Enterococcal Infections Clinical Presentation

  • Author: Susan L Fraser, MD; Chief Editor: John L Brusch, MD, FACP  more...
Updated: Mar 17, 2016


Urinary tract infections

The most common type of infection caused by enterococci is usually nosocomial (associated with urinary tract catheterization or instrumentation).

Cystitis and pyelonephritis are common infections.

Occasionally, prostatitis and perinephric abscesses may develop.

Occasional infections may occur in young healthy women (< 5%).


Sources of enterococcal bacteremia include the urinary tract, intra-abdominal foci, wounds, and intravascular catheters, especially catheters in femoral locations.

Community-acquired enterococcal bacteremia is more commonly associated with endocarditis (up to 36% of cases) than nosocomial bacteremia (0.8%).

Nosocomial enterococcal bacteremias may arise from various sources. Polymicrobial bacteremias including enterococci and other bowel flora should increase the index of suspicion for an intra-abdominal source. Other sources may include surgical sites and burn wounds infections.

Blood cultures that grow enterococci may be positive because of contamination of the skin with these organisms. A blood culture positive for Enterococcus species in the absence of evidence of ongoing infection should raise this possibility.


Enterococci cause 5-15% of all endocarditis cases.

Enterococcal endocarditis usually occurs in older patients, particularly men.

The presentation of enterococcal endocarditis is typically subacute and infrequently associated with peripheral stigmata of endocarditis. Enterococcal endocarditis of native valves carries a relatively low short-term mortality rate.

Most cases of enterococcal endocarditis are left-sided. In two recent series of endocarditis caused by VRE, the aortic valve was involved more often than the mitral valve.[20, 21]

E faecalis causes most cases of endocarditis. Vancomycin-resistant E faecium is more likely to cause endocarditis than other VRE species, especially cases acquired nosocomially.

Risk factors for enterococcal endocarditis may include UTI or instrumentation.

Intra-abdominal and pelvic infections

Such infections include biliary tract infection, intra-abdominal abscess, spontaneous bacterial peritonitis, endometritis, and salpingitis.

Enterococci are usually part of mixed aerobic and anaerobic flora.

Antimicrobial regimens with minimal in vitro antienterococcal activity are often effective in treating mixed infections; therefore, the pathogenicity of enterococci in this setting is questionable.

Antienterococcal bactericidal activity is recommended when blood culture results are positive for enterococci.

In more seriously ill patients, enterococcal infections have been associated with higher risk of treatment failure and mortality. Consider administering antibiotics with antienterococcal activity to immunocompromised patients at high risk for bacteremia, patients with peritonitis and valvular heart disease, patients with severe sepsis of abdominal origin who have recently received broad-spectrum antibiotics, and patients with persistent intra-abdominal fluid collections without clinical improvement.[22]

Other infections

Enterococcal wound infections often manifest as part of a mixed infection.

Enterococcal meningitis is uncommon and is usually associated with neurosurgical procedures or anatomic defects, accounting for only 0.3-6% of cases.

Neonatal sepsis may occur.

Respiratory tract infections can develop, especially in older debilitated patients who are receiving tube feedings.[23] However, isolation of enterococci from respiratory secretions usually represents colonization rather than infection.

Other uncommon infections caused by enterococci include osteomyelitis and septic joint infections.



Physical examination findings in patients with enterococcal infections vary widely and depend on the associated infectious syndrome; therefore, direct the examination according to the patient's symptoms and laboratory findings.

Evaluate the patient for suprapubic or flank tenderness if laboratory findings are consistent with enterococcal UTI.

If the patient has enterococcal bacteremia, carefully evaluate the patient for signs consistent with endocarditis, which include the following:

  • Fever
  • Peripheral stigmata (Janeway lesions, Osler nodes, Roth spots, petechiae or splinter hemorrhages)
  • New heart murmur (usually a regurgitant murmur)

Examine the abdomen carefully for signs of organ tenderness, for peritoneal signs of peritonitis, and for ascites.

