Antimicrobial resistance pattern of enterococcus species among clinical isolates in Iran: A systematic review and meta-analysis.

Enterococcus faecalis (E. faecalis) and Enterococcus faecium (E. faecium) are leading pathogens responsible for both community-acquired and nosocomial infections, with escalating antibiotic resistance reported worldwide. This meta-analysis evaluated resistance patterns in Iran by reviewing 46 studies published between 2017 and 2023, retrieved from PubMed, Scopus, and national Iranian databases (SID, Magiran, Scimed). Among 2379 E. faecalis and 1219 E. faecium isolates, resistance was markedly higher in E. faecium. The highest resistance rate in E. faecalis was observed against trimethoprim/sulfamethoxazole (82.0 %), whereas E. faecium demonstrated the highest resistance to ampicillin-sulbactam (91.7 %). Vancomycin-resistant Enterococci (VRE) prevalence was notably elevated (E. faecium: 52.3 %; E. faecalis: 15.8 %). Linezolid remained the most effective agent, with low resistance rates reported for E. faecalis (1.6 %) and E. faecium (3.1 %). These findings highlight a critical level of antimicrobial resistance in clinical Enterococcus isolates in Iran, underscoring the urgent need for strengthened infection control measures and comprehensive antibiotic stewardship policies.