Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: a systematic review and meta-analysis

Abstract

Background Vancomycin-resistant Enterococci (VRE) infections are recurrently reported in different parts of India in the last two decades. However, an up-to-date, countrywide information concerning the prevalence and the rate of VRE in India is limited and hence this study aimed to estimate the pooled prevalence of VRE in India. Methods A literature search was performed using various databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Cross-sectional studies reporting the prevalence of VRE in India from human samples whereby at least two Enterococci were isolated between 1 January 2000 and 31 December 2022 were sought for inclusion. Data were extracted and analysed using Microsoft Excel and Comprehensive Meta-analysis version 4, respectively. Results Nineteen studies were included in the analyses. A collective total of 3683 Enterococci isolates were examined, of which 368 were VRE strains. The pooled prevalence of VRE in India was calculated at 12.4% (95% CI: 8.6–17.5; Q = 189.69; I2 = 90.51%; p = < 0.001). E. faecalis was the most frequently isolated species (1450 [39.37%]) followed by E. faecium (724 [19.66%]). Amongst the VRE strains, E. faecium was the most prevalent (214 [58.15%]) followed by E. faecalis (134 [36.41%]). An upsurge in the rate of VRE infections was observed in India over time: VRE prevalence was estimated at 4.8% between 2000 and 2010 and 14.1% between 2011 and 2020. Conclusion This study presents the most up-to-date information on the rate of VRE infections in India. Though lower than the findings for some less developed countries, VRE prevalence in India is notable and on the rise.

Prevalence and Susceptibility Pattern of Enterococcus spp in Clinical Samples: A Retrospective Study From a Tertiary Care Teaching Hospital in an Eastern Indian State

“…The most common species isolated in this study was E. faecalis (n = 120, 60%) followed by E. faecium (n = 55, 27.5%) while other species account for only 12.5% of strains isolated. This is in agreement with many previous studies [8,15]. E. faecalis is the most common species of this genus (80-90%), causing clinical infections, while E. faecium accounts for a very low percentage (5-15%) [16].…”

“…The prevalence of vancomycin resistant Enterococci (VRE) is increasing worldwide [7]. Studies from India show a widespread variation in the prevalence of VRE, ranging from 0-30% with an overall prevalence of 12.4%, and studies have shown a steady increase from 4.8% in 2010 to 14.1% in 2020 [8]. Enterococci are known reservoirs of antibiotic resistance genes and effectively transfer them to different bacteria, like methicillin resistant Staphylococcus aureus [9].…”

Study on Biofilm Formation Among Enterococcus Isolates and Association With Their Antibiotic Resistance Patterns

“…However, in this study, all Enterococcus strains were sensitive to linezolid and vancomycin, which is discordant with our study. This difference could be due to the emerging resistance to second-line drugs [ 12 ].…”

Vancomycin Resistant Enterococci Prevalence, Antibiotic Susceptibility Patterns and Colonization Risk Factors Among HIV-Positive Patients in Health-Care Facilities in Debre Berhan Town, Ethiopia

“… 2 In India, based on 19 selected studies, the pooled prevalence of VRE was estimated at 12.4% (95% CI 8.6–17.5). 6 In Africa, an overall pooled prevalence of VRE was 26.8% (95% CI 10.7–43.0%) with a one-health perspective. 7 In Ethiopia, different prevalence studies among different study populations and clinical specimens reported 6.7–22.7% VRE.…”