Prevalencia de Enterococcus faecium y Enterococcus faecalis resistentes a la vancomicina: revisión sistemática

Abstract

Introduction: Enterococcus faecalis and Enterococcus faecium are opportunistic hospital pathogens capable of persisting and acquiring antimicrobial resistance. Vancomycin resistance (VRE) represents a global threat, associated with increased mortality, hospital stay, and costs, especially in intensive care unit (ICU) and hematopoietic transplant recipients. Objectives: To establish the worldwide prevalence of vancomycin-resistant E. faecium and E. faecalis, identify factors associated with mortality and therapeutic failure, and evaluate antimicrobial and infection control strategies. Methodology: Cross-sectional observational studies published between 2015 and 2025, in English or Spanish, on hospitalized patients with VRE infection or colonization were included. Quality was assessed using Joanna Briggs Institute (JBI) and National Heart, Lung, and Blood Institute (NHLBI), complemented by narrative analysis and comparative tables. Results: A total of 29 studies met the criteria from 1,612 records, with samples ranging from 46 to over 9,000 patients from Europe, America, and Asia. Colonization varied between 4% and 43%, and mortality reached 50%. E. faecium showed higher resistance, mortality, and hospital stay. Linezolid and daptomycin showed variable results, while control measures reduced transmission. Discussion: Prevalence varied by region and population. Most studies presented a low to moderate risk of bias, although methodological differences and sampling limitations existed. Resistance was related to therapeutic failure, especially in E. faecium. Conclusions: Vancomycin resistance represents a growing challenge, with a worse prognosis and limited therapeutic options. It is essential to strengthen surveillance, optimize antimicrobial use, and develop new treatment and control strategies. Keywords: Enterococcus faecalis, Enterococcus faecium, vancomycin resistance, antimicrobial therapy, epidemiological surveillance