Vancomycin-resistant Enterococcus in tanzania: a one health pathway to sustainable control

Abstract

Enterococcus is a commensal bacterium and opportunistic pathogen, with certain strains showing resistance to vancomycin, a last-resort antibiotic. The misuse of vancomycin in both human and veterinary medicine has led to the emergence of vancomycin-resistant Enterococcus (VRE), a high-priority pathogen that can persist in diverse environments and transfer resistance genes. This article assesses the prevalence of VRE in Tanzania, its cross-sectoral occurrence, and the factors driving its spread. This narrative review used a structured methodology to assess VRE prevalence and drivers in Tanzania. We performed a comprehensive literature search across major databases like PubMed, Scopus, and Google Scholar. The initial search yielded 150 articles, which were then screened based on abstracts and titles. After a full-text review, 72 articles were found to be relevant, and from those, 34 were ultimately selected for final analysis. The extracted data included study settings, VRE prevalence, resistance genes, and factors associated with its emergence. The review highlights VRE’s cross-sectoral presence and its association with antibiotic misuse. Current research is limited by its narrow geographic scope, insufficient investigation into underlying causes, a focus on specific patient populations (e.g., HIV-positive individuals), and the underutilization of molecular tools. These limitations hinder a comprehensive understanding of the full VRE burden. The findings underscore the need for a coordinated, evidence-based “One Health” approach to address the VRE threat in Tanzania. Future efforts should prioritize filling research gaps, strengthening national antimicrobial resistance (AMR) control, and implementing comprehensive surveillance programs.