Genotypic features of antimicrobial resistance, virulence determinants, and clonal lineages of Enterococcus spp. reported in Brazil: a scoping review with marked regional asymmetry.

PURPOSE: Vancomycin-resistant Enterococcus faecium is listed in the 2024 WHO Bacterial Priority Pathogens List as a high-priority agent of hospital-acquired infections. Its persistence is supported by marked genomic plasticity across human, animal, food, and environmental sources. We aimed to map antimicrobial resistance genes, virulence determinants, and clonal lineages of Enterococcus spp. reported in Brazil across these four sampling contexts.

METHODS

Scoping review following JBI methodological guidance and reported per PRISMA-ScR. Four databases (PubMed, Embase, SciELO, LILACS) were searched without time restrictions in English, Portuguese, and Spanish. Two reviewers screened studies in Rayyan and extracted data using a standardised instrument.

RESULTS

A total of 133 studies (1999 to 2025) were included. Evidence was concentrated in the Southeast and South. Sixty-seven acquired resistance genes and 11 chromosomal mutations were identified across 14 species, predominantly E. faecalis and E. faecium. Twelve broadly reported genes, including vanA, erm(B), and tet(M), spanned all four One Health contexts. Of 67 E. faecium sequence types, 28 (42%) were assigned to CC17 according to the current PubMLST classification and were reported across 26 studies in six states. Forty-six virulence determinants were mapped, with nine adhesion- and biofilm-associated genes shared across all four contexts.

CONCLUSION

Enterococcus resistance, virulence, and lineage diversity in Brazil show a structured but unevenly characterised distribution with substantial surveillance gaps relevant to infection control and antimicrobial stewardship. The co-occurrence of PubMLST-assigned CC17 STs and last-resort resistance genes across compartments underscores the need for coordinated genomic surveillance.