---
title: "Vancomycin-Resistant Enterococci in Oman: Six-Year Epidemiology, Resistance Trends, and Mortality"
id: "pubmed-42747766"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42747766"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42747766/"
doi: "10.1007/s15010-026-02979-5"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Vancomycin-Resistant Enterococci in Oman: Six-Year Epidemiology, Resistance Trends, and Mortality
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42747766
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42747766/)
- **DOI:** [10.1007/s15010-026-02979-5](https://doi.org/10.1007%2Fs15010-026-02979-5)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This six-year retrospective cohort study (2020–2025) from a tertiary hospital in Sohar, Oman, analysed 1,626 non-duplicate Enterococcus isolates from 1,018 patients to characterise **VRE epidemiology**, resistance patterns and in-hospital mortality predictors. - A composite VRE definition combined vancomycin-resistant susceptibility results and laboratory VRE flags; 395/1,626 isolates (24.3%) met this composite definition. - Only 196 (49.6%) of the composite VRE isolates were vancomycin-resistant on susceptibility testing; 199 (50.4%) were flagged as VRE without a vancomycin result, and 66 isolates were vancomycin-resistant but unflagged. - Introduction of active rectal screening in 2024 contributed 186 of 395 VRE isolates (47.1%) and largely explains the marked rise in composite VRE proportion from 1.8% in 2020 to 47.4% in 2025. - When restricted to tested clinical non-vanC isolates, vancomycin resistance rose from 0.5% (2020) to 21.8% by 2023 and then plateaued (21.8% in 2023, 20.7% in 2024, 21.8% in 2025). - Of 193 VRE-positive patients, 96 (49.7%) were detected by rectal screening alone, 30 (15.5%) carried intrinsically resistant vanC species, and 67 (34.7%) had acquired resistance in a clinical specimen; 29 patients (15.0%) were bacteraemic. - **E. faecium** predominated, accounting for 141 of 193 VRE-positive patients (73.1%). - Last-line agents retained activity: **linezolid** (0.9% non-susceptible) and **tigecycline** (1.9% non-susceptible) showed near-complete activity according to the abstract. - In a chart-reviewed cohort (213 patients), 163 were microbiologically confirmed VRE-positive; among 149 confirmed patients with outcome data, in-hospital mortality was 29.5% (44/149). - Low serum albumin was an independent predictor of mortality on complete-case analysis but lost statistical significance after multiple imputation; **ICU admission** remained the most robust predictor (imputed OR 3.14, 95% CI 1.36–7.24, p = 0.007). - Prognostic models based on routine admission biomarkers had modest and unstable discrimination (cross-validated AUC 0.775, SD 0.128) and imperfect calibration, limiting clinical utility and supporting a hypothesis-generating role. - The authors conclude the apparent recent increase in VRE is largely attributable to changes in surveillance (active rectal screening) and inclusion of vanC species, and that half of VRE-positive patients were colonised rather than infected.
