Enterococci; increase in infection rate and antibiotic resistance

Enterococci (mainly Enterococcus faecalis and E. faecium) are increasingly isolated as causative agents of infections, notably in hospitalised patients. Most infections are urinary tract infections, septicaemia and endocarditis. Dutch figures indicate that 10.8% of all bacteria isolated in seven regional microbiological laboratories were enterococci; the samples came not only from hospital infections. Of the isolates 34% were from faecal samples, 14% from urinary tract samples and 14% from genital organ samples. Antibiotic resistance is an increasing problem. Enterococci are moderately resistant to the antibiotics commonly used to treat Gram positive infections. The infections may be treated with (high dose) penicillin and (or) in combination with an aminoglycoside or with a glycopeptide. Unrestricted use of antibiotics increases the risk of resistance. Recently enterococci have been isolated which are resistant to ampicillin, gentamycin and vancomycin: such infections are virtually untreatable.