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. 2021 Jan 20;13:9. doi: 10.1186/s13073-020-00825-3

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© The Author(s) 2021

Open AccessThis 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 licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence 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 licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 5 — Country-wide contribution of dissemination modes in the spread of vanA-type vancomycin resistance in the Netherlands. VRE isolates (n = 225) with complete metadata, hierBAPS SC, plasmid type, and Tn1546 assignments were considered. In this analysis, time intervals of 2 years (January 2012–December 2013; January 2013–December 2014; January 2014–December 2015) were considered to group the isolates. For each time interval, all windows of 12 consecutive months with at least 10 isolates were considered. From each window, we undertook a pairwise comparison to estimate the frequency of the following events: (i) clonal dissemination, pairs of isolates sharing the same hierBAPS SC, vanA plasmid type, and Tn1546 variant; (ii) plasmid dissemination, pairs of isolates sharing the same vanA plasmid type and Tn1546 variant but distinct hierBAPS SC; (iii) clonal dissemination associated with Tn1546 mobilization, pairs of isolates sharing the same hierBAPS SC and Tn1546 variant but different vanA plasmid type; (iv) Tn1546 mobilization linked to clonal and horizontal dissemination, pairs of isolates sharing the same Tn1546 variant and distinct hierBAPS SC and vanA plasmid type; and (v) unrelated cases, pairs of isolates with distinct Tn1546 variants