Enterococci are commensals of the intestinal tract of many animals and humans. Of the various known and still unnamed new enterococcal species, only isolates of Enterococcus faecium and Enterococcus faecalis have received increased medical and public health attention. According to textbook knowledge, the majority of infections are caused by E. faecalis. In recent decades, the number of enterococcal infections has increased, with the increase being exclusively associated with a rising number of nosocomial E. faecium infections. This increase has been accompanied by the dissemination of certain hospital-acquired strain variants and an alarming progress in the development of antibiotic resistance namely vancomycin resistance. With this review we focus on a description of the specific situation of vancomycin resistance among clinical E. faecium isolates in Germany over the past 30 years. The present review describes three VRE episodes in Germany, each of which is framed by the beginning and end of the respective decade. The first episode is specified by the first appearance of VRE in 1990 and a country-wide spread of specific vanA-type VRE strains (ST117/CT24) until the late 1990s. The second decade was initially marked by regional clusters and VRE outbreaks in hospitals in South-Western Germany in 2004 and 2005, mainly caused by vanA-type VRE of ST203. Against the background of a certain “basic level” of VRE prevalence throughout Germany, an early shift from the vanA genotype to the vanB genotype in clinical isolates already occurred at the end of the 2000s without much notice. With the beginning of the third decade in 2010, VRE rates in Germany have permanently increased, first in some federal states and soon after country-wide. Besides an increase in VRE prevalence, this decade was marked by a sharp increase in vanB-type resistance and a dominance of a few, novel strain variants like ST192 and later on ST117 (CT71, CT469) and ST80 (CT1065). The largest VRE outbreak, which involved about 2,900 patients and lasted over three years, was caused by a novel and until that time, unknown strain type of ST80/CT1013 (vanB). Across all periods, VRE outbreaks were mainly oligoclonal and strain types varied over space (hospital wards) and time. The spread of VRE strains obviously respects political borders; for instance, both vancomycin-variable enterococci which were highly prevalent in Denmark and ST796 VRE which successfully disseminated in Australia and Switzerland, were still completely absent among German hospital patients, until to date.

肠球菌是许多动物和人类肠道的共生菌。在各种已知但尚未命名的新肠球菌物种中，只有屎肠球菌和粪肠球菌的分离株受到了医学和公共卫生越来越多的关注。根据教科书知识，大多数感染是由粪肠球菌引起的。近几十年来，肠球菌感染的数量有所增加，而这种增加仅与院内粪肠球菌数量增加有关感染。这种增加伴随着某些医院获得性菌株变体的传播以及抗生素耐药性（即万古霉素耐药性）发展的惊人进展。在这篇综述中，我们重点描述了过去 30 年德国临床屎肠球菌分离株中万古霉素耐药性的具体情况。本评论描述了德国的三个 VRE 事件，每个事件都以各自十年的开始和结束为框架。第一集由1990年VRE的首次出现和特定vanA-的全国传播指定VRE 型菌株 (ST117/CT24) 直到 1990 年代后期。第二个十年最初的标志是 2004 年和 2005 年德国西南部医院的区域性集群和 VRE 暴发，主要是由ST203 的vanA型 VRE引起的。在整个德国 VRE 流行率达到一定“基本水平”的背景下，临床分离株中从vanA基因型到vanB基因型的早期转变已经发生在 2000 年代末，而没有引起太多注意。随着 2010 年第三个十年的开始，德国的 VRE 率一直在上升，首先是在一些联邦州，随后是在全国范围内。除了 VRE 患病率增加外，这十年的特点是vanB急剧增加型抗性和少数新型菌株变体的优势，如 ST192 和后来的 ST117 (CT71、CT469) 和 ST80 (CT1065)。最大的 VRE 爆发涉及约 2,900 名患者并持续了三年多，是由一种新的、直到那时为止未知的 ST80/CT1013 ( vanB )菌株类型引起的。在所有时期，VRE 暴发主要是寡克隆和菌株类型随空间（医院病房）和时间而变化。VRE 菌株的传播显然尊重政治边界；例如，在丹麦高度流行的万古霉素变异肠球菌和在澳大利亚和瑞士成功传播的 ST796 VRE，直到迄今为止，在德国医院患者中仍然完全不存在。