{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:00:21Z","timestamp":1793318421238,"version":"4.5.0"},"reference-count":110,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Antimicrobial resistance (AMR) poses a profound threat to modern healthcare, with vancomycin-resistant Enterococcus faecium (VREfm) emerging as a particularly resilient and clinically significant pathogen. This mini-review examines the biological mechanisms underpinning VREfm resistance, including biofilm formation, stress tolerance, and the acquisition of resistance genes such as vanA and vanB. It also explores the behavioural, social, and healthcare system factors that facilitate VREfm transmission, highlighting disparities in burden across vulnerable populations and low-resource settings. Prevention strategies are mapped across the disease pathway, spanning primary, secondary, and tertiary levels, with a particular focus on the role and evolving challenges of antimicrobial stewardship programmes (ASP). We highlight emerging threats, such as rifaximin-induced cross-resistance to daptomycin, which challenge conventional stewardship paradigms. Finally, we propose future directions to enhance global surveillance, promote equitable stewardship interventions, and accelerate the development of innovative therapies. Addressing VREfm requires a coordinated, multidisciplinary effort to safeguard the efficacy of existing antimicrobials and protect at-risk patient populations.<\/jats:p>","DOI":"10.3390\/antibiotics14050522","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T11:54:26Z","timestamp":1747655666000},"page":"522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Vancomycin-Resistant E. faecium: Addressing Global and Clinical Challenges"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8781-7459","authenticated-orcid":false,"given":"Daniel E.","family":"Radford-Smith","sequence":"first","affiliation":[{"name":"Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1380-6655","authenticated-orcid":false,"given":"Daniel C.","family":"Anthony","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"ref_1","unstructured":"Fleming, A. (2025, April 10). Penicillin. Presented at the Nobel Lecture. Available online: https:\/\/www.nobelprize.org\/prizes\/medicine\/1945\/fleming\/lecture\/."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Salam, M.A., Al-Amin, M.Y., Salam, M.T., Pawar, J.S., Akhter, N., Rabaan, A.A., and Alqumber, M.A.A. (2023). Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare, 11.","DOI":"10.20944\/preprints202305.0555.v1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100947","DOI":"10.1016\/j.lanmic.2024.07.010","article-title":"Antimicrobial Resistance: A Concise Update","volume":"6","author":"Ho","year":"2025","journal-title":"Lancet Microbe"},{"key":"ref_4","unstructured":"UKHSA (2024). Laboratory Surveillance of Enterococcus spp. Bacteraemia (England): 2022."},{"key":"ref_5","unstructured":"CDC (2019). Antibiotic Resistance Threats in the United States, 2019."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"dlab185","DOI":"10.1093\/jacamr\/dlab185","article-title":"Replacement of Enterococcus faecalis by Enterococcus faecium as the Predominant Enterococcus in UK Bacteraemias","volume":"3","author":"Horner","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_7","unstructured":"UKHSA (2024). Surveillance of Bloodstream Infections in Critical Care Units, England: May 2016 to March 2024 Report."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2001628","DOI":"10.2807\/1560-7917.ES.2021.26.45.2001628","article-title":"Hospital-Acquired Infections Caused by Enterococci: A Systematic Review and Meta-Analysis, WHO European Region, 1 January 2010 to 4 February 2020","volume":"26","author":"Brinkwirth","year":"2021","journal-title":"Eurosurveillance"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.femsec.2005.03.016","article-title":"Survival of Enterococcal Species in Aquatic Environments","volume":"54","author":"del","year":"2005","journal-title":"FEMS Microbiol. Ecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jhin.2010.11.008","article-title":"Environmental Survival of Vancomycin-Resistant Enterococcus faecium","volume":"77","author":"Wagenvoort","year":"2011","journal-title":"J. Hosp. