Global prevalence of antibiotic resistance in blood-isolated Enterococcus faecalis and Enterococcus faecium: a systematic review and meta-analysis

Figures & data

Figure 1 Flow diagram of the literature search and study selection (PRISMA flow chart).

Table 1 Prevalence of antibiotic resistance in blood-isolated Enterococcus spp.

Antibiotic	Enterococcus faecalis			Enterococcus faecium			Enterococcus spp.
	Pooled prevalence (%) (95% CI)	n/N	N of studies	Pooled prevalence (%) (95% CI)	n/N	N of studies	Pooled prevalence (%) (95% CI)	n/N	N of studies
Vancomycin	1.6 (1.4–2.5)	336/14,741	88	10 (8–13)	1762/12,695	108	6.6 (5.7–7.7)	3029/34,708	245
Gentamicin	36.5 (33–40)	7167/20,163	89	46.5 (39–45)	2019/4196	53	37.5 (35–40)	11,284/29,958	181
Ampicillin	4 (2.3–7)	921/11,047	48	78 (73–82.5)	2979/3747	45	43.5 (39.3–47.8)	5678/20,870	133
Teicoplanin	2 (1.2–3)	215/7031	41	14.5 (9.5–22)	488/2246	36	6 (5–6.5)	1285/14,876	110
Linezolid	0.6 (0.3–1)	52/8762	34	1.7 (1–2.8)	34/3293	34	0.9 (0.7–1.3)	104/17,947	100
Ciprofloxacin	43.5 (36–51)	2855/6840	40	75 (69–80)	1944/2513	32	57.5 (53–61.7)	6530/12,666	99
Streptomycin	35 (30.5–40)	2805/8097	42	50.5 (42.2–59)	1336/2377	35	38.53 (4.5–45.5)	5192/13,207	88
Erythromycin	70 (65–74)	3952/5553	27	84 (79–88)	1661/1977	26	73.7 (70–77)	6969/10,874	69
Penicillin	18 (12–26.5)	868/5382	26	85.5 (81–89)	1656/1926	24	61 (55.5–66)	2900/8437	66
Chloramphenicol	30 (23.3–38)	543/1838	19	17.5 (11.5–26)	113/657	14	26 (22.3–30)	1355/5419	62
Levofloxacin	27.5 (22–34)	1511/5045	17	79.3 (72.6–84.7)	1182/1484	17	45 (40.7–49.6)	4397/10,437	54
Quinupristin/dalfopristin	97 (89–99.2)	2170/2479	9	8 (4.6–13.8)	225/1972	23	44.5 (36–53)	4435/7862	50
Tetracycline	81.5 (74.6–87)	2822/3497	21	59 (49.2–68)	651/1194	16	66 (62–70)	4951/7028	48
Daptomycin	0.2 (0.1–0.5)	0/3636	11	0.6 (0.2–1.2)	0/1308	12	0.4 (0.3–0.6)	2/8704	40
Nitrofurantoin	2 (0.8–5.6)	77/2494	14	43 (30.5–56.7)	455/1003	14	21.5 (15.7–28.5)	703/4401	33
Amoxicillin/clavulanic acid	3.2 (0.5–18.5)	8/400	5	54 (35–72)	110/207	5	29.5 (19.5–41.5)	183/976	19
Imipenem	5 (0.6–21.2)	119/1076	6	79.3 (57.2–91.7)	548/669	5	45 (25.5–66)	731/2327	16
Tigecycline	0.5 (0.1–1.7)	1/738	4	1 (0.2–4.5)	3/492	4	0.5 (0.2–1)	4/3404	11
Norfloxacin	23.5 (13–38.6)	122/434	3	70.3 (40.89.3)	114/144	3	57.3 (49.6–64.7)	446/902	10
Amikacin	21.5 (17–27.3)	51/236	2	31 (20.5–45.5)	19/62	2	23.3 (19–28.3)	133/633	10
Linezolid	0.9 (0.1–7)	1/537	4	0.9 (0.2–4.3)	0/172	3	1 (0.1–2.7)	2/834	9

Table 2 Prevalence of antibiotic resistance in blood-isolated Enterococcus spp. by WHO regional offices