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Online ahead of print. # Epidemiology, antimicrobial resistance trends, and predictors of mortality among vancomycin-resistant enterococci: a six-year retrospective cohort study from Oman [Mohan Bilikallahalli Sannathimmappa](https://pubmed.ncbi.nlm.nih.gov/?term=Sannathimmappa+MB&cauthor_id=42747766)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-1 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman. drmohan123@gmail.com."), [Mohammed Idris Qureshi](https://pubmed.ncbi.nlm.nih.gov/?term=Qureshi+MI&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Syeda Heyam](https://pubmed.ncbi.nlm.nih.gov/?term=Heyam+S&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Majid Al Lawati](https://pubmed.ncbi.nlm.nih.gov/?term=Al+Lawati+M&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Tasnim Saif Alamri](https://pubmed.ncbi.nlm.nih.gov/?term=Alamri+TS&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Qabas Hamood Al-Harmali](https://pubmed.ncbi.nlm.nih.gov/?term=Al-Harmali+QH&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Vinod Nambiar](https://pubmed.ncbi.nlm.nih.gov/?term=Nambiar+V&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Salima Al-Maqbali](https://pubmed.ncbi.nlm.nih.gov/?term=Al-Maqbali+S&cauthor_id=42747766)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#full-view-affiliation-3 "Department of Pathology & Blood Bank, Sohar Hospital, Sohar, Oman.") Affiliations Expand ### Affiliations * 1 Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman. drmohan123@gmail.com. * 2 Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman. * 3 Department of Pathology & Blood Bank, Sohar Hospital, Sohar, Oman. * PMID: **42747766** * DOI: [ 10.1007/s15010-026-02979-5 ](https://doi.org/10.1007/s15010-026-02979-5) Item in Clipboard # Epidemiology, antimicrobial resistance trends, and predictors of mortality among vancomycin-resistant enterococci: a six-year retrospective cohort study from Oman Mohan Bilikallahalli Sannathimmappa et al. Infection. 2026. Show details Display options Display options Format Abstract PubMed PMID Infection Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Infection%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Infection%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42747766/) . 2026 Sep 16. doi: 10.1007/s15010-026-02979-5. Online ahead of print. ### Authors [Mohan Bilikallahalli Sannathimmappa](https://pubmed.ncbi.nlm.nih.gov/?term=Sannathimmappa+MB&cauthor_id=42747766)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-1 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman. drmohan123@gmail.com."), [Mohammed Idris Qureshi](https://pubmed.ncbi.nlm.nih.gov/?term=Qureshi+MI&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Syeda Heyam](https://pubmed.ncbi.nlm.nih.gov/?term=Heyam+S&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Majid Al Lawati](https://pubmed.ncbi.nlm.nih.gov/?term=Al+Lawati+M&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Tasnim Saif Alamri](https://pubmed.ncbi.nlm.nih.gov/?term=Alamri+TS&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Qabas Hamood Al-Harmali](https://pubmed.ncbi.nlm.nih.gov/?term=Al-Harmali+QH&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Vinod Nambiar](https://pubmed.ncbi.nlm.nih.gov/?term=Nambiar+V&cauthor_id=42747766)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-2 "Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman."), [Salima Al-Maqbali](https://pubmed.ncbi.nlm.nih.gov/?term=Al-Maqbali+S&cauthor_id=42747766)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42747766/#short-view-affiliation-3 "Department of Pathology & Blood Bank, Sohar Hospital, Sohar, Oman.") ### Affiliations * 1 Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman. drmohan123@gmail.com. * 2 Department of Microbiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar Campus, Sohar, Sultanate of Oman. * 3 Department of Pathology & Blood Bank, Sohar Hospital, Sohar, Oman. * PMID: **42747766** * DOI: [ 10.1007/s15010-026-02979-5 ](https://doi.org/10.1007/s15010-026-02979-5) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Vancomycin-resistant enterococci (VRE) are an escalating cause of healthcare-associated infection, yet longitudinal data from the Arabian Peninsula remain scarce. We characterised the epidemiology, resistance patterns and predictors of in-hospital mortality of enterococci over six years at a tertiary hospital in Oman, with explicit attention to the effect of changing surveillance practice and to the distinction between colonisation and infection. **Methods:** We analysed 1,626 non-duplicate Enterococcus isolates from 1,018 patients (2020-2025). VRE was defined a priori as a vancomycin-resistant result on susceptibility testing or a laboratory VRE flag; agreement between these two routes was quantified, and all trend analyses were repeated using a phenotype-only definition restricted to clinical (non-screening) specimens and excluding intrinsically resistant vanC species. A