Limited, outbreak-biased and unevenly reported: genomic insights into vancomycin-resistant Enterococcus faecium in...

Whole-genome sequencing (WGS) has improved our understanding on epidemiology and transmission of vancomycin-resistant Enterococcus faecium (VRE). However, regional differences in strain distribution patterns remain poorly reported. In this narrative review, we summarize current evidence in Germany.

A systematic PubMed search was conducted for studies describing WGS-based typing of VRE in Germany published between 2015 and 2025 (n = 39). A relevant national surveillance report was included additionally.

Data availability varies regionally, with highest reporting rates in north-western and south-eastern Germany. The German VRE population is predominantly composed of six major lineages: vanB-positive sequence types (ST) 80, 117, 192, and 203, and vanA-positive ST78 and ST1299. While ST192, ST203, and ST78 declined over time, ST80 and ST117 and their sub-lineages are nationally endemic. Core genome analyses demonstrate stable distribution of regionally specific complex types (CT) including ST80/CT1065/vanB and ST1299/CT1903/vanA in southern Germany, and ST117/CT71/vanB and ST80/CT1470/vanA in the north-west. Notably, ST80 exhibits greater CT diversity than ST117, reflecting its wider evolutionary plasticity.

Although unevenly reported, persistent regional differences in dominant lineages are evident, underscoring the necessity and value of high-resolution genomic surveillance beyond national-level reporting. Ultimately, this strategy could improve transmissions and outbreak analysis, and facilitate identification of lineage-specific virulence determinants.