Critical genomic insights into vancomycin-resistant <i>Enterococcus faecium</i> in Lebanon

The healthcare system in Lebanon faces substantial challenges due to ongoing economic instability and limited resources, creating a conducive environment for the spread of antimicrobial resistance. Vancomycin-resistant <i>Enterococcus faecium</i> (VRE) represents a growing public health threat, yet studies addressing its genetics in Lebanon are scarce. This study provided critical insights into the genomic features of VRE in clinical settings, highlighting the potential clonal dissemination of multidrug-resistant isolates carrying the <i>vanHAX</i> operon and belonging to CC17, a globally prevalent, hospital-associated lineage. Resistance to novel antimicrobials, such as telavancin, dalbavancin, and eravacycline, is alarming and necessitates immediate action to preserve these critical last-resort interventions. Notably, the identification of clonal spread and a novel sequence type (ST2711) within Lebanese hospitals, alongside resistance to last-resort antimicrobials, highlights the dynamic evolution of VRE and the urgent need to strengthen antimicrobial stewardship programs in Lebanon and beyond. Addressing this challenge requires integrated One Health strategies.