Table 2 Summary of the studies on VRE carried out in German hospitals and hospitals in the Dutch-German cross-border region (1999–2022)
Study | Design | Year | Setting | Patient population | Sample site | Clinical relevance | Species | Sample size | Outcome | Resistance gene (%) |
|---|---|---|---|---|---|---|---|---|---|---|
Outbreak Reports | ||||||||||
Elsner et al. [42] | Outbreak report | 1993–1997 | 1 university hospital | Pediatric ICU/wards | ND | Infection, colonization | E. faecium | ND | Patients: 32 (5 infections) | vanA (100%) |
Knoll et al. [43] | Outbreak report | 1999–2001 | 1 university hospital | Hematology | Urine, fecal, axilla | Colonization | E. faecium | 1124 patients | Patients: 44 prevalence: 3.9% | vanA (100%) |
Borgmann et al. [44] | Outbreak report | 2001 | 1 university hospital | NICU | Fecal | Colonization | E. faecium | ND | Patients: 24 | vanA (100%) |
Borgmann et al. [45] | Outbreak report | 2004–2005 | 1 university hospital | ICU, wards | Rectal, fecal, wound, organ swabs | Infection, colonization | E. faecium | ND | Patients: 248 (94 infections) | vanA (90%) |
Liese et al. [46] | Outbreak report | 2010–2016 | 1 university hospital | All hospital | Rectal, fecal, intraoperative samples, ascites, aspirates, BSI | Infection, colonization | E. faecium | ND | VRE isolates*: 773 patients: 796 (159 infections) | vanB (78.5%), vanA (21.5%) |
Bender et al. [47] | Outbreak report | 2015–2019 | 2 hospitals | ND | Rectal, clinical specimen | Infection, colonization | E. faecium | ND | Patients: 2905 (127 infections) | vanB (98%), vanA (2%) |
Studies reporting on the prevalence of VRE colonization | ||||||||||
Wendt et al. [51] | Cross-sectional | 1995 | 1 university, 1 community hospital | ICU, surgical-medical wards | Rectal | Colonization | E. faecium, E. faecalis | 552 isolates | Prevalence: 8.63% (university h), 1.77% (community h) | vanA (80%), vanB (20%) |
Gruber et al. [52] | Cross-sectional | 2006–2007 | 1 non-university hospital | Geriatric clinic | Rectal | Colonization | E. faecium | 46 patients | Patients: 7 prevalence: 15.2% | ND |
Liss et al. [53] | Cross-sectional | 2008–2009 | 1 university hospital | Hematology-oncology | Fecal | Colonization | ND | 513 patients | Patients: 51 prevalence: 9.9% | ND |
Messler et al. [61] | Pre-post | 2012–2013 | 1 university hospital | Surgical ICU | Rectal, clinical specimen | Colonization | E. faecium | 2485 patients | Patients: 86. prevalence: 3.6% | vanA (61%), vanB (39%) |
Neumann et al. [54] | Cohort | 2014–2015 | 1 tertiary care hospital | Hematology-oncology | Rectal | Colonization | E. faecium | 1606 patients | Patients: 111 prevalence: 23.8% | vanB (91%), vanA (9%) |
Bui et al. [55] | Cross-sectional | 2014–2015 | 1 university hospital | Wards (exc. ICU) | Rectal | Colonization | E. faecium | 4013 patients | Patients: 48. prevalence: 1.2% | ND |
Xanthopoulou et al. [56] | Cross-sectional | 2014–2018 | 6 university hospitals | Wards (exc. ICU) | Rectal | Colonization | E. faecium | 16,350 patients | Patients: 263; prevalence: 2014, 0.8%; 2015, 1.2%; 2016, 1.3%; 2017, 1.5%; 2018, 2.6% | vanB (78.5%), vanA (20.2%), vanA + vanB (1.2%) |
Biehl et al. [62] | Cohort | 2016 | 4 university hospitals | Hematology-oncology wards | Rectal, fecal | Colonization | E. faecium, E. faecalis | 2928 patients | Patients: 176 (E. faecium, 173; E faecalis, 3). prevalence: 6% | vanB (77.8%), vanA (22%) vanA + vanB (0.2%) |
Sommer et al. [57] | Cross-sectional | 2017–2018 | 25 hospitals | All hospital | Rectal, wound | Colonization | E. faecium | 629 patients | Prevalence: 5.7% | ND |
Heininger et al. [58] | Cross-sectional | 2018 | 1 university hospital | High risk patients at admission | Rectal | Colonization | E. faecium | 2572 patients | Patients: 712 prevalence: 27.7% | ND |
Chhatwal et al. [59] | Cross-sectional | 2018–2019 | 1 university hospital | Hematology, oncology wards | Rectal, anal, fecal | Colonization | E. faecium | 555 patients | Patients: 132 prevalence: 23.8% | vanB (93%), vanA (7%) |