Examine prosthetic devices and the local skin (eg, orthopedic, cardiac, catheter insertion sites) for signs of infection, including erythema, swelling, tenderness, and/or warmth.

Contributor Information and Disclosures

Susan L Fraser, MD Chief, Infectious Diseases Service, Fort Belvoir Community Hospital; Chairman, Infection Control Committee; Associate Professor of Medicine, Uniformed Services University of the Health Sciences

Susan L Fraser, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.


Robert A Salata, MD Chief and Clinical Program Director of Division of Infectious Diseases, Vice Chair for International Affairs, Professor, Department of Medicine, Case Western Reserve University School of Medicine

Robert A Salata, MD is a member of the following medical societies: American Association of Immunologists, American Federation for Medical Research, American Medical Association, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Ohio State Medical Association, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Curtis J Donskey, MD Chairman of Infection Control, Instructor, Department of Internal Medicine, Section of Infectious Diseases, Stokes Cleveland VA Medical Center, Case Western Reserve University

Curtis J Donskey, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

David Hall Shepp, MD Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received salary from Gilead Sciences for management position.


Julia Lim, MD Associate Program Director, Internal Medicine Residency Program, Tripler Army Medical Center

Disclosure: Nothing to disclose.

  1. de Perio MA, Yarnold PR, Warren J, et al. Risk factors and outcomes associated with non-Enterococcus faecalis, non-Enterococcus faecium enterococcal bacteremia. Infect Control Hosp Epidemiol. 2006 Jan. 27(1):28-33. [Medline].

  2. Courvalin P. Vancomycin resistance in gram-positive cocci. Clin Infect Dis. 2006 Jan 1. 42 Suppl 1:S25-34. [Medline].

  3. Deshpande LM, Fritsche TR, Moet GJ, et al. Antimicrobial resistance and molecular epidemiology of vancomycin-resistant enterococci from North America and Europe: a report from the SENTRY antimicrobial surveillance program. Diagn Microbiol Infect Dis. 2007 Jun. 58(2):163-70. [Medline].

  4. Klibi N, Ben Slama K, Sáenz Y, et al. Detection of virulence factors in high-level gentamicin-resistant Enterococcus faecalis and Enterococcus faecium isolates from a Tunisian hospital. Can J Microbiol. 2007 Mar. 53(3):372-9. [Medline].

  5. Long JK, Choueiri TK, Hall GS, Avery RK, Sekeres MA. Daptomycin-resistant Enterococcus faecium in a patient with acute myeloid leukemia. Mayo Clin Proc. 2005 Sep. 80(9):1215-6. [Medline].

  6. Smith JR, Barber KE, Raut A, Aboutaleb M, Sakoulas G, Rybak MJ. β-Lactam combinations with daptomycin provide synergy against vancomycin-resistant Enterococcus faecalis and Enterococcus faecium. J Antimicrob Chemother. 2015 Jun. 70 (6):1738-43. [Medline].

  7. Hindler JA, Wong-Beringer A, Charlton CL, Miller SA, Kelesidis T, Carvalho M, et al. In Vitro Activity of Daptomycin in Combination with β-Lactams, Gentamicin, Rifampin, and Tigecycline against Daptomycin-Nonsusceptible Enterococci. Antimicrob Agents Chemother. 2015 Jul. 59 (7):4279-88. [Medline].

  8. Centers for Disease Control and Prevention (CDC). Vancomycin-resistant Staphylococcus aureus--New York, 2004. MMWR Morb Mortal Wkly Rep. 2004 Apr 23. 53(15):322-3. [Medline].

  9. Chang S, Sievert DM, Hageman JC, Boulton ML, Tenover FC, Downes FP, et al. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N Engl J Med. 2003 Apr 3. 348(14):1342-7. [Medline].

  10. Sakka V, Tsiodras S, Galani L, e al. Risk-factors and predictors of mortality in patients colonised with vancomycin-resistant enterococci. Clin Microbiol Infect. 2008 Jan. 14(1):14-21. [Medline].