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4630","DOI":"10.1128\/AAC.00757-16","article-title":"In Vitro Emergence of High Persistence upon Periodic Aminoglycoside Challenge in the ESKAPE Pathogens","volume":"60","author":"Michiels","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1038\/s41579-018-0107-z","article-title":"Biofilm-Associated Infection by Enterococci","volume":"17","author":"Chong","year":"2019","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1128\/IAI.01396-15","article-title":"Role of the Emp Pilus Subunits of Enterococcus faecium in Biofilm Formation, Adherence to Host Extracellular Matrix Components, and Experimental Infection","volume":"84","author":"Montealegre","year":"2016","journal-title":"Infect. Immun."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/1574-6968.12418","article-title":"Influence of Isolate Origin and Presence of Various Genes on Biofilm Formation by Enterococcus faecium","volume":"353","author":"Almohamad","year":"2014","journal-title":"FEMS Microbiol. Lett."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Paganelli, F.L., Willems, R.J.L., Jansen, P., Hendrickx, A., Zhang, X., Bonten, M.J.M., and Leavis, H.L. (2013). Enterococcus faecium Biofilm Formation: Identification of Major Autolysin AtlAEfm, Associated Acm Surface Localization, and AtlAEfm-Independent Extracellular DNA Release. mBio, 4.","DOI":"10.1128\/mBio.00154-13"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.micinf.2011.08.006","article-title":"Contribution of the Enterococcal Surface Protein Esp to Pathogenesis of Enterococcus faecium Endocarditis","volume":"13","author":"Heikens","year":"2011","journal-title":"Microbes Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3192","DOI":"10.1128\/IAI.02016-06","article-title":"Inhibition of Enterococcus faecium Adherence to Collagen by Antibodies against High-Affinity Binding Subdomains of Acm","volume":"75","author":"Nallapareddy","year":"2007","journal-title":"Infect. Immun."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Top, J., Paganelli, F.L., Zhang, X., van Schaik, W., Leavis, H.L., van Luit-Asbroek, M., van der Poll, T., Leendertse, M., Bonten, M.J.M., and Willems, R.J.L. (2013). The Enterococcus faecium Enterococcal Biofilm Regulator, EbrB, Regulates the Esp Operon and Is Implicated in Biofilm Formation and Intestinal Colonization. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0065224"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lebreton, F., van Schaik, W., Sanguinetti, M., Posteraro, B., Torelli, R., Le Bras, F., Verneuil, N., Zhang, X., Giard, J.-C., and Dhalluin, A. (2012). AsrR Is an Oxidative Stress Sensing Regulator Modulating Enterococcus faecium Opportunistic Traits, Antimicrobial Resistance, and Pathogenicity. PLoS Pathog., 8.","DOI":"10.1371\/journal.ppat.1002834"},{"key":"ref_20","first-page":"74","article-title":"Prevalence of Biofilm Formation and Vancomycin-Resistant Genes among Enterococcus faecium Isolated from Clinical and Environmental Specimens in Lorestan Hospitals","volume":"10","author":"Goudarzi","year":"2018","journal-title":"Iran. J. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Novais, C., Tedim, A.P., Lanza, V.F., Freitas, A.R., Silveira, E., Escada, R., Roberts, A.P., Al-Haroni, M., Baquero, F., and Peixe, L. (2016). Co-Diversification of Enterococcus faecium Core Genomes and PBP5: Evidences of Pbp5 Horizontal Transfer. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.01581"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.idc.2020.08.004","article-title":"Resistance in Vancomycin-Resistant Enterococci","volume":"34","author":"Miller","year":"2020","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E146","DOI":"10.1086\/374929","article-title":"Linezolid-Resistant, Vancomycin-Resistant Enterococcus faecium Infection in Patients without Prior Exposure to Linezolid","volume":"36","author":"Rahim","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kinnear, C.L., Hansen, E., Morley, V.J., Tracy, K.C., Forstchen, M., Read, A.F., and Woods, R.J. (2020). Daptomycin Treatment Impacts Resistance in Off-Target Populations of Vancomycin-Resistant Enterococcus faecium. PLoS Biol., 18.","DOI":"10.1371\/journal.pbio.3000987"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jgar.2014.04.002","article-title":"Vancomycin-Resistant Enterococci: Troublemaker of the 21st Century","volume":"2","author":"Ranotkar","year":"2014","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1086\/491711","article-title":"Vancomycin Resistance in Gram-Positive Cocci","volume":"42","author":"Courvalin","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1093\/jac\/dkx387","article-title":"Distribution of Putative Virulence Markers in Enterococcus faecium: Towards a Safety Profile