{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:53:15Z","timestamp":1784307195795,"version":"3.55.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Antimicrobial resistance is a critical and growing global health concern. While drug-resistant Gram-negative bacilli pose a significant threat, multidrug-resistant Gram-positive bacteria\u2014such as methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA), vancomycin-resistant\n                      <jats:italic>Enterococcus<\/jats:italic>\n                      (VRE), and \u03b2-lactamase-resistant\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      \u2014also present serious clinical challenges.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study provides an epidemiological analysis of resistant Gram-positive bacteria, focusing on VRE, at a tertiary university hospital in Western Greece from 2018 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 276 blood cultures with vancomycin-resistant\n                      <jats:italic>Enterococcus<\/jats:italic>\n                      spp. were recorded. A significant increase in VRE prevalence was observed in intensive care units (ICUs), with cases rising from 4 in 2020 to 36 in 2021. A broader increase across medical and surgical wards was noted in 2022\u20132023. Linezolid resistance remained low throughout the study period. Mortality data revealed a marked increase in deaths after 2020 compared to 2018\u20132019, coinciding with the rise in VRE-related bloodstream infections. The Coronavirus Disease 2019 (COVID-19) pandemic was associated with higher VRE rates in ICU patients, likely due to prolonged hospitalizations, increased use of invasive devices, and broad-spectrum antibiotic use. Resistance rates to both linezolid and tigecycline remained low, while daptomycin resistance showed an increasing trend the same period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The number of VRE increased over the study period. Linezolid and tigecycline remained largely effective, but emerging resistance patterns\u2014particularly to daptomycin\u2014underscore the urgent need for strengthened antimicrobial stewardship and the development of novel therapeutic options to address rising resistance among Gram-positive pathogens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2025.1656334","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T14:54:00Z","timestamp":1759416840000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of the COVID-19 pandemic on vancomycin-resistant Enterococcus bloodstream infections: a 6-year study in Western Greece"],"prefix":"10.3389","volume":"16","author":[{"given":"Maria","family":"Lagadinou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Michailides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christodoulos","family":"Chatzigrigoriadis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Erginousakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prodromos","family":"Avramidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Amerali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fotini","family":"Tasouli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Chondroleou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Skintzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Spiliopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fevronia","family":"Kolonitsiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidia","family":"Leonidou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stelios F.","family":"Assimakopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markos","family":"Marangos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.jiph.2022.12.022","article-title":"Impact of COVID-19 pandemic on multidrug-resistant Gram-positive and Gram-negative pathogens: a systematic review","volume":"16","author":"Abubakar","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0255187","DOI":"10.1371\/journal.pone.0255187","article-title":"Novel genomic islands and a new vanD subtype in the first sporadic VanD-type vancomycin-resistant enterococci in Norway","volume":"16","author":"Al Rubaye","year":"2021","journal-title":"PLoS One"},{"key":"B3","doi-asserted-by":"publisher","first-page":"194","DOI":"10.4103\/ijmr.IJMR_1976_17","article-title":"Detection of heterogeneous vancomycin-intermediate Staphylococcus aureus: a preliminary report from South India","volume":"150","author":"Amberpet","year":"2019","journal-title":"Indian J. Med. Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1080043","DOI":"10.3389\/fimmu.2023.1080043","article-title":"Gut and airway microbiota dysbiosis and their role in COVID-19 and long-COVID","volume":"14","author":"Ancona","year":"2023","journal-title":"Front Immunol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.1097\/CCM.0000000000004748","article-title":"Unexpectedly high frequency of enterococcal bloodstream infections in coronavirus disease 2019 patients admitted to an Italian ICU: an observational study","volume":"49","author":"Bonazzetti","year":"2021","journal-title":"Crit Care Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1007\/s00134-021-06346-w","article-title":"COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network","volume":"47","author":"Buetti","year":"2021","journal-title":"Intensive Care Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1186\/s13054-022-04166-y","article-title":"Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study","volume":"26","author":"Buetti","year":"2022","journal-title":"Crit Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1128\/CMR.13.4.686","article-title":"Vancomycin-resistant enterococci","volume":"13","author":"Cetinkaya","year":"2000","journal-title":"Clin Microbiol Rev."