Vancomycin-resistant enterococci (VRE) in hospital settings across European borders: a scoping review comparing the epidemiology in the Netherlands and Germany

Abstract

The rising prevalence of vancomycin-resistant enterococci (VRE) is a matter of concern in hospital settings across Europe without a distinct geographical pattern. In this scoping review, we compared the epidemiology of vancomycin-resistant Enterococcus spp. in hospitals in the Netherlands and Germany, between 1991 and 2022. We searched PubMed and summarized the national antibiotic resistance surveillance data of the two countries. We included 46 studies and summarized national surveillance data from the NethMap in the Netherlands, the National Antimicrobial Resistance Surveillance database in Germany, and the EARS-Net data. In total, 12 studies were conducted in hospitals in the Netherlands, 32 were conducted in German hospitals, and an additional two studies were conducted in a cross-border setting. The most significant difference between the two countries was that studies in Germany showed an increasing trend in the prevalence of VRE in hospitals, and no such trend was observed in studies in the Netherlands. Furthermore, in both Dutch and German hospitals, it has been revealed that the molecular epidemiology of VREfm has shifted from a predominance of vanA towards vanB over the years. According to national surveillance reports, vancomycin resistance in Enterococcus faecium clinical isolates fluctuates below 1% in Dutch hospitals, whereas it follows an increasing trend in German hospitals (above 20%), as supported by individual studies. This review demonstrates that VRE is more frequently encountered in German than in Dutch hospitals and discusses the underlying factors for the difference in VRE occurrence in these two neighboring countries by comparing differences in healthcare systems, infection prevention control (IPC) guidelines, and antibiotic use in the Netherlands and Germany.

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“…Our findings revealed that VRE constituted 15.9% of the total sample, while VSE made up 84.1%. This VRE incidence was consistent with recent studies [ 12 , 13 ]. The highest incidence of VRE was observed in E. casseliflavus (75%), followed by E. gallinarum (50%).…”

Prevalence and Antimicrobial Resistance Patterns of Hospital Acquired Infections through the COVID-19 Pandemic: Real-Word Data from a Tertiary Urological Centre

“…In our study, 77% of E. faecium isolates were VRE. The prevalence of VRE colonization in different patient groups was investigated in nine cross-sectional studies, two cohort studies and one pre-post study in hospitals in Europe [29]. The prevalence ranged between 1.2% and 27.7% [21].…”

“…VRE continues to be a serious issue in healthcare due to the few available treatment options and rising prevalence of VRE in Europe. Effective strategies to control the spread of VRE are required [29].…”

Antimicrobial Resistance in Enterococcus spp. Isolates from Red Foxes (Vulpes vulpes) in Latvia

“…The ability of Enterococcus spp. to acquire additional resistance via, e.g., mobile genetic elements or sporadic chromosomal mutations, raises concerns about the available therapeutical options for the treatment of enterococcal infections [12,13]. Vancomycin-resistant E. faecium (VRE) isolates have been recognized as high-priority pathogens by the World Health Organization, for which new antibiotics are urgently needed, and the increasing prevalence of VRE has been reported in hospitals in Europe [14,15].…”