Review","volume":"73","author":"Freitas","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jgar.2025.01.016","article-title":"Vancomycin-Resistant Enterococcus faecium: A Current Perspective on Resilience, Adaptation, and the Urgent Need for Novel Strategies","volume":"41","author":"Novais","year":"2025","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Crouzet, L., Rigottier-Gois, L., and Serror, P. (2015). Potential Use of Probiotic and Commensal Bacteria as Non-Antibiotic Strategies against Vancomycin-Resistant Enterococci. FEMS Microbiol. Lett., 362.","DOI":"10.1093\/femsle\/fnv012"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S175.e5","DOI":"10.1016\/j.ajic.2008.10.010","article-title":"The Risk of Developing a Vancomycin-Resistant Enterococcus Bloodstream Infection for Colonized Patients","volume":"36","author":"Salgado","year":"2008","journal-title":"Am. J. Infect. Control."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1093\/clinids\/23.4.767","article-title":"Risk Factors Associated with Vancomycin-Resistant Enterococcus faecium Infection or Colonization in 145 Matched Case Patients and Control Patients","volume":"23","author":"Tornieporth","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13756-019-0647-7","article-title":"Predictors for Vancomycin Resistant Enterococcus faecium Transforming from Colonization to Infection: A Case Control Study","volume":"8","author":"Chen","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1086\/314874","article-title":"Effect of Parenteral Antibiotic Administration on Persistence of Vancomycin-Resistant Enterococcus faecium in the Mouse Gastrointestinal Tract","volume":"180","author":"Donskey","year":"1999","journal-title":"J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"175","DOI":"10.7326\/0003-4819-135-3-200108070-00009","article-title":"The Effect of Vancomycin and Third-Generation Cephalosporins on Prevalence of Vancomycin-Resistant Enterococci in 126 U.S. Adult Intensive Care Units","volume":"135","author":"Fridkin","year":"2001","journal-title":"Ann. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1007\/s100960000360","article-title":"Epidemiological, Microbiological, Clinical, and Prognostic Factors of Bacteremia Caused by High-Level Vancomycin-Resistant Enterococcus Species","volume":"19","author":"Peset","year":"2000","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1086\/342904","article-title":"Risk Factors for Development of Vancomycin-Resistant Enterococcal Bloodstream Infection in Patients with Cancer Who Are Colonized with Vancomycin-Resistant Enterococci","volume":"35","author":"Zaas","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1016\/S0140-6736(96)02331-8","article-title":"Epidemiology of Colonisation of Patients and Environment with Vancomycin-Resistant Enterococci","volume":"348","author":"Bonten","year":"1996","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"de Bruin, M.A., and Riley, L.W. (2007). Does Vancomycin Prescribing Intervention Affect Vancomycin-Resistant Enterococcus Infection and Colonization in Hospitals? A Systematic Review. BMC Infect. Dis., 7.","DOI":"10.1186\/1471-2334-7-24"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.ajic.2012.01.009","article-title":"Risk Factors for Vancomycin-Resistant Enterococci Infection and Mortality in Colonized Patients on Intensive Care Unit Admission","volume":"40","author":"Kim","year":"2012","journal-title":"Am. J. Infect. Control."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.drup.2018.10.002","article-title":"Update on Prevalence and Mechanisms of Resistance to Linezolid, Tigecycline and Daptomycin in Enterococci in Europe: Towards a Common Nomenclature","volume":"40","author":"Bender","year":"2018","journal-title":"Drug Resist. Updates"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/nyas.12948","article-title":"Mechanisms of Drug Resistance: Daptomycin Resistance","volume":"1354","author":"Tran","year":"2015","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Zeng, W., Feng, L., Qian, C., Chen, T., Wang, S., Zhang, Y., Zheng, X., Wang, L., Liu, S., and Zhou, T. (2022). Acquisition of Daptomycin Resistance by Enterococcus faecium Confers Collateral Sensitivity to Glycopeptides. Front. Microbiol., 13.","DOI":"10.3389\/fmicb.2022.815600"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e01317-20","DOI":"10.1128\/AAC.01317-20","article-title":"Daptomycin Resistance in Enterococcus faecium Can Be Delayed by Disruption of the LiaFSR Stress Response Pathway","volume":"65","author":"Prater","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.ijantimicag.2016.07.006","article-title":"Mutant