  11. Schmidt-Hieber M, Blau IW, Schwartz S, et al. Intensified strategies to control vancomycin-resistant enterococci in immunocompromised patients. Int J Hematol. 2007 Aug. 86(2):158-62. [Medline].

  12. Anderson AC, Jonas D, Huber I, Karygianni L, Wölber J, Hellwig E, et al. Enterococcus faecalis from Food, Clinical Specimens, and Oral Sites: Prevalence of Virulence Factors in Association with Biofilm Formation. Front Microbiol. 2015. 6:1534. [Medline].

  13. Brusch JL. Microbiology of infective endocarditis and clinical correlates: Gram-positive organisms. Brusch JL, ed. Infective Endocarditis: Management in the Era of Intravascular Devices. Informa Healthcare; 2007.

  14. Qin X, Singh KV, Weinstock GM, Murray BE. Effects of Enterococcus faecalis fsr genes on production of gelatinase and a serine protease and virulence. Infect Immun. 2000 May. 68(5):2579-86. [Medline]. [Full Text].

  15. Lee do K, Kim Y, Park KS, et al. Antimicrobial activity of mupirocin, daptomycin, linezolid, quinupristin/dalfopristin and tigecycline against vancomycin-resistant enterococci (VRE) from clinical isolates in Korea (1998 and 2005). J Biochem Mol Biol. 2007 Nov 30. 40(6):881-7. [Medline].

  16. Ceci M, Delpech G, Sparo M, Mezzina V, Sánchez Bruni S, Baldaccini B. Clinical and microbiological features of bacteremia caused by Enterococcus faecalis. J Infect Dev Ctries. 2015 Nov 30. 9 (11):1195-203. [Medline].

  17. DiazGranados CA, Zimmer SM, Klein M, et al. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis. 2005 Aug 1. 41(3):327-33. [Medline].

  18. Erlandson KM, Sun J, Iwen PC, et al. Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia. Clin Infect Dis. 2008 Jan 1. 46(1):30-6. [Medline].

  19. Butler KM. Enterococcal infection in children. Semin Pediatr Infect Dis. 2006 Jul. 17(3):128-39. [Medline].

  20. Stevens MP, Edmond MB. Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature. Clin Infect Dis. 2005 Oct 15. 41(8):1134-42. [Medline].

  21. McDonald JR, Olaison L, Anderson DJ, et al. Enterococcal endocarditis: 107 cases from the international collaboration on endocarditis merged database. Am J Med. 2005 Jul. 118(7):759-66. [Medline].

  22. Chatterjee I, Iredell JR, Woods M, et al. The implications of enterococci for the intensive care unit. Crit Care Resusc. 2007 Mar. 9(1):69-75. [Medline].

  23. Berk SL, Verghese A, Holtsclaw SA, Smith JK. Enterococcal pneumonia. Occurrence in patients receiving broad-spectrum antibiotic regimens and enteral feeding. Am J Med. 1983 Jan. 74(1):153-4. [Medline].

  24. Claeys KC, Zasowski EJ, Lagnf AM, Rybak MJ. Comparison of outcomes between patients with single versus multiple positive blood cultures for Enterococcus: Infection versus illusion?. Am J Infect Control. 2016 Jan 1. 44 (1):47-9. [Medline].

  25. Bouza E, Kestler M, Beca T, Mariscal G, Rodríguez-Créixems M, Bermejo J, et al. The NOVA score: a proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia. Clin Infect Dis. 2015 Feb 15. 60 (4):528-35. [Medline].

  26. Fernández-Hidalgo N, Almirante B, Gavaldà J, Gurgui M, Peña C, de Alarcón A, et al. Ampicillin plus ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective endocarditis. Clin Infect Dis. 2013 May. 56(9):1261-8. [Medline].

