Prevalence of vancomycin‐resistant enterococci in Asia—A systematic review and meta‐analysis

Abstract

Enterococci are gram-positive flora of the human intestine, of which E. faecalis and E. faecium are responsible for the majority of the infections in humans amongst at least 59 validly published species. 1,2 They are common causes of some serious infections such as endocarditis, urinary tract infection, wound infection and nosocomial bacteremia. [3][4][5] Enterococci are resistant to a wide range of antimicrobials used in the treatment of gram-positive bacterial infection and inherent resistance is shown to aminoglycosides, clindamycin and co-trimoxazole. 3,6 They also have the ability for the acquisition of resistant genes to antimicrobials through mutations or attainment

Rapid detection ofEnterococcusand vancomycin resistance using recombinase polymerase amplification

“…VRE was found to be 8.10% prevalent throughout Asia. The Enterococcus faecium showed higher resistance to vancomycin than E. faecalis (22.4% vs. 3.7%) ( Shrestha et al, 2021 ). As shown in a survey from China, Enterococcus spp.…”

Distribution of multidrug-resistant Enterococcus faecalis and Enterococcus faecium isolated from clinical specimens in the Zainoel Abidin General Hospital, Banda Aceh, Indonesia

“…These findings corroborate previous report elucidating that both multidrugresistant enterococcal pathogens remain sensitive to these last resort antibiotics including oxazolidinones (linezolid, tedizolid), novel tetracyclines (tigecycline), and lipopeptides (daptomycin) (Bender et al 2018). However, it is worth noting that the resistance development of enterococcal pathogens against vancomycin (Shrestha et al 2021), linezolid (Bi et al 2018), and tigecycline (Bai et al 2022) is emerging. The primary mechanism of vancomycin resistance in enterococci is the modification of the peptidoglycan production pathway, which results in decreased binding affinity of vancomycin medicines to the normal cell wall (Ahmed and Baptiste 2017), whereas linezolid resistance is achieved by the mutation of 23S rRNA of ribosomal methyl transferase gene cfr as well as optrA (oxazolidinone phenicol transferable resistance) gene (Bi et al 2018), and tigecycline resistance was established through mutation of tigecycline target sites and upregulation of efflux pumps (Bai et al 2022).…”

Vancomycin Resistance in Enterococcus and Staphylococcus aureus

“…Although the acquisition of vancomycin resistance via MGEs has been shown to incur a high and immediate fitness cost in enterococci [ 409 ], the prevalence of VRE has continually increased globally since emergence in the 1980s [ 260 , 270 , 410 , 411 ]. However, even in the absence of vancomycin selection, van -carrying enterococcal MGEs have demonstrated high rates of intra-species conjugation, stability within the host [ 412 ], impose little to no fitness cost when uninduced [ 413 , 414 ] and rapidly mitigate biological costs upon growth and form beneficial host-plasmid associations [ 409 ].…”

“…Globally, the prevalence of antibiotic-resistant enterococcal infections remains high and rising in many different countries around the world, with heavy burdens of disease in both developing and developed nations [ 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 ]. In 2019, E. faecalis and E. faecium were attributed to 100,000–250,000 fatalities associated with antimicrobial resistance (AMR) [ 268 ].…”

“…In the United States, VRE constituted 30% of all HA infections in 2017, resulting in approximately 54,500 hospitalizations and 5400 deaths [ 29 ]. A 2021 meta-analysis by Shrestha et al showed the pooled prevalence of VRE in Asia to be 8.1%, higher than those reported from Europe [ 269 ] but lower than North America (21%) [ 260 ]. In 2020, the reported overall pooled prevalence of VRE in Africa was 26.8% [ 270 ], while Australia had an overall vancomycin resistance rate in E. faecium of 32.6% [ 271 ], with VRE constituting up to 64.2% of all bloodstream infections in some regions of the country that same year [ 272 ].…”