Prevention Concentrations of Daptomycin for Enterococcus faecium Clinical Isolates","volume":"48","author":"Sinel","year":"2016","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3251","DOI":"10.1128\/AAC.42.12.3251","article-title":"The Oxazolidinone Linezolid Inhibits Initiation of Protein Synthesis in Bacteria","volume":"42","author":"Swaney","year":"1998","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1128\/AAC.00070-08","article-title":"Increasing Incidence of Linezolid-Intermediate or -Resistant, Vancomycin-Resistant Enterococcus faecium Strains Parallels Increasing Linezolid Consumption","volume":"52","author":"Scheetz","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1093\/jac\/dkv116","article-title":"A Novel Gene, optrA, That Confers Transferable Resistance to Oxazolidinones and Phenicols and Its Presence in Enterococcus faecalis and Enterococcus faecium of Human and Animal Origin","volume":"70","author":"Wang","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1093\/jac\/dky088","article-title":"Characterization of poxtA, a Novel Phenicol-Oxazolidinone-Tetracycline Resistance Gene from an MRSA of Clinical Origin","volume":"73","author":"Antonelli","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Ruiz-Ripa, L., Fe\u00dfler, A.T., Hanke, D., Eichhorn, I., Azcona-Guti\u00e9rrez, J.M., P\u00e9rez-Moreno, M.O., Seral, C., Aspiroz, C., Alonso, C.A., and Torres, L. (2020). Mechanisms of Linezolid Resistance Among Enterococci of Clinical Origin in Spain\u2014Detection of optrA- and Cfr(D)-Carrying E. faecalis. Microorganisms, 8.","DOI":"10.3390\/microorganisms8081155"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1093\/jac\/dkaa227","article-title":"Linezolid-Resistant (Tn6246::fexB-poxtA) Enterococcus faecium Strains Colonizing Humans and Bovines on Different Continents: Similarity without Epidemiological Link","volume":"75","author":"Freitas","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1093\/jac\/dkaa075","article-title":"Linezolid Resistance in Enterococcus faecium and Enterococcus faecalis from Hospitalized Patients in Ireland: High Prevalence of the MDR Genes optrA and poxtA in Isolates with Diverse Genetic Backgrounds","volume":"75","author":"Egan","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_52","first-page":"mgen001055","article-title":"Emergence of Linezolid-Resistant Enterococcus faecium in a Tertiary Hospital in Copenhagen","volume":"9","author":"Misiakou","year":"2023","journal-title":"Microb. Genom."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3334","DOI":"10.1128\/AAC.46.10.3334-3336.2002","article-title":"Gene Dosage and Linezolid Resistance in Enterococcus faecium and Enterococcus faecalis","volume":"46","author":"Marshall","year":"2002","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1038\/s41586-024-08095-4","article-title":"Rifaximin Prophylaxis Causes Resistance to the Last-Resort Antibiotic Daptomycin","volume":"635","author":"Turner","year":"2024","journal-title":"Nature"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1016\/j.cmi.2020.04.027","article-title":"Daptomycin in the Treatment of Enterococcal Bloodstream Infections and Endocarditis: A EUCAST Position Paper","volume":"26","author":"Turnidge","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1089\/mdr.1999.5.45","article-title":"Decreased Incidence of VanA-Type Vancomycin-Resistant Enterococci Isolated from Poultry Meat and from Fecal Samples of Humans in the Community after Discontinuation of Avoparcin Usage in Animal Husbandry","volume":"5","author":"Klare","year":"1999","journal-title":"Microb. Drug Resist."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"113067","DOI":"10.1016\/j.envpol.2019.113067","article-title":"Freshwater Environments as Reservoirs of Antibiotic Resistant Bacteria and Their Role in the Dissemination of Antibiotic Resistance Genes","volume":"254","author":"Nnadozie","year":"2019","journal-title":"Environ. Pollut."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1101\/gr.232629.117","article-title":"Detection of Vancomycin-Resistant Enterococcus faecium Hospital-Adapted Lineages in Municipal Wastewater Treatment Plants Indicates Widespread Distribution and Release into the Environment","volume":"29","author":"Gouliouris","year":"2019","journal-title":"Genome Res."