  27. Gavaldà J, Len O, Miró JM, Muñoz P, Montejo M, Alarcón A, et al. Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone. Ann Intern Med. 2007 Apr 17. 146(8):574-9. [Medline].

  28. Smith JR, Barber KE, Raut A, Aboutaleb M, Sakoulas G, Rybak MJ. β-Lactam combinations with daptomycin provide synergy against vancomycin-resistant Enterococcus faecalis and Enterococcus faecium. J Antimicrob Chemother. 2015. 70 (6):1738-43. [Medline].

  29. Hindler JA, Wong-Beringer A, Charlton CL, Miller SA, Kelesidis T, Carvalho M, et al. In vitro activity of daptomycin in combination with β-lactams, gentamicin, rifampin, and tigecycline against daptomycin-nonsusceptible enterococci. Antimicrob Agents Chemother. 2015 Jul. 59 (7):4279-88. [Medline].

  30. Senneville E, Caillon J, Calvet B, Jehl F. Towards a definition of daptomycin optimal dose: Lessons learned from experimental and clinical data. Int J Antimicrob Agents. 2016 Jan. 47 (1):12-9. [Medline].

  31. Ramaswamy DP, Amodio-Groton M, Scholand SJ. Use of daptomycin in the treatment of vancomycin-resistant enterococcal urinary tract infections: a short case series. BMC Urol. 2013 Jul 16. 13(1):33. [Medline]. [Full Text].

  32. Gavaldà J, Len O, Miró JM, et al. Brief communication: treatment of Enterococcus faecalis endocarditis with ampicillin plus ceftriaxone. Ann Intern Med. 2007 Apr 17. 146(8):574-9. [Medline].

  33. Cunha BA. Antimicrobial therapy of multidrug-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus. Med Clin North Am. 2006 Nov. 90(6):1165-82. [Medline].

  34. Smith PF, Booker BM, Ogundele AB, et al. Comparative in vitro activities of daptomycin, linezolid, and quinupristin/dalfopristin against Gram-positive bacterial isolates from a large cancer center. Diagn Microbiol Infect Dis. 2005 Jul. 52(3):255-9. [Medline].

  35. Plosker GL, Figgitt DP. Linezolid: a pharmacoeconomic review of its use in serious Gram-positive infections. Pharmacoeconomics. 2005. 23(9):945-64. [Medline].

  36. Velissariou IM. Linezolid in children: recent patents and advances. Recent Patents Anti-Infect Drug Disc. 2007 Jan. 2(1):73-7. [Medline].

  37. Kainer MA, Devasia RA, Jones TF, et al. Response to emerging infection leading to outbreak of linezolid-resistant enterococci. Emerg Infect Dis. 2007 Jul. 13(7):1024-30. [Medline].

  38. Pogue JM, Paterson DL, Pasculle AW, et al. Determination of risk factors associated with isolation of linezolid-resistant strains of vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol. 2007 Dec. 28(12):1382-8. [Medline].

  39. Poutsiaka DD, Skiffington S, Miller KB, et al. Daptomycin in the treatment of vancomycin-resistant Enterococcus faecium bacteremia in neutropenic patients. J Infect. 2007 Jun. 54(6):567-71. [Medline].

  40. Britt NS, Potter EM, Patel N, Steed ME. Comparison of the Effectiveness and Safety of Linezolid and Daptomycin in Vancomycin-Resistant Enterococcal Bloodstream Infection: A National Cohort Study of Veterans Affairs Patients. Clin Infect Dis. 2015 Sep 15. 61 (6):871-8. [Medline].

  41. Arias CA, Panesso D, McGrath DM, Qin X, Mojica MF, Miller C, et al. Genetic basis for in vivo daptomycin resistance in enterococci. N Engl J Med. 2011 Sep 8. 365(10):892-900. [Medline].

  42. Vouillamoz J, Moreillon P, Giddey M, et al. Efficacy of daptomycin in the treatment of experimental endocarditis due to susceptible and multidrug-resistant enterococci. J Antimicrob Chemother. 2006 Dec. 58(6):1208-14. [Medline].

