A Possible Role of Insertion Sequence IS in Dissemination of Multidrug-Resistant Elements MES and MES between and ST59 .

Sequence type 59 (ST59) is the dominant type of community-associated methicillin-resistant (MRSA) in Taiwan. Previously, we reported that ST59 MRSA harbors enterococcal IS-mediated multidrug-resistant composite transposons MES or MES. The MES were found to have a mosaic structure, largely originating in enterococci and partly native to . The current study aimed to track the origin of the MES and how they disseminated from enterococci to ST59 . A total of 270 enterococcal isolates were analyzed, showing that two ST64 isolated in 1992 and 11 clonal complex 17 harbored MES-like and MES-like structures, respectively. Sequence analysis revealed that ST64 strain N48 acquired the MES-like structure on the plasmid pEflis48. The pEflis48 harbored the enterococci-originated region (erythromycin, kanamycin, and streptomycin resistances) and the -originated region (chloramphenicol resistance) of MES but was separated by the replication region of the plasmid. Homologous recombination between the two direct repeats of IS resulted in excision of the replication region of the plasmid to regenerate MES. The p4780-1 and pV19 of carried MES-like structures with IS, albeit with multiple insertions by other insertion sequences. The findings show that IS plays important roles in bidirectional gene transfer of multidrug resistance between enterococci and .