# Dissemination of Enterococcuscal Genetic Lineages: A One Health Perspective
## 4 Enterococcal Genetic Traits: Dissemination in the One Health Continuum
### Dissemination of Genetic Traits across One Health Sectors
faecalis_ ST6 (CC2) carrying pheromone-like _vanA_ plasmids is disseminated among human and swine hosts in Europe. Furthermore, [PERSON] et al. [128] performed a core genome MLST analysis of _E. faecalis_ strains collected from human infection and colonization, showing a close relationship with isolates from clinical sewage/wastewater, belonging to ST6. From the 97 ST6 enterococci, 57 were allocated in 34 distinct CTs, indicating high potential for rapid adaptation. The authors [128] also found that human-clinical associated lineage ST6 included most of the VRE observed. [PERSON] et al. [129] identified enterococci belonging to ST6 in natural gilthead seabream recovered off the coast of Portugal. Regarding _E. facecium_, in Portugal, ST132 (CC17) conveying _vanA_ plasmids was found to be spread between humans and swine. The ST273 described in the previous study was also found in a wastewater treatment plant in Czech Republic (Table 3) [112; 129]. A major study [101], using MLST, investigated the prevalence of antimicrobial-resistant and virulence genes in _E. faecalis_ from ducks at slaughterhouses, and the dominant sequence types were ST170, ST593, ST314, ST903, and ST192. The other STs present were represented by a single isolate, and the overall results revealed the presence of 16 distinct CCs. It should also be noted that ST170, a single-locus variant (SLV) of ST82, has already been identified in a hospitalized patient in Poland. Additionally, ST116 recovered from duck skin is an SLV of ST145, which has previously been isolated in hospitalized patients from Spain. CC93 comprises four STs, including ST75 (already found in a hospitalized patient from Portugal), ST657 (in a hospitalized patient from China), ST226 (from poultry meat), and ST98 [101]. Overall, the abovementioned data highlight that _E. faecalis_ is loaded from ducks are associated with human healthcare-related enterococci, which may pose a serious risk to public health. Furthermore, regarding antimicrobial patterns, the vast majority of the duck isolates were resistant to tetracycline, doxycycline, erythromycin, and norfloxacin, which may be associated with therapeutic failure. Other noteworthy STs include ST29, which was identified in poultry, wild birds, rodents, and non-hospitalized humans [130] and in pigs from six different Brazilian states [131]; ST13, which was recovered from poultry in Sweden [132]; ST242, ST214, and ST955, which were all found in bovine feces [104], with ST242 being also discovered in wild Magellanic Penguins [133]; ST214, which was observed in non-hospitalized humans [134]; and ST955, which was found in a hospitalized human in Canada [135]. Other studies, such as the one performed by [PERSON] et al. [105], demonstrated the presence of the clinical _E. facecium_ CC17 and transmission of multiple STs carrying ARGs and MGEs, from poultry litter to agricultural soil. In Malaysia, a research group analyzed the genetic variability and evolutionary relationships of VRE isolated from humans, poultry, and swine [108]. Regarding VREfm, enterococci belonging to ST203 (CC17) were found in both humans and poultry. This sequence type has been associated with healthy individuals, farms, slaughterhouses, and the environment. Moreover, another isolate of ST17 (CC17), one of the most widespread genetic lineages associated with human infections, was identified in swine- [136] and poultry-based products [111]. Overall, antibiotic-resistant bacteria dissemination through food-producing animals or the food chain is considered a public health problem, but its real effect as an impact on human health continues to be uncertain [137]. The rise of AMR poses significant challengesto global health and food safety, to the extent that the WHO anticipates entry into the post- antimicrobial era during the present century [138]. Numerous studies [139; 140; 141] addressed antimicrobial resistance patterns and virulence factors in food products.