  43. Carugati M, Bayer AS, Miró JM, Park LP, Guimarães AC, Skoutelis A, et al. High-dose daptomycin therapy for left-sided infective endocarditis: a prospective study from the international collaboration on endocarditis. Antimicrob Agents Chemother. 2013 Dec. 57(12):6213-22. [Medline]. [Full Text].

  44. Draghi DC, Benton BM, Krause KM, Thornsberry C, Pillar C, Sahm DF. Comparative surveillance study of telavancin activity against recently collected gram-positive clinical isolates from across the United States. Antimicrob Agents Chemother. 2008 Jul. 52(7):2383-8. [Medline]. [Full Text].

  45. Kosowska-Shick K, Clark C, Pankuch GA, McGhee P, Dewasse B, Beachel L. Activity of telavancin against staphylococci and enterococci determined by MIC and resistance selection studies. Antimicrob Agents Chemother. 2009 Oct. 53(10):4217-24. [Medline]. [Full Text].

  46. Corey GR, Kabler H, Mehra P, Gupta S, Overcash JS, Porwal A, et al. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med. 2014 Jun 5. 370(23):2180-90. [Medline].

  47. Prokocimer P, De Anda C, Fang E, Mehra P, Das A. Tedizolid phosphate vs linezolid for treatment of acute bacterial skin and skin structure infections: the ESTABLISH-1 randomized trial. JAMA. 2013 Feb 13. 309(6):559-69. [Medline]. [Full Text].

  48. Moran GJ, Fang E, Corey GR, Das AF, De Anda C, Prokocimer P. Tedizolid for 6 days versus linezolid for 10 days for acute bacterial skin and skin-structure infections (ESTABLISH-2): a randomised, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis. 2014 Jun 5. [Medline].

  49. Manley KJ, Fraenkel MB, Mayall BC, et al. Probiotic treatment of vancomycin-resistant enterococci: a randomised controlled trial. Med J Aust. 2007 May 7. 186(9):454-7. [Medline].

  50. [Guideline] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116(15):1736-54. [Medline].

  51. [Guideline] Strausbaugh LJ, Siegel JD, Weinstein RA. Preventing transmission of multidrug-resistant bacteria in health care settings: a tale of 2 guidelines. Clin Infect Dis. 2006 Mar 15. 42(6):828-35. [Medline].

  52. Singh N, Léger MM, Campbell J, et al. Control of vancomycin-resistant enterococci in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2005 Jul. 26(7):646-9. [Medline].

  53. Huskins WC, Huckabee CM, O'Grady NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med. 2011 Apr 14. 364(15):1407-18. [Medline].

  54. Guglielmo BJ, Dudas V, Maewal I, et al. Impact of a series of interventions in vancomycin prescribing on use and prevalence of vancomycin-resistant enterococci. Jt Comm J Qual Patient Saf. 2005 Aug. 31(8):469-75. [Medline].

  55. de Bruin MA, Riley LW. Does vancomycin prescribing intervention affect vancomycin-resistant enterococcus infection and colonization in hospitals? A systematic review. BMC Infect Dis. 2007 Apr 10. 7:24. [Medline].

  56. Drees M, Snydman DR, Schmid CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis. 2008 Mar 1. 46(5):678-85. [Medline].

  57. Eckstein BC, Adams DA, Eckstein EC, et al. Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis. 2007 Jun 21. 7:61. [Medline].

  58. Vernon MO, Hayden MK, Trick WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med. 2006 Feb 13. 166(3):306-12. [Medline].

  59. Fridkin SK, Edwards JR, Courval JM, et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units. Ann Intern Med. 2001 Aug 7. 135(3):175-83. [Medline].

  60. US Food and Drug Administration. FDA Drug Safety Communication: Serious CNS reactions possible when linezolid (Zyvox®) is given to patients taking certain psychiatric medications. Available at http://www.fda.gov/Drugs/DrugSafety/ucm265305.htm. Accessed: July 27, 2011.

