Global occurrence of linezolid-resistant Enterococcus (LRE): The first systematic review and meta-analysis

We present the first global systematic review and meta-analysis of the prevalence of Linezolid-Resistant Enterococcus (LRE). PubMed and Google Scholar were searched for articles. Independent reviewers extracted the data, and looked at the results. The reviewers independently examined the study methodology and study quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the Joanna Briggs Institute (JBI) critical assessment checklist for prevalence data. OpenMeta analyst and comprehensive meta-analysis (CMA) was used for the meta-analysis. The study protocol was registered with PROSPERO (registration number: CRD42022319724). The random-effect model was used, and publication bias was assessed using the Eggers test, Begg’s test and funnel plot. Between-study heterogeneity was assessed, and the sources were analyzed using the leave-one-out meta-analysis, subgroup analysis, and meta-regression. Eighty-four studies met the eligibility criteria and were therefore added to the final meta-analysis. Of the 157,776 isolates tested in the included studies, 3728 were LRE. The pooled prevalence of LRE was estimated at 3.3% (95% CI; 2.3 – 4.6%; I2 = 98.63%; P < 0.001). Between-study variability was high (t2 = 2.453; heterogeneity I2 = 98.63% with heterogeneity chi-square (Q) = 6038.831, degrees of freedom (df) = 83, and P < 0.001). The funnel plot showed bias which was confirmed by Egger’s test (t-value = 1.0124; P = 0.15717), and estimates from the leave-one-out forest plot did not affect the pooled prevalence. Pooled prevalence of LRE in humans and animals were 1.9% (CI=1.3 – 2.8%) and 6.3%, (CI=3.1 – 12.3%) respectively. Enterococcus faecalis and optrA gene was reported most with more studies being reported in China and used broth microdilution as the detection method. Increased coordinated monitoring of LRE is required.