# 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
Specifically, the latter are considered a cost-effective point of control for the dissemination of AMR determinants in the environment, as WWTPs gather excreted urine and feces from urban surrounding areas [102]. Accordingly, _E. ficecalis_ and _E. ficecium_ are used as indicators of fecal contamination in water [102]. A comparative genomics study [102] of VRE and MDR enterococci isolated from WWTPs recently performed, described a variety of _E. ficecium_and _E. faecalis_ STs and associated ARGs, virulence genes, and MGEs (Table 3), pointing to WWTPs as key to achieving a better understanding of the linkage between enterococci present in this setting and AMR dissemination [102]. Another recent study [148] detected VREfm and ampicillin-resistant _E. facecium_ hospital-adapted lineages in municipal WWTPs, whose levels in untreated wastewater were significantly higher than directly received hospital sewage. From 28 different ARGs found in the hospital-adapted _E. facecium_ clade, 23 were present in bloodstream infection, hospital sewage, and municipal WWTP enterococci, indicating a genetic overlap between isolates from all sectors and a potential ARG transmission route [148]. An additional study [149] detected _vanA_-positive _E. facecium_ ST17 and ST80 (CC17) in hospital wastewater, once again highlighting the possible dissemination of healthcare-associated antimicrobial-resistant strains to the environment and community through wastewater. For instance, the ST78 strain from the vast CC17 was associated with isolates derived from WWTP samples, according to [107]. Another study [112] identified the same genetic lineage in WWTP from the Czech Republic. Those ST78 clones were also isolated from bovine meat/milk in Tunisia samples [143; 150], which described this complex clone as one of the most common in Chinese cities, leading to its spread throughout the world and indicating clonal persistence in different settings. [PERSON] and [PERSON] [107] described a set of distinct STs (e.g., ST66, ST361, and ST386) (Table 3) in the Gulf of Gdansk, Poland in wastewater and marine outfalls, influencing the quality of waters. ST66 was also found in water sources for agriculture/recational purposes in Australia [151]. One study [103], which focused on VREfm ST133 isolated from an aquatic environment in Switzerland (Table 3), demonstrated a close phylogenetic relationship to ST133 recovered from swine feces, highlighting the role of surface water in VRE dissemination. [PERSON] et al. [18] explored the mobilome and resistance of _E. facecium_ across two disparate geographic locations (Canada and United Kingdom) and found that the dissemination of _E. facecium_ MGEs and antimicrobial resistance determinants is not limited by within-species phylogeny, habitat (clinical, agriculture, municipal and agricultural wastewater, and natural water sources), or geography. Nevertheless, the authors [18] found association between specific gene profiles and MGEs with the habitat and pointed out the possibility of enterococcal pathogenicity features being associated with a group of clinical/municipal wastewater genomes, which might constitute a human-associated ecotype within clade A. Recently, a One Health comparative genomic analysis of virulence, resistance, and mobilome in _E. facecium_ and _E. faccalis_ isolated from livestock, human clinical samples, municipal wastewater, and other environmental sources was performed [36]. The study [36] identified 31 _E. facecium_ and 34 _E. faccalis_ ARGs (62 and 68% being plasmid-associated, respectively), with tetracycline (_tetL_ and _tetM_, frequently found on pM7M2) and macrolide (_ermB_) resistance being described in all sectors of the One Health continuum. Additionally, [PERSON] et al. [152] also observed the presence of _tetM_, _ermA_, and _ermB_ genes in virulent-MDR _E. faecalis_ strains recovered from poultry in Korea, highlighting the spread of tetracycline and macrolide resistance genes among enterococcal isolates from various sectors.