  61. Weber SG, Huang SS, Oriola S, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: Position statement from the Joint SHEA and APIC Task Force. Am J Infect Control. 2007 Mar. 35(2):73-85. [Medline].

  62. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005 Jun 14. 111(23):e394-434. [Medline].

  63. Beezhold DW, Slaughter S, Hayden MK, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis. 1997 Apr. 24(4):704-6. [Medline].

  64. Bisno AL, Dismukes WE, Durack DT, et al. Antimicrobial treatment of infective endocarditis due to viridans streptococci, enterococci, and staphylococci. JAMA. 1989 Mar 10. 261(10):1471-7. [Medline].

  65. Boyce JM, Opal SM, Chow JW, et al. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol. 1994 May. 32(5):1148-53. [Medline].

  66. Bradley SJ, Wilson AL, Allen MC, et al. The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage. J Antimicrob Chemother. 1999 Feb. 43(2):261-6. [Medline].

  67. Carmeli Y, Samore MH, Huskins C. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med. 1999 Nov 8. 159(20):2461-8. [Medline].

  68. Centers for Disease Control and Prevention. Preventing the Spread of Vancomycin Resistance--A Report from the Hospital Infection Control Practices Advisory Committee prepared by the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals. Fed Regist. 1994 May 17. 59(94):25758-63. [Medline].

  69. Chow JW, Kuritza A, Shlaes DM, et al. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J Clin Microbiol. 1993 Jun. 31(6):1609-11. [Medline].

  70. Cooper GS, Shlaes DM, Jacobs MR. The role of Enterococcus in intraabdominal infections: case control analysis. Infect Dis Clin Practice. 1993. 2:332-9.

  71. Cunha B. Antibiotic Essentials. 9th ed. Sudbury, MA: Jones & Bartlett; 2010.

  72. Cunha BA, Mickail N, Eisenstein L. E. faecalis vancomycin-sensitive enterococcal bacteremia unresponsive to a vancomycin tolerant strain successfully treated with high-dose daptomycin. Heart Lung. 2007 Nov-Dec. 36(6):456-61. [Medline].

  73. DeLisle S, Perl TM. Vancomycin-resistant enterococci: a road map on how to prevent the emergence and transmission of antimicrobial resistance. Chest. 2003 May. 123(5 Suppl):504S-18S. [Medline].

  74. Donskey CJ, Chowdhry TK, Hecker MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med. 2000 Dec 28. 343(26):1925-32. [Medline].

  75. Dougherty SH. Role of enterococcus in intraabdominal sepsis. Am J Surg. 1984 Sep. 148(3):308-12. [Medline].

  76. Edmond MB, Ober JF, Weinbaum DL, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis. 1995 May. 20(5):1126-33. [Medline].

  77. Farr BM. What to think if the results of the National Institutes of Health randomized trial of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus control measures are negative (and other advice to young epidemiologists): a review and an au revoir. Infect Control Hosp Epidemiol. 2006 Oct. 27(10):1096-106. [Medline].

  78. Gonzales RD, Schreckenberger PC, Graham MB, et al. Infections due to vancomycin-resistant Enterococcus faecium resistant to linezolid. Lancet. 2001 Apr 14. 357(9263):1179. [Medline].

  79. Goossens H. Spread of vancomycin-resistant enterococci: differences between the United States and Europe. Infect Control Hosp Epidemiol. 1998 Aug. 19(8):546-51. [Medline].

  80. Green M, Shlaes JH, Barbadora K, et al. Bacteremia due to vancomycin-dependent Enterococcus faecium. Clin Infect Dis. 1995 Mar. 20(3):712-4. [Medline].

  81. Greer ND. Tigecycline (Tygacil): the first in the glycylcycline class of antibiotics. Proc (Bayl Univ Med Cent). 2006 Apr. 19(2):155-61. [Medline].

