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Fig. 2 | Antimicrobial Resistance & Infection Control

Fig. 2

From: Enterococcus faecium: from microbiological insights to practical recommendations for infection control and diagnostics

Fig. 2

Course of events in the epidemiology of AREfm and VREfm and the differences between the US and Europe from 1970 till 2010. In the United States (US) the increase of AREfm started around 1980 followed by an increase of VRE. In Europe, this event started 20 years later. Note the different situation between the US and Europe; in contrast to the US, Europe did have a large reservoir of VRE in the community in the 1990s, yet without suitable HA AREfm populations in hospitals to take up the van genes and become HA VREfm. This reservoir of VRE was linked to the avoparcin use in husbandry. In blue: Hospital Clade A1-VSEfm (AREfm). In red: hospital-Clade A1 VREfm. HGT: horizontal gene transfer (of van genes). Threshold: hypothetical critical number of hospital clade A1 AREfm strains needed for the introduction of van genes

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