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/S2542-5196(23)00278-4","article-title":"The Need for One Health Systems-Thinking Approaches to Understand Multiscale Dissemination of Antimicrobial Resistance","volume":"8","author":"Arnold","year":"2024","journal-title":"Lancet Planet. Health"},{"key":"ref_60","doi-asserted-by":"crossref","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":"ref_61","unstructured":"CDC (2013). Antibiotic Resistance Threats in the United States, 2013."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e00048-19","DOI":"10.1128\/CMR.00048-19","article-title":"Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries","volume":"33","author":"Gandra","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.4103\/jfmpc.jfmpc_275_19","article-title":"India\u2019s National Action Plan for Antimicrobial Resistance\u2014An Overview of the Context, Status, and Way Ahead","volume":"8","author":"Ranjalkar","year":"2019","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_64","unstructured":"CDC (2021). HAI Pathogens and Antimicrobial Resistance Report."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"S\u00f6rstedt, E., Ahlbeck, G., and Snygg-Martin, U. (2024). Trends in Enterococcus faecium Bacteremia: Exploring Risk Factors with Emphasis on Prior Antibiotic Exposure. Microorganisms, 12.","DOI":"10.20944\/preprints202407.0623.v1"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Huang, C., Moradi, S., Sholeh, M., Tabaei, F.M., Lai, T., Tan, B., Meng, J., and Azizian, K. (2025). Global Trends in Antimicrobial Resistance of Enterococcus faecium: A Systematic Review and Meta-Analysis of Clinical Isolates. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1505674"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1093\/jac\/dkt525","article-title":"Infection Control and Prevention Measures to Reduce the Spread of Vancomycin-Resistant Enterococci in Hospitalized Patients: A Systematic Review and Meta-Analysis","volume":"69","author":"Cataldo","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ijantimicag.2007.08.026","article-title":"Vancomycin-Resistant Enterococci (VRE): Transmission and Control","volume":"31","author":"Tacconelli","year":"2008","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s15010-018-1202-9","article-title":"Vancomycin-Resistant Enterococci (VRE): A Reason to Isolate?","volume":"47","author":"Vehreschild","year":"2019","journal-title":"Infection"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e216","DOI":"10.1016\/j.jhin.2018.02.016","article-title":"Recommendations for the Successful Control of a Large Outbreak of Vancomycin-Resistant Enterococcus faecium in a Non-Endemic Hospital Setting","volume":"100","author":"Frakking","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1056\/NEJMoa1207290","article-title":"Targeted versus Universal Decolonization to Prevent ICU Infection","volume":"368","author":"Huang","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1186\/s13756-019-0628-x","article-title":"Vancomycin-Resistant Enterococci (VRE) Screening and Isolation in the General Medicine Ward: A Cost-Effectiveness Analysis","volume":"8","author":"Mac","year":"2019","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jhin.2014.09.002","article-title":"Controlling the Spread of Vancomycin-Resistant Enterococci. Is Active Screening Worthwhile?","volume":"88","author":"Humphreys","year":"2014","journal-title":"J. Hosp. Infect."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jhin.2024.01.019","article-title":"Vancomycin-Resistant Enterococcus faecium: Impact of Ending Screening and Isolation in a Danish University Hospital","volume":"146","author":"Hansen","year":"2024","journal-title":"J. Hosp. Infect."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1017\/ash.2021.215","article-title":"Impact of a Vancomycin-Resistant Enterococcus (VRE) Screening Result on Appropriateness of Antibiotic Therapy","volume":"1","author":"Reynolds","year":"2021","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1016\/j.ijid.2008.05.525","article-title":"Efficacy of Probiotic for Inhibition of Intestinal Colonization by Vancomycin-Resistant Enterococci","volume":"12","author":"Fazeli","year":"2008","journal-title":"Int. J. Infect. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Li, X., Song, L., Zhu, S., Xiao, Y., Huang, Y., Hua, Y., Chu, Q., and Ren, Z. (2019). Two Strains of Lactobacilli Effectively Decrease the Colonization of VRE in a Mouse Model. Front. Cell. Infect. Microbiol., 9.","DOI":"10.3389\/fcimb.2019.00006"},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Crouzet, L., Derrien, M., Cherbuy, C., Plancade, S., Foulon, M., Chalin, B., van Hylckama Vlieg, J.E.T., Grompone, G., Rigottier-Gois, L., and Serror, P. (2018). Lactobacillus Paracasei CNCM I-3689 Reduces Vancomycin-Resistant Enterococcus Persistence and Promotes Bacteroidetes Resilience in the Gut Following Antibiotic Challenge. