Enterococcus spp. as emerging pathogens in wound infections: prevalence, Vancomycin resistance, risk factors and clinical outcomes in a tertiary care hospital in Lebanon

Abstract

<title>Abstract</title> Background <italic>Enterococcus species</italic> have emerged as important nosocomial pathogens in wound infections, with growing concern regarding antimicrobial resistance and increasing prevalence over time. This study aimed to evaluate prevalence trends, Vancomycin resistance patterns, associated risk factors, and clinical outcomes of <italic>Enterococcus</italic> -associated wound infections in a tertiary care hospital in Lebanon. Methods A retrospective observational study was conducted including 1,352 patients with confirmed wound infections between 2018 and 2022. Microbiological identification was performed using the VITEK system, and antimicrobial susceptibility testing was interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Demographic, clinical, and microbiological data were analyzed. Results <italic>Enterococcus spp</italic> . accounted for 10.8% of wound isolates, with <italic>Enterococcus faecalis</italic> predominating (77%). A progressive increase in prevalence was observed from 2018 to 2021, followed by a slight decline in 2022. Infections were predominantly hospital-acquired and were significantly associated with diabetes mellitus, chronic kidney disease, cancer, and prior antibiotic exposure (p &lt; 0.05). The prevalence of vancomycin-resistant <italic>Enterococcus</italic> (VRE) was 21.9%, with higher resistance observed in <italic>Enterococcus faecium</italic> . Patients with <italic>Enterococcus</italic> infections had higher mortality rates compared to non- <italic>Enterococcus</italic> cases. Conclusion <italic>Enterococcus spp</italic> . are emerging pathogens in wound infections, demonstrating an increasing prevalence and significant antimicrobial resistance. These findings highlight the need for strengthened infection control strategies and antimicrobial stewardship programs to limit the growing burden of <italic>Enterococcus</italic> -associated infections.