Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future

Emerg Infect Dis. Apr-Jun 1998;4(2):239-49. doi: 10.3201/eid0402.980211.

Abstract

Enterococci, leading causes of nosocomial bacteremia, surgical wound infection, and urinary tract infection, are becoming resistant to many and sometimes all standard therapies. New rapid surveillance methods are highlighting the importance of examining enterococcal isolates at the species level. Most enterococcal infections are caused by Enterococcus faecalis, which are more likely to express traits related to overt virulence but--for the moment--also more likely to retain sensitivity to at least one effective antibiotic. The remaining infections are mostly caused by E. faecium, a species virtually devoid of known overt pathogenic traits but more likely to be resistant to even antibiotics of last resort. Effective control of multiple-drug resistant enterococci will require 1) better understanding of the interaction between enterococci, the hospital environment, and humans, 2) prudent antibiotic use, 3) better contact isolation in hospitals and other patient care environments, and 4) improved surveillance. Equally important is renewed vigor in the search for additional drugs, accompanied by the evolution of new therapeutic paradigms less vulnerable to the cycle of drug introduction and drug resistance.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Drug Resistance, Microbial
  • Drug Resistance, Multiple*
  • Enterococcus / drug effects*
  • Enterococcus / pathogenicity
  • Enterococcus faecalis / drug effects
  • Enterococcus faecalis / pathogenicity
  • Enterococcus faecium / drug effects
  • Enterococcus faecium / pathogenicity
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / microbiology*
  • Humans
  • Microbial Sensitivity Tests
  • Virulence

Substances

  • Anti-Bacterial Agents