chart-reviewed cohort provided comorbidity, biomarker and outcome data. Mortality models were fitted on complete cases and after multiple imputation by chained equations (m = 20, Rubin's rules), and discrimination and calibration were assessed by repeated stratified five-fold cross-validation. **Results:** VRE by the composite definition accounted for 395 of 1,626 isolates (24.3%). Only 196 (49.6%) were vancomycin-resistant on testing; 199 (50.4%) were flag-only with no vancomycin result, and a further 66 isolates were vancomycin-resistant but unflagged. Active rectal screening began only in 2024 and contributed 186 of 395 VRE isolates (47.1%). The composite VRE proportion therefore rose from 1.8% (2020) to 47.4% (2025) (Cochran-Armitage Z = 16.56, p < 0.001), whereas vancomycin resistance among tested clinical non-vanC isolates rose from 0.5% to 21.8% and plateaued after 2023 (21.8%, 20.7%, 21.8% in 2023, 2024 and 2025; Z = 8.32, p < 0.001). Of 193 VRE-positive patients, 96 (49.7%) were detected by rectal screening alone and 30 (15.5%) carried vanC species, leaving 67 (34.7%) with acquired resistance in a clinical specimen; 29 (15.0%) were bacteraemic. E. faecium accounted for 141 of 193 VRE-positive patients (73.1%). Linezolid (0.9%) and tigecycline (1.9%) retained near-complete activity. In the chart-reviewed cohort, 163 of 213 patients were microbiologically confirmed as VRE-positive; in-hospital mortality was 29.5% (44/149) among confirmed patients. Low albumin was an independent predictor on complete-case analysis (adjusted OR 0.86 per g/L, 95% CI 0.77-0.95, p = 0.004; n = 82, 24 events) but attenuated after multiple imputation (OR 0.94, 0.87-1.00, p = 0.066), whereas intensive-care admission was the most robust predictor (imputed OR 3.14, 1.36-7.24, p = 0.007). Cross-validated discrimination was modest and unstable (logistic AUC 0.775, SD 0.128; fold range 0.345-1.000), calibration slope was 0.81, and accuracy at a 0.5 threshold (73.8%) barely exceeded the 70.7% obtained by predicting survival for every patient. **Conclusions:** Enterococcal vancomycin resistance increased substantially at this centre and is concentrated in E. faecium, with preserved last-line susceptibility. However, much of the apparent rise after 2023 is attributable to the introduction of active rectal screening and to intrinsically resistant vanC species, and half of VRE-positive patients were colonised rather than infected. Prognostic models built on routine admission biomarkers were insufficiently discriminating and calibrated for clinical use and should be regarded as hypothesis-generating. **Keywords:** Enterococcus faecium; Active surveillance screening; Antimicrobial resistance; Colonisation; In-hospital mortality; Oman; Serum albumin; Vancomycin-resistant enterococci. © 2026. Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional research and ethics committee of Sohar Hospital, Ministry of Health, Oman vide under approval number MOH/CSR/25/31104 dated 24/12/2025. Because the study was a retrospective analysis of anonymised, routinely collected laboratory and clinical data, the requirement for individual informed consent was waived by the committee. Consent for publication: Not applicable; the manuscript contains no individually identifiable data. ## References 1. 1. Arias CA, Murray BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol. 2012;10(4):266–78. - [DOI](https://doi.org/10.1038/nrmicro2761) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/22421879/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/3621121/) 2. 1. Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55. - [DOI](https://doi.org/10.1016/s0140-6736\(21\)02724-0) 3. 1. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18(3):318–27. - [DOI](https://doi.org/10.1016/s1473-3099\(17\)30753-3) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29276051/) 4. 1. Lucian-Daniel P, Andreea-Eliza Z, Nicoleta-Maricica M, Cosmin-Răducu R, Elena-Roxana MV, Alice-Crina C, et al. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in nosocomial infections: a systematic review of resistance, pathogenesis, and clinical management. Microorganisms. 2026;14(2):428. - [DOI](https://doi.org/10.3390/microorganisms14020428) 5. 1. Taur Y, Xavier JB, Lipuma L, Ubeda C, Goldberg J, Gobourne A, et al. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis. 2012;55(7):905–14. - [DOI](https://doi.org/10.1093/cid/cis580) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/22718773/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/3657523/) Show all 46 references [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42747766/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42747766%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42747766/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42747766%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42747766%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42747766/) [x] NCBI Literature Resources
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