A One-Health Perspective on Enterococcus in Ghana: A Review and Meta-Analysis.

Enterococcus species are part of normal microbiota but can cause severe infections, especially among hospital-adapted strains. In Ghana, data on their dynamics, including prevalence and resistance patterns, remain limited. This systematic review and meta-analysis is the first to assess the current scope and identify gaps in One-Health research on Enterococcus. We searched PubMed/MEDLINE, Scopus, and Web of Science following PRISMA 2020 guidelines for studies published up to October 24, 2024 (search conducted October 12-24, 2024). A random-effects model with restricted maximum likelihood was used to pool prevalence and antimicrobial resistance. Sixty-nine studies met the inclusion criteria with nineteen eligible for meta-analysis. The pooled prevalence of Enterococcus was 6.76% (CI: 1.19-16.39, I2 = 99.3%, p < 0.0001) while adjusted vancomycin-resistance isolates was 0.06% (CI: 0.00-27.86; I2 = 99.4%, p < 0.0001). Antibiotic resistance rates were comparable across human and animal studies, often higher in animals. Ciprofloxacin showed the lowest resistance (1.30%), while cloxacillin had the highest (17.46%). This review underscores the one-sided focus on humans, limiting understanding of transmission within the One-Health spectrum. We advocate integrating genomic approaches, particularly environmental genomics, into One-Health frameworks to resolve transmission pathways, inform policy, and strengthen antimicrobial resistance control in Ghana.