Enterococci remain an important cause of nosocomial infection, particularly among the critically ill. Nationwide, the incidence of enterococcal infections is rising, with an increasing proportion caused by resistant organisms. The spread of vancomycin-resistant enterococci (VRE) within hospitals has been well studied and helps to explain the proliferation of enterococcal disease. After hospital admission of an individual carrying VRE, persistent colonization contributes to the development of a reservoir of colonized inpatients. VRE is usually spread patient to patient by health care workers caring for colonized individuals. To interrupt this phenomenon, infection control efforts including improved hand hygiene, use of gloves and cover gowns, and antibiotic control measures have been promoted. Prospective data concerning the relative benefit of each intervention are limited, and no consensus has emerged regarding the optimal strategy for limiting the dissemination of VRE. Appropriate treatment of an individual patient infected with VRE depends upon successful interpretation of the antibiotic susceptibility profile of the infecting strain. For the critically ill patient, an aggressive approach to diagnosis and therapy is essential. However, even the newest agents available to treat resistant enterococci are limited because of emerging resistance and toxicity.