WHO regional office	America		Africa		Europe		South-East Asia		Western Pacific		Eastern Mediterranean
Antibiotic	Pooled prevalence (%) (95% CI)	N of study	Pooled prevalence (%) (95% CI)	N of study	Pooled prevalence (%) (95% CI)	N of study	Pooled prevalence (%) (95% CI)	N of study	Pooled prevalence (%) (95% CI)	N of study	Pooled prevalence (%) (95% CI)	N of study
Enterococcus faecalis
Vancomycin	4.5 (3–7)	9	1 (0.1–7)	2	1 (0.8–1.6)	48	4 (2–7.2)	11	0.6 (0.1–4.6)	7	5 (2.6–9)	11
Gentamicin	30.5 (28–33)	8	51 (41.5–60.5)	2	36 (31–41)	49	43 (31–52)	12	43.7 (33.7–54)	7	32.2 (25.5–40)	11
Ampicillin	1.5 (1–2)	9	1 (0.1–7)	2	1.5 (0.6–3)	13	50 (34.7–65)	10	0.4 (0.2–1)	7	11.7 (6.7–19.6)	11
Teicoplanin	2.5 (1.2–5.5)	7	0.6 (0–9)	1	1 (0.6–1.7)	17	4 (0.8–19)	6	4.2 (2–9)	1	4 (2.5–6.5)	9
Linezolid	0.3 (0.2–0.6)	8	3.6 (0.5–21.5)	1	0.4 (0.2–0.9)	9	2 (0.2–22)	3	0.5 (0.2–1.7)	7	1.5 (0.4–6)	6
Enterococcus faecium
Vancomycin	10.5 (25.5–57)	10	1.3 (0.1–17)	1	6.5 (5–8.6)	71	6 (2–15.3)	10	20.5 (12–33)	7	23.2 (11–42.3)	11
Gentamicin	28 (15–45.3)	8	61.5 (45.5–75.3)	1	42 (28–57.5)	17	49.7 (35.6–64)	12	65.5 (53.2–76)	7	39 (20–62)	10
Ampicillin	81.5 (76.5–85.5)	9	95 (81.7–98.7)	1	83.5 (78–88)	14	50.5 (36–65)	9	86 (79–91)	7	64.5 (49.7–77)	7
Teicoplanin	29 (14–51)	7	1.3 (0.1–17)	1	8 (2.5–22)	12	8 (2.5–22)	7	21 (11–37)	1	20 (8.5–39.5)	10
Linezolid	0.8 (0.4–2)	8	–	–	1.3 (0.7–2.5)	10	4 (2–9)	4	1.5 (0.3–7)	7	3 (1.2–7.7)	7

Table 3 Prevalence of antibiotic resistance in blood-isolated Enterococcusspp. by study time groups

Study year	2000–2005			2005–2010			2010–2016
Antibiotic	Pooled prevalence (%) (95% CI)	n/N	N of studies	Pooled prevalence (%) (95% CI)	n/N	N of studies	Pooled prevalence (%) (95% CI)	n/N	N of studies
Enterococcus faecalis
Vancomycin	1 (0.5–2)	52/5148	25	2.2 (1.5–3.2)	199/6401	37	2.7 (1.5–5)	85/3084	24
Gentamicin	36.5 (28.5–45.5)	1476/3790	21	39.7 (34–45.5)	1910/4905	23	34.5 (30–39)	3726/11,360	43
Ampicillin	4 (1.7–9)	521/3753	17	2 (0.7–6)	143/4832	14	9 (4–21)	257/2354	15
Teicoplanin	0.9 (0.4–2)	7/1468	9	1.8 (0.9–36)	160/4020	19	4.4 (2.5–8)	55/1472	13
Linezolid	0.3 (0.1–0.8)	1/1543	6	0.4 (0.1–1)	14/5020	15	2 (0.8–5.5)	43/2180	13
Enterococcus faecium
Vancomycin	8.2 (5–12.5)	166/1861	24	9 (6.5–12.5)	1232/9674	62	22 (14–33)	364/1121	21
Gentamicin	42.5 (28–58.5)	547/1447	20	44 (34–54)	806/1648	20	57.5 (42–72.5)	642/1062	12
Ampicillin	74.5 (65–82.5)	826/1116	16	81 (75–85.5)	1404/1692	17	76.5 (62–87)	712/900	11
Teicoplanin	11.2 (7–17.7)	44/454	9	13 (6.5–25.5)	257/1177	15	24.5 (12–43.5)	187/576	11
Linezolid	0.8 (0.3–2.2)	0/709	7	1.6 (0.9–2.8)	14/1722	17	3 (1–8)	20/862	10

Figure 2 Time trend meta-analysis: prevalence of vancomycin resistance in blood-isolated Enterococcus faecalis by WHO regional offices.

Figure 3 Global prevalence of vancomycin resistance in blood-isolated Enterococcus faecalis.

Figure 4 Time trend meta-analysis: prevalence of vancomycin resistance in blood-isolated Enterococcus faecium by WHO regional offices.

Figure 5 Global prevalence of vancomycin resistance in blood-isolated Enterococcus faecium.