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-23437-9"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2801","DOI":"10.1128\/AAC.01765-09","article-title":"Effects of Probiotics on Acquisition and Spread of Multiresistant Enterococci","volume":"54","author":"Willems","year":"2010","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1128\/JCM.00473-10","article-title":"Probiotics and Intestinal Colonization by Vancomycin-Resistant Enterococci in Mice and Humans","volume":"48","author":"Vidal","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"454","DOI":"10.5694\/j.1326-5377.2007.tb00995.x","article-title":"Probiotic Treatment of Vancomycin-Resistant Enterococci: A Randomised Controlled Trial","volume":"186","author":"Manley","year":"2007","journal-title":"Med. J. Aust."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1038\/s41564-021-00920-0","article-title":"Probiotics Impact the Antibiotic Resistance Gene Reservoir along the Human GI Tract in a Person-Specific and Antibiotic-Dependent Manner","volume":"6","author":"Montassier","year":"2021","journal-title":"Nat. Microbiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jgar.2021.12.016","article-title":"Glycopeptide Resistance in Enterococcus Spp. and Coagulase-Negative Staphylococci from Hospitalised Patients in Germany: Occurrence, Characteristics and Dalbavancin Susceptibility","volume":"28","author":"Kresken","year":"2022","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1093\/jac\/dkw451","article-title":"Comparative in Vitro Activity of Oritavancin and Other Agents against Vancomycin-Susceptible and -Resistant Enterococci","volume":"72","author":"Sweeney","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_85","first-page":"Doc07","article-title":"Temporal Trends of the in Vitro Activity of Tigecycline and Comparator Antibiotics against Clinical Aerobic Bacterial Isolates Collected in Germany, 2006\u20132014: Results of the Tigecycline Evaluation and Surveillance Trial (TEST)","volume":"4","author":"Kresken","year":"2016","journal-title":"GMS Infect. Dis."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e17091","DOI":"10.1097\/MD.0000000000017091","article-title":"Efficacy and Safety of High-Dose Tigecycline for the Treatment of Infectious Diseases: A Meta-Analysis","volume":"98","author":"Gong","year":"2019","journal-title":"Medicine"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1093\/jac\/dkv007","article-title":"\u03b2-Lactam Combinations with Daptomycin Provide Synergy against Vancomycin-Resistant Enterococcus faecalis and Enterococcus faecium","volume":"70","author":"Smith","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1128\/AAC.05551-11","article-title":"Ampicillin Enhances Daptomycin- and Cationic Host Defense Peptide-Mediated Killing of Ampicillin- and Vancomycin-Resistant Enterococcus faecium","volume":"56","author":"Sakoulas","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1002\/phar.1922","article-title":"Role of Combination Antimicrobial Therapy for Vancomycin-Resistant Enterococcus faecium Infections: Review of the Current Evidence","volume":"37","author":"Yim","year":"2017","journal-title":"Pharmacotherapy"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1345\/aph.1M324","article-title":"Multidrug-Resistant Enterococcus faecium Endocarditis Treated with Combination Tigecycline and High-Dose Daptomycin","volume":"43","author":"Schutt","year":"2009","journal-title":"Ann. Pharmacother."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"3392","DOI":"10.1128\/AAC.00646-13","article-title":"Efficacy of Tigecycline Alone and in Combination with Gentamicin in the Treatment of Experimental Endocarditis Due to Linezolid-Resistant Enterococcus faecium","volume":"57","author":"Pontikis","year":"2013","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1002\/jhm.236","article-title":"Linezolid- and Vancomycin-Resistant Enterococcus faecium Endocarditis: Successful Treatment with Tigecycline and Daptomycin","volume":"2","author":"Jenkins","year":"2007","journal-title":"J. Hosp. