Second leading cause of nosocomial infection and the third most common cause of nosocomial bacteremia.

Normal intestinal flora.

Genus has more than 17 species, but only a few are related to clinical infections.

Anaerobic organisms that are Gram positive cocci in chains.

In culture organisms can hydrolyze esculin in the presence of bile, can grow in 6.5% saline and demonstrate pyrrolidonyl arylamidase and leucine aminopeptidase and react with group D antiserum.

E. faecalis and E. faecium most prevalent species in humans-accounting for 90% of isolates.

The analysis of fecal microbiota in patients undergoing bone marrow transplantation acute graft versus host disease was associated with enterococcal domination and decreased overall survival increased mortality from GVHD.

Enterococcus faecalis species is responsible for most infections with enterococci is usually susceptible to in vitro vancomycin and penicillins.

Enterococcus faecium intrinsically more resistant to antibiotics than Enterococcus faecalis accounts for 10% of enterococci infections and a significant number of nosocomial infections.

Enterococcus faecium accounts for 90% of VRE in hospitals and early all are resistant to ampicillin.

Therapy of choice for infections is penicillin or ampicillin, plus an aminoglycoside for the treatment of endocarditis.

Vancomycin is an alternative drug for patients with penicillin allergy or resistance.

About 12% of isolates are vancomycin resistant.

Clonal spread is the major factor in dissemination of multidrug-resistant Enterococcal infection.

Resistant organisms encode genes with virulence factors such as the production of gelatinase, hemolytic, adherence to caco-2 and hep-2 cells and biofilm formation.

As part of thevtreatment of enterococcal infections, all suspected intravenous lines, and urinary catheters should be removed, if possible, and abscesses drained.

Infections that do not require bactericidal therapy are usually treated with a single antibiotic Andy

these infections include urinary tract infections, most intra-abdominal infections, and uncomplicated wound infections.

Monotherapy is adequate treatment in many patients with enterococcal bacteremia without evidence of endocarditis.

A combination therapy with a cell wall–active agent and a synergistic aminoglycoside should be considered for treating serious enterococcal infections, in patients with evidence of sepsis, as well as in patients with endocarditis, meningitis, osteomyelitis, or joint infections.

Ampicillin is the drug of choice for monotherapy of susceptible E faecalis infection, and for strains that are resistant to ampicillin because of beta-lactamase production, ampicillin plus sulbactam may be used.

Vancomycin should be used in patients with a penicillin allergy or infections with strains that have high-level penicillin resistance.

Nitrofurantoin is effective forbenterococcal urinary tract infections, including many caused by vancomycin-resistant enterococci (VRE) strains.

Linezolid, daptomycin, and tigecycline, may be used to treat VRE infections.

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