Trautmannsberger et al. [60] | Cross-sectional | 2019–2020 | 1 university children’s hospital | NICU, PICU, surgical-medical wards | Rectal | Colonization | E. faecium | 693 patients | Patients: 33 prevalence: 4.8% | vanB (54.5%), vanA (45.5%) |
Studies reporting the proportion of VRE in nosocomial infections and the incidence of VREfm in BSIs | ||||||||||
Gastmeier et al. [67] | Cross-sectional | 2007–2012 | ICU-KISS, OP-KISS, Pathogen-KISS | ICU, surgical wards | Rectal, BSI, SSI UTI | Infection, colonization | E. faecium E. faecalis | ND | Nosocomial VRE infections: 2007–08, 79; 2009–10, 106; 2011–12, 14 proportion of VRE from 2007 to 2012: in SSI, 0.87% to 4.58%; in BSI, 4.91% to 12.99%; in UTI, 2.23% to 6.19% | ND |
Remschmidt et al. [65] | Cross-sectional | 2007–2016 | ICU-KISS, OP-KISS | ICU (857), surgical wards (1119) | BSI, SSI, UTI | Infection | E. faecium, E. faecalis | ND | VRE infections: 2007–08, 79; 2009–10, 106; 2011–12, 143; 2013–14, 187; 2014–15, 318 proportion of VRE from 2007/2008 to 2015/2016: overall, 1.4% to 10%; in BSI, 5.9% to 16.7%; in UTI, 2.9% to 9.9%; in SSI, 0.9% to 5% | ND |
Correa-Martinez, et al.[66] | Longitudinal | 2016–2019 | 31 microbiology laboratories | ND | BSI | Infection | E. faecium | ND | VRE isolates: 755 incidence per 100,000 inhabitants: 2016, 0.48; 2019, 1.48 | 2016, vanA (64.5%); 2017, vanB (68.8%); 2018, vanB (83.1%); 2019, vanB (74.7) |
Brinkwirth et al. [68] | Cross-sectional | 2015–2020 | ARS | ND | BSI | Infection | E. faecium | ND | VRE isolates: 3417 incidence per 100,000 inhabitants: 2015, 1.4%; 2020, 29% | ND |
Studies reporting the frequency of VRE among all clinical and screening cultures | ||||||||||
Jones et al. [70] | Cross-sectional (surveillance) | 2000–2002 | 169 hospitals | ICU | ND | Infection, colonization | E. faecium E. faecalis | 621,636 isolates | Proportion of E. faecium, 4.8; proportion of E. faecalis, 0.3 | ND |
Remschmidt et al. [75] | Cohort | 2001–2015 | SARI (44 hospitals) | ICU (77) | ND | Infection, colonization | E. faecium, E. faecalis | 263,639 isolates | ND | ND |
Kohlenberg et al. [71] | Cross-sectional | 2005–2006 | MDR-KISS ICU | ICU (176) | Rectal, clinical specimen | Infection, colonization | E. faecium, E. faecalis | 284,142 patients | Patients: 301 incidence per 1000 patient days: 0.1 | ND |
Scharlach et al. [79] | Cross-sectional | 2006–2010 | ARMIN—9 laboratories in Lower Saxony | ND | ND | Infection, colonization | E. faecium | 6,672,431 isolates | VRE isolates: 2006, 667; 2010, 2431 proportion of VRE: 2006, 13.6; 2010, 5.6% | ND |
Meyer et al. [74] | Cross-sectional | 2007–2009 | 4 university hospitals | All hospital | ND | Infection, colonization | E. faecium | 896,822 patients | Patients: 2007, 159; 2008, 277; 2009, 423 incidence per 10.000 patients: 2007, 5; 2008, 9; 2009,14) | ND |
Kramer et al. [76] | Cross-sectional (point prevalence survey) | 2010 | 5 tertiary, 4 secondary care hospitals | ICU, surgical-medical wards | ND | Infection, colonization | E. faecium, E. faecalis | 3411 patients | Patients: 12 prevalence: 0.49% | ND |
Huebner et al. [73] | Cross-sectional (point prevalence survey) | 2012 | 37 acute-care hospitals | ICU, surgical-medical wards | ND | Infection, colonization | E. faecium | 7154 patients | Prevalence: 0.38% | ND |
Wegner et al. [77] | Cross-sectional (point prevalence survey) | 2012 | 10 tertiary, 20 secondary, 26 primary care hospitals | ICU, surgical-medical wards | ND | Infection, colonization | E. faecium, E. faecalis | 12,968 patients | Prevalence: 0.27% | ND |
Huebner et al. [78] | Cross-sectional (point prevalence survey) | 2014 | 45 tertiary, 76 secondary, 208 primary care hospitals | ICU, surgical-medical wards | ND | Infection, colonization | E. faecium, E. faecalis | 73,938 patients/isolates | VRE isolates: 207 prevalence, 0.25% | ND |
Remschmidt et al. [72] | Ecologic | 2014–2015 | 1 university hospital | ICU, surgical-medical and hematology-oncology wards | Rectal, clinical specimen | Infection, colonization | E. faecium, E. faecalis | 204,054 patients | Patients (n): 1430 prevalence: 0.7% | ND |