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We are studying the evolution of normally commensal enterococci, including Enterococcus faecalis and Enterococcus faecium, into antibiotic resistant, hospital-adapted pathogens. Using comparative genomics and high-throughput phenotyping of a serial outbreak of E. faecalis bacteremia, we have gained novel insights into how enterococci adapt to growth and proliferation in the human bloodstream. We have further demonstrated the connection between agricultural practices and the emergence of hospital adapted enterococci by showing that strains collected by Consumer Reports from raw chicken sold in supermarkets were highly related to those infecting humans in hospital settings, and also carried genetic elements known to confer resistance to important classes of antibiotics. Finally, we have identified genomic signatures that are informing studies of the molecular mechanisms underlying transfer of resistance from enterocci to other pathogens, like the staphylococci, and providing new insights into the gene repertoire, biology and selective pressures that have shaped members of this clinically important group.

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