  82. Gullberg RM, Homann SR, Phair JP. Enterococcal bacteremia: analysis of 75 episodes. Rev Infect Dis. 1989 Jan-Feb. 11(1):74-85. [Medline].

  83. Hoge CW, Adams J, Buchanan B, et al. Enterococcal bacteremia: to treat or not to treat, a reappraisal. Rev Infect Dis. 1991 Jul-Aug. 13(4):600-5. [Medline].

  84. Kaye D. Enterococci. Biologic and epidemiologic characteristics and in vitro susceptibility. Arch Intern Med. 1982 Oct 25. 142(11):2006-9. [Medline].

  85. Kirkpatrick BD, Harrington SM, Smith D, et al. An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit. Clin Infect Dis. 1999 Nov. 29(5):1268-73. [Medline].

  86. Landman D, Quale JM. Management of infections due to resistant enterococci: a review of therapeutic options. J Antimicrob Chemother. 1997 Aug. 40(2):161-70. [Medline].

  87. Lautenbach E, Bilker WB, Brennan PJ. Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol. 1999 May. 20(5):318-23. [Medline].

  88. Livornese LL Jr, Dias S, Samel C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med. 1992 Jul 15. 117(2):112-6. [Medline].

  89. Low DE, Keller N, Barth A, et al. Clinical prevalence, antimicrobial susceptibility, and geographic resistance patterns of enterococci: results from the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis. 2001 May 15. 32 Suppl 2:S133-45. [Medline].

  90. Lucas GM, Lechtzin N, Puryear DW, et al. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis. 1998 May. 26(5):1127-33. [Medline].

  91. Maki DG, Agger WA. Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine (Baltimore). 1988 Jul. 67(4):248-69. [Medline].

  92. Marothi YA, Agnihotri H, Dubey D. Enterococcal resistance--an overview. Indian J Med Microbiol. 2005 Oct. 23(4):214-9. [Medline].

  93. Martone WJ. Spread of vancomycin-resistant enterococci: why did it happen in the United States?. Infect Control Hosp Epidemiol. 1998 Aug. 19(8):539-45. [Medline].

  94. Megran DW. Enterococcal endocarditis. Clin Infect Dis. 1992 Jul. 15(1):63-71. [Medline].

  95. Moellering RC Jr. Emergence of Enterococcus as a significant pathogen. Clin Infect Dis. 1992 Jun. 14(6):1173-6. [Medline].

  96. Montecalvo MA, Jarvis WR, Uman J, et al. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med. 1999 Aug 17. 131(4):269-72. [Medline].

  97. Montecalvo MA, Shay DK, Gedris C, et al. A semiquantitative analysis of the fecal flora of patients with vancomycin-resistant enterococci: colonized patients pose an infection control risk. Clin Infect Dis. 1997 Oct. 25(4):929-30. [Medline].

  98. Morris JG Jr, Shay DK, Hebden JN, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Ann Intern Med. 1995 Aug 15. 123(4):250-9. [Medline].

  99. Murray BE. Diversity among multidrug-resistant enterococci. Emerg Infect Dis. 1998 Jan-Mar. 4(1):37-47. [Medline].

  100. Murray BE. Vancomycin-resistant enterococci. Am J Med. 1997 Mar. 102(3):284-93. [Medline].

  101. Murray BE, Singh KV, Markowitz SM, et al. Evidence for clonal spread of a single strain of beta-lactamase- producing Enterococcus (Streptococcus) faecalis to six hospitals in five states. J Infect Dis. 1991 Apr. 163(4):780-5. [Medline].

  102. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004 Dec. 32(8):470-85. [Medline].

  103. Norris AH, Reilly JP, Edelstein PH, et al. Chloramphenicol for the treatment of vancomycin-resistant enterococcal infections. Clin Infect Dis. 1995 May. 20(5):1137-44. [Medline].