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1017\/ice.2021.391","volume":"43","author":"DeVoe","year":"2022"},{"key":"B10","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jhin.2023.09.008","article-title":"Epidemiology and outcomes of vancomycin-resistant enterococcus infections: a systematic review and meta-analysis","volume":"141","author":"Eichel","year":"2023","journal-title":"J. Hosp. Infect"},{"key":"B11","volume-title":"Surveillance of antimicrobial resistance in Europe\u2014Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net).","year":"2018"},{"key":"B12","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.chest.2021.04.002","article-title":"Hospital-acquired infections in critically ill patients with COVID-19","volume":"160","author":"Grasselli","year":"2021","journal-title":"Chest"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1007\/s10096-024-04806-x","article-title":"Multidrug-resistant organism bloodstream infection and hospital acquisition among inpatients in three tertiary Greek hospitals during the COVID-19 era","volume":"43","author":"Karakosta","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1101\/2020.04.25.060350","article-title":"SARS-CoV-2 productively infects human gut enterocytes","volume":"369","author":"Lamers","year":"2020","journal-title":"Science"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.3390\/microorganisms11051299","article-title":"The hidden cost of COVID-19: focus on antimicrobial resistance in bloodstream infections","volume":"11","author":"Micheli","year":"2023","journal-title":"Microorganisms"},{"key":"B17","doi-asserted-by":"publisher","first-page":"996","DOI":"10.3390\/life11100996","article-title":"COVID-19 and antimicrobial resistance: data from the Greek electronic system for the surveillance of antimicrobial resistance\u2014WHONET-Greece (January 2018\u2013March 2021)","volume":"11","author":"Polemis","year":"2021","journal-title":"Life"},{"key":"B18","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s12275-024-00122-3","article-title":"Balancing act of the intestinal antimicrobial proteins on gut microbiota and health","volume":"62","author":"Ra","year":"2024","journal-title":"J. Microbiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jgar.2024.05.010","article-title":"Scoping review of bacterial resistance among inpatients amidst the COVID-19 pandemic","volume":"38","author":"Reffat","year":"2024","journal-title":"J Glob Antimicrob Resist"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1537456","DOI":"10.3389\/fcimb.2025.1537456","article-title":"Microbiome dysbiosis in SARS-CoV-2 infection: implication for pathophysiology and management strategies of COVID-19","volume":"15","author":"Smail","year":"2025","journal-title":"Front. Cell Infect Microbiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"312","DOI":"10.3390\/antibiotics12020312","article-title":"Tale of two pandemics: antimicrobial resistance patterns of Enterococcus spp. in COVID-19","volume":"12","author":"Toc","year":"2023","journal-title":"Antibiotics"},{"key":"B23","doi-asserted-by":"publisher","first-page":"220","DOI":"10.3390\/ijtm2020020","article-title":"Enterococcus and COVID-19: The emergence of a perfect storm?","volume":"2","author":"Toc","year":"2022","journal-title":"Int J Transl Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1180336","DOI":"10.3389\/fimmu.2023.1180336","article-title":"The relationship between gut microbiota and COVID-19 progression: new insights into immunopathogenesis and treatment","volume":"14","author":"Wang","year":"2023","journal-title":"Front Immunol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1017\/ice.2021.362","article-title":"The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network","volume":"43","author":"Weiner-Lastinger","year":"2022","journal-title":"Infect Control Hosp. Epidemiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1038\/s41575-022-00698-4","article-title":"Gut microbiota in COVID-19: key microbial changes, potential mechanisms and clinical applications","volume":"20","author":"Zhang","year":"","journal-title":"Nat. Rev. Gastroenterol. Hepatol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1220363","DOI":"10.3389\/fmicb.2023.1220363","article-title":"Analysis of distribution and antibiotic resistance of Gram-positive bacteria isolated from a tertiary-care hospital in southern China: an 8-year retrospective study","volume":"14","author":"Zhang","year":"","journal-title":"Front Microbiol"}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2025.1656334\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T12:20:31Z","timestamp":1761308431000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2025.1656334\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":27,"alternative-id":["10.3389\/fmicb.2025.1656334"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2025.1656334","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]},"article-number":"1656334"}}