Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020

Abstract

Background Hospital-acquired infections (HAI) caused by Enterococcus spp., especially vancomycin-resistant Enterococcus spp. (VRE), are of rising concern. Aim We summarised data on incidence, mortality and proportion of HAI caused by enterococci in the World Health Organization European Region. Methods We searched Medline and Embase for articles published between 1 January 2010 and 4 February 2020. Random-effects meta-analyses were performed to obtain pooled estimates. Results We included 75 studies. Enterococcus spp. and VRE accounted for 10.9% (95% confidence interval (CI): 8.7–13.4; range: 6.1–17.5) and 1.1% (95% CI: 0.21–2.7; range: 0.39–2.0) of all pathogens isolated from patients with HAI. Hospital wide, the pooled incidence of HAI caused by Enterococcus spp. ranged between 0.7 and 24.8 cases per 1,000 patients (pooled estimate: 6.9; 95% CI: 0.76–19.0). In intensive care units (ICU), pooled incidence of HAI caused by Enterococcus spp. and VRE was 9.6 (95% CI: 6.3–13.5; range: 0.39–36.0) and 2.6 (95% CI: 0.53–5.8; range: 0–9.7). Hospital wide, the pooled vancomycin resistance proportion among Enterococcus spp. HAI isolates was 7.3% (95% CI: 1.5–16.3; range: 2.6–11.5). In ICU, this proportion was 11.5% (95% CI: 4.7–20.1; range: 0–40.0). Among patients with hospital-acquired bloodstream infections with Enterococcus spp., pooled all-cause mortality was 21.9% (95% CI: 15.7–28.9; range: 14.3–32.3); whereas all-cause mortality attributable to VRE was 33.5% (95% CI: 13.0–57.3; range: 14.3–41.3). Conclusions Infections caused by Enterococcus spp. are frequently identified among hospital patients and associated with high mortality.

Measuring Epidemiologic Effects of Enterococcal Bacteremia and Outcomes From a Nationwide Inpatient Sample Database

“…A systemic review and meta-analysis by the WHO (European region) pooled all-cause mortality of hospitalacquired infections caused by Enterococcus, ranging between 14.3% and 32.3% (pooled estimate: 21.9%; 95%CI: 15.7-28.9, five studies) [11]. This rate is considerably higher than in our study, which is 11.07%.…”

Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia

“…Resistance of Staphylococcus aureus to oxacillin (35.5%), but not vancomycin (0%), was in line with reports showing very low rates of VRSA in Europe [ 29 ]. Vancomycin-resistant enterococci (VRE), on the other hand, were identified in 28.9% of cases, which was a finding of concern since Europe-wide resistance rates were identified at a much lower rate (7.3%) [ 30 ].…”

Enterococcus Virulence and Resistant Traits Associated with Its Permanence in the Hospital Environment

“…Initially portrayed as organisms of little clinical importance, enterococci, particularly Enterococcus faecalis and Enterococcus faecium , have been progressively associated with an increasing number of hospital-acquired infections (HAIs) in both human and veterinary medicine [ 3 ]. In fact, enterococci account for 6.1–17.5% of all isolates retrieved between 2010 and 2020 from European patients with these types of infections in human medicine [ 4 ]. Apart from these two species, other enterococcal species can also be isolated, such as Enterococcus hirae , Enterococcus durans, Enterococcus gallinarium and Enterococcus casseliflavus , not only in veterinary medicine [ 3 ], but also in human medicine [ 5 , 6 , 7 ], although they are not as commonly associated with HAIs and thus are less commonly studied.…”

“…This infection-inducing capacity becomes especially critical when its degree of antibiotic resistance is considered. The intrinsic and extrinsic resistance traits associated with this genus allow it to be resistant to several antibiotics, including β-lactams, aminoglycosides and glycopeptides, rendering it difficult to combat these infections [ 1 , 3 , 4 , 8 , 9 ]. In fact, vancomycin-resistant Enterococcus faecium is considered by the World Health Organization (WHO) [ 10 ] as a high priority pathogen for which new antimicrobial therapies are needed.…”