Multidrug-resistant high-risk Enterococcus faecium clones: can we really define them?

•Strain typing methods and genomic evolution data are continuously reshaping the definition of E. faecium high-risk clones.•Genetic capitalism is a pivotal driver of the emergence and persistence of E. faecium high-risk clones.•Direct transmission of E. faecium high-risk clones from non-clinical settings is arguable.•Increasing knowledge on the E. faecium unlimited pan-genome may be useful to redefine specialised subpopulations.•Increasing knowledge on the E. faecium unlimited pan-genome may be useful to elaborate effective control strategies.