Background: Emergence of vancomycin resistant enterococci (VRE) become a major public health problem since it has been first reported. VRE are among the most common resistant pathogens frequently causing healthcare associated infections and a growing concern for health care professionals. The rising proportions of VRE infections are being reported worldwide. This study aims to estimate the pooled prevalence of VRE and the antimicrobial resistance profiles of enterococci in Ethiopia.

Methods: Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines/checklists. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I² tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test. The study protocol was not registered

Results: Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8 % (95% CI; 8.7 – 24.3). Compared to vancomycin resistance, enterococci had higher rate of resistance to penicillin (60.7%), amoxicillin (56.5 %), doxycycline (55.1 %) and tetracycline (53.7 %). Relatively low rate of resistance was found for daptomycin and linezolid with a pooled estimate of 3.2 % (95 % CI; 0.5 – 19.7 %) and 9.9 % (95 % CI; 2.8 – 29.0 %); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0 % (95 % CI; 42.9 – 75.0%).

Conclusion: High proportion of VRE and drug resistant enterococci are emerging in Ethiopia. Enterococcal isolates showed resistance to one or more of the drug of choices in different or same drug lines. High resistance to commonly used antibiotics and MDR enterococci were observed. Although the rates were low, the emergence of resistance to daptomycin and linezolid is an alarm for searching new ways for the treatment and control of VRE infections.

Key words: Enterococcus, vancomycin resistance, systematic review, Ethiopia