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1093\/jac\/dkm542","article-title":"Selection of Linezolid-Resistant Enterococcus faecium in an in Vitro Dynamic Model:: Protective Effect of Doxycycline","volume":"61","author":"Zinner","year":"2008","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1128\/AAC.49.4.1664-1665.2005","article-title":"Emergence of Daptomycin Resistance in Enterococcus faecium during Daptomycin Therapy","volume":"49","author":"Sabol","year":"2005","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"198599","DOI":"10.1016\/j.virusres.2021.198599","article-title":"Novel Lytic Bacteriophage vB_GEC_EfS_9 against Enterococcus faecium","volume":"307","author":"Rigvava","year":"2022","journal-title":"Virus Res."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Stellfox, M.E., Fernandes, C., Shields, R.K., Haidar, G., Hughes Kramer, K., Dembinski, E., Mangalea, M.R., Arya, G., Canfield, G.S., and Duerkop, B.A. (2024). Bacteriophage and Antibiotic Combination Therapy for Recurrent Enterococcus faecium Bacteremia. mBio, 15.","DOI":"10.1128\/mbio.03396-23"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1038\/s41579-024-01058-6","article-title":"Enterococcus faecium: Evolution, Adaptation, Pathogenesis and Emerging Therapeutics","volume":"22","author":"Wei","year":"2024","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"504S","DOI":"10.1378\/chest.123.5_suppl.504S","article-title":"Vancomycin-Resistant Enterococci: A Road Map on How To Prevent the Emergence and Transmission of Antimicrobial Resistance","volume":"123","author":"DeLisle","year":"2003","journal-title":"Chest"},{"key":"ref_99","unstructured":"Coombs, G., Bell, J., Blyth, C., Bond, K., Daley, D., Cooley, L., Gottlieb, T., Iredell, J., Warner, M., and Robson, J. (2024). Australian Group on Antimicrobial Resistance Surveillance Outcomes Programs. Bloodstream Infections: 2023 Report."},{"key":"ref_100","unstructured":"UKHSA (2023). Start Smart Then Focus: Antimicrobial Stewardship Toolkit for Inpatient Care Settings."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"i51","DOI":"10.1093\/jac\/dks202","article-title":"Improving the Quality of Antibiotic Prescribing in the NHS by Developing a New Antimicrobial Stewardship Programme: Start Smart--Then Focus","volume":"67","author":"Sharland","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1093\/jac\/dkv492","article-title":"Implementation of Antimicrobial Stewardship Interventions Recommended by National Toolkits in Primary and Secondary Healthcare Sectors in England: TARGET and Start Smart Then Focus","volume":"71","author":"Budd","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"621","DOI":"10.3399\/bjgp12X659132","article-title":"European Antibiotic Awareness Day 2012: TARGET Antibiotics through Guidance, Education, and Tools","volume":"62","author":"Moore","year":"2012","journal-title":"Br. J. Gen. Pract."},{"key":"ref_104","unstructured":"UKHSA (2023). Antimicrobial Prescribing and Stewardship Competency Framework."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e057471","DOI":"10.1136\/bmjopen-2021-057471","article-title":"Mixed-Methods Evaluation of a Behavioural Intervention Package to Identify and Amend Incorrect Penicillin Allergy Records in UK General Practice","volume":"12","author":"Wanat","year":"2022","journal-title":"BMJ Open"},{"key":"ref_106","unstructured":"UK Government (2024). Confronting Antimicrobial Resistance 2024 to 2029."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1177\/1757177416687832","article-title":"Outbreak of Vancomycin-Resistant Enterococcus on a Haematology Ward: Management and Control","volume":"18","author":"Castro","year":"2017","journal-title":"J. Infect. Prev."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1038\/nature07250","article-title":"Vancomycin-Resistant Enterococci Exploit Antibiotic-Induced Innate Immune Deficits","volume":"455","author":"Brandl","year":"2008","journal-title":"Nature"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1080\/14787210.2023.2263643","article-title":"How Can We Tackle the Overuse of Antibiotics in Low- and Middle-Income Countries?","volume":"21","author":"Sulis","year":"2023","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1139\/cjm-2024-0024","article-title":"Enterococci as a One Health Indicator of Antimicrobial Resistance","volume":"70","author":"Zaidi","year":"2024","journal-title":"Can. J. Microbiol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/5\/522\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:35:19Z","timestamp":1760031319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/5\/522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":110,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["antibiotics14050522"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14050522","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]}}}