  104. Ostrowsky BE, Trick WE, Sohn AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med. 2001 May 10. 344(19):1427-33. [Medline].

  105. Ostrowsky BE, Venkataraman L, D'Agata EM, et al. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med. 1999 Jul 12. 159(13):1467-72. [Medline].

  106. Patterson JE, Sweeney AH, Simms M, et al. An analysis of 110 serious enterococcal infections. Epidemiology, antibiotic susceptibility, and outcome. Medicine (Baltimore). 1995 Jul. 74(4):191-200. [Medline].

  107. Poulakou G, Giamarellou H. Oritavancin: a new promising agent in the treatment of infections due to Gram-positive pathogens. Expert Opin Investig Drugs. 2008 Feb. 17(2):225-43. [Medline].

  108. Rafferty ME, McCormick MI, Bopp LH, et al. Vancomycin-resistant enterococci in stool specimens submitted for Clostridium difficile cytotoxin assay. Infect Control Hosp Epidemiol. 1997 May. 18(5):342-4. [Medline].

  109. Rice LB. Emergence of vancomycin-resistant enterococci. Emerg Infect Dis. 2001 Mar-Apr. 7(2):183-7. [Medline].

  110. Roghmann MC, McCarter RJ Jr, Brewrink J, et al. Clostridium difficile infection is a risk factor for bacteremia due to vancomycin-resistant enterococci (VRE) in VRE-colonized patients with acute leukemia. Clin Infect Dis. 1997 Nov. 25(5):1056-9. [Medline].

  111. Shay DK, Maloney SA, Montecalvo M, et al. Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections. J Infect Dis. 1995 Oct. 172(4):993-1000. [Medline].

  112. Shlaes DM, Levy J, Wolinsky E. Enterococcal bacteremia without endocarditis. Arch Intern Med. 1981 Apr. 141(5):578-81. [Medline].

  113. Siegel JD, Rhinehart E, Jackson M, Chiarello L, HICPAC. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007. CDC. June 2007. Available at http://www.cdc.gov/ncidod/dhap/pdf/isolation2007.pdf.

  114. Siegel JD, Rhinehart E, Jackson M, Chiarello L, HICPAC. Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006. CDC. 2006. Available at http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf.

  115. Suppola JP, Kuikka A, Vaara M, et al. Comparison of risk factors and outcome in patients with Enterococcus faecalis vs Enterococcus faecium bacteraemia. Scand J Infect Dis. 1998. 30(2):153-7. [Medline].

  116. Suppola JP, Volin L, Valtonen VV, et al. Overgrowth of Enterococcus faecium in the feces of patients with hematologic malignancies. Clin Infect Dis. 1996 Oct. 23(4):694-7. [Medline].

  117. Trick WE, Kuehnert MJ, Quirk SB, et al. Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients. J Infect Dis. 1999 Aug. 180(2):391-6. [Medline].

  118. Whiteside M, Moore J, Ratzan K. An investigation of enterococcal bacteremia. Am J Infect Control. 1983 Aug. 11(4):125-9. [Medline].

  119. Willems RJ, Top J, van Santen M, Robinson DA, Coque TM, Baquero F, et al. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex. Emerg Infect Dis. 2005 Jun. 11(6):821-8. [Medline].

  120. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004 Aug 1. 39(3):309-17. [Medline].

  121. Zeana C, Kubin CJ, Della-Latta P, et al. Vancomycin-resistant Enterococcus faecium meningitis successfully managed with linezolid: case report and review of the literature. Clin Infect Dis. 2001 Aug 15. 33(4):477-82. [Medline].

  122. Zirakzadeh A, Patel R. Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clin Proc. 2006 Apr. 81(4):529-36. [Medline].

  123. Zuckerman RA, Steele L, Venezia RA, et al. Undetected vancomycin-resistant Enterococcus in surgical intensive care unit patients. Infect Control Hosp Epidemiol. 1999 Oct. 20(10):685-6. [Medline].

Medscape Consult
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.