Global prevalence of vancomycin-resistant Enterococcus in patients with haematological malignancies: a systematic review and meta-analysis

BackgroundThis systematic review and meta-analysis evaluated the global prevalence of vancomycin-resistant enterococci among patients with hematological malignancies, particularly vulnerable immunocompromised populations including leukemia, lymphoma, neutropenia, and hematopoietic stem cell transplantation patients.MethodsA systematic literature search of PubMed, Scopus, and Google Scholar was conducted for studies published up to March 2026. Eligible observational studies reporting the prevalence of VRE in patients with hematological malignancies were included. Study quality was assessed using the Joanna Briggs Institute checklist and PRISMA 2020 guidelines. Random-effects meta-analysis using logit-transformed proportions was performed in OpenMetaAnalyst and Comprehensive Meta-Analysis software. Heterogeneity was assessed using Cochran’s Q and I2 statistics. Subgroup analysis, sensitivity analysis, publication bias assessment, and meta-regression were conducted to identify potential sources of heterogeneity.ResultsA total of 120 studies involving patients with hematological malignancies were included. The pooled prevalence of VRE was 18.4% (95% CI: 15.5–21.6%), with substantial heterogeneity (I2 = 97.56%, p < 0.001). Publication bias was detected by funnel plot asymmetry, Egger’s regression (p = 0.0224), and Begg’s test (p = 0.0226). Subgroup analysis demonstrated considerable geographic variation, with the highest prevalence observed in South America (25.5%) and Australia (22.8%). HSCT patients showed the highest pooled prevalence (97.1%), followed by neutropenic patients (91.2%) and acute myeloid leukemia patients (68.3%). Meta-regression identified continent as a significant contributor to heterogeneity (Q = 11.68, p = 0.0395), whereas detection method and sample type were not significant moderators.ConclusionVRE represents a substantial global burden among patients with hematological malignancies, particularly in HSCT and neutropenic populations.Systematic review registration10.17605/OSF.IO/2VH9D.