The rise of the Enterococcus: beyond vancomycin resistance

Nat Rev Microbiol. 2012 Mar 16;10(4):266-78. doi: 10.1038/nrmicro2761.


The genus Enterococcus includes some of the most important nosocomial multidrug-resistant organisms, and these pathogens usually affect patients who are debilitated by other, concurrent illnesses and undergoing prolonged hospitalization. This Review discusses the factors involved in the changing epidemiology of enterococcal infections, with an emphasis on Enterococcus faecium as an emergent and challenging nosocomial problem. The effects of antibiotics on the gut microbiota and on colonization with vancomycin-resistant enterococci are highlighted, including how enterococci benefit from the antibiotic-mediated eradication of gram-negative members of the gut microbiota. Analyses of enterococcal genomes indicate that there are certain genetic lineages, including an E. faecium clade of ancient origin, with the ability to succeed in the hospital environment, and the possible virulence determinants that are found in these genetic lineages are discussed. Finally, we review the most important mechanisms of resistance to the antibiotics that are used to treat vancomycin-resistant enterococci.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / genetics
  • Bacterial Proteins / metabolism
  • Cross Infection / epidemiology
  • Cross Infection / microbiology*
  • Drug Resistance, Multiple, Bacterial / genetics
  • Enteritis / epidemiology
  • Enteritis / microbiology
  • Enterococcus faecium / drug effects
  • Enterococcus faecium / genetics
  • Enterococcus faecium / pathogenicity*
  • Gastrointestinal Tract / microbiology
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / microbiology*
  • Gram-Positive Bacterial Infections / transmission
  • Humans
  • Microbial Interactions
  • Vancomycin / pharmacology
  • Vancomycin Resistance / genetics
  • Vancomycin Resistance / physiology*
  • Virulence Factors / genetics
  • Virulence Factors / metabolism


  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Virulence Factors
  • Vancomycin