A quarter of E faecium isolates were vancomycin resistant in pooled global data

Design

Systematic review and meta-analysis of prevalence studies

Population

349 studies of clinical, environmental and animal enterococcal isolates

Primary outcome

Prevalence of vancomycin resistance

Effect

E faecium 25%, E faecalis 5%; rectal swabs 76%, hospital environment 74%

A meta-analysis of 349 studies estimated the prevalence of vancomycin resistance in enterococci from clinical, environmental and animal samples worldwide, up to April 2025. Pooled resistance was 25% in E faecium and 5% in E faecalis, and both rose over the last two decades.

The highest rates came from rectal swabs (76%) and hospital environmental samples (74%), with lower but substantial rates in environmental water and animal stool. That pattern points to colonisation and the ward environment as the main reservoirs, and to animals and water as possible contributors outside hospital.

Prevalence varies widely by country and by hospital, so the pooled figures are a backdrop rather than a local guide. What they reinforce is the species difference: E faecium is far more often resistant, which shapes empirical choices once the species is known.

• Identify enterococci to species level; E faecium is far more often vancomycin resistant
• Use your own hospital antibiogram rather than global figures for empirical choices
• Reinforce environmental cleaning and contact precautions for VRE-colonised patients
• Consider VRE when a patient with known rectal colonisation develops a bloodstream infection

Why it matters

The rise in resistance is what makes the daptomycin dosing question in today's practice-changer urgent.

Don't overread it

Pooled prevalence across very different settings and sample types does not tell you the rate in your own hospital.

The statistics, in plain English

A pooled prevalence averages many studies; here they ranged from hospital wards to river water, so the 25% figure is a broad summary rather than a rate any single patient group shares.

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