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Review
. 2023 Apr 11;98(1):8.
doi: 10.1186/s42506-023-00133-9.

Prevalence of Vancomycin-resistant enterococci (VRE) in Egypt (2010-2022): a systematic review and meta-analysis

Ahmed Azzam  1 , Hoda Elkafas  2 , Heba Khaled  3 , Ahmed Ashraf  4 , Mohammed Yousef  5 , Aya Awny Elkashef  6
Affiliations
Review

Prevalence of Vancomycin-resistant enterococci (VRE) in Egypt (2010-2022): a systematic review and meta-analysis

Ahmed Azzam et al. J Egypt Public Health Assoc. .

Abstract

Background: Vancomycin-resistant Enterococci (VRE) represent a critical medical and public health concerns due to their association with serious nosocomial infections and a high risk of mortality. We aimed to reveal the pooled prevalence of VRE and antimicrobial resistance profiles among enterococci clinical isolates in Egypt.

Methods: A PubMed, Scopus, Google Scholar, and Web of Science literature search was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Only published studies documenting the prevalence of VRE between 2010 and 2022 were included. Using the random effects model and the 95% confidence intervals, the pooled estimate of VRE was calculated by MedCalc Version 20.113. Cochran's Q and I2 tests were used to evaluate the degree of heterogeneity, and publication bias was examined by visually examining the funnel plot and its associated tests (Begg's and Egger's tests).

Results: The pooled prevalence of VRE among enterococci clinical isolates in Egypt was estimated to be 26% (95% CI 16.9 to 36.3). E. faecalis had a greater pooled prevalence than E. faecium, with 61.22% (95% CI 53.65 to 68.53) and 32.47% (95% CI 27 to 38.2), respectively. The VanA gene is more frequent than the VanB gene among VRE, with a pooled prevalence of 63.3% (95% CI 52.1 to 73.7) and 17.95% (95% CI 7.8 to 31), respectively. The pooled resistance rate of linezolid was substantially lower than that of ampicillin and high-level gentamicin (HLG) 5.54% (95% CI 2.33 to 10%), 65.7% (95% CI 50.8 to 79.2%), and 61.1% (95% CI 47.4 to 73.9), respectively.

Conclusion: The prevalence of VRE is alarmingly high in Egypt. It is imperative that antimicrobial stewardship activities and infection control programs are strictly adhered to and implemented to prevent further escalation of the problem.

Keywords: Egypt; Linezolid; Systematic review; VanA; VanB; Vancomycin-resistant Enterococci.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart depicting the selection of publications
Fig. 2
Fig. 2
The prevalence of VRE among clinical isolates in Egypt. a Forest plot of VRE among total enterococci. b Funnel plot of VRE among total enterococci
Fig. 3
Fig. 3
The prevalence of E. faecalis and E. faecium among total enterococci isolates. a Forest plot of E. faecalis among total enterococci. b Forest plot E. faecium among total enterococci
Fig. 4
Fig. 4
Funnel plot of publication bias for E. faecalis and E. faecium among total enterococci isolates. a Funnel plot of E. faecalis among total enterococci. b Funnel plot of E. faecium among total enterococci
Fig. 5
Fig. 5
The prevalence of Vancomycin-resistant E. faecalis among total E. faecalis. a Forest plot Vancomycin-resistant E. faecalis. b Funnel plot of Vancomycin-resistant E. faecalis
Fig. 6
Fig. 6
The prevalence of Vancomycin-resistant E. faecium among total E. faecium. a Forest plot of Vancomycin-resistant E. faecium. b Funnel plot of Vancomycin-resistant E. faecium
Fig. 7
Fig. 7
The dissemination of VanA and VanB among VRE. a Forest plot of VanA among VRE. b Forest plot of VanB gene among VRE
Fig. 8
Fig. 8
The resistance profile of enterococci isolates to linezolid and ampicillin. a Forest plot of linezolid resistance among total enterococci isolates. b Forest plot of ampicillin resistance among total enterococci isolates
Fig. 9
Fig. 9
Forest plot of enterococci isolates resistant to high-level gentamicin
Fig. 10
Fig. 10
Funnel plots of the resistance profile of the enterococcal isolates to linezolid and ampicillin. a Funnel plot of linezolid resistance. b Funnel plot of resistance ampicillin
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