Rapid in vivo development of resistance to daptomycin in vancomycin-resistant Enterococcus faecium due to genomic rearrangements

Resistance mechanisms of daptomycin are not fully understood. In this project we analysed the genomic changes leading to a daptomycin-susceptible vancomycin-resistant Enterococcus faecium (VREfm) isolate becoming resistant after 40 days of daptomycin and linezolid combination therapy. The two isogenic VREfm isolates (daptomycin-susceptible and daptomycin-resistant) were closed using whole genome sequencing with Illumina and Nanopore.