unknown (unk). Most of the imported isolates belonged to NGS clusters 5 and 6. However, smaller clusters (e.g., cluster 2) and single isolates have also been observed. (B) Timeline of VREfm isolates imported in the hospital. As within the hospital, a sharp increase in the import of VREfm isolates was noted. Interestingly, the composition of NGS clusters of the imported strains, observed from October 2015 onwards, was also dominated by NGS clusters 5 and 6.