• Significant human enterococcal infections are due to E. faecalis and E. faecium.

• Enterococcal urinary tract infections are common. Ampicillin is usually sufficient for treatment of UTI.

• Enterococci cause about 10 to 20% of bacterial endocarditis localized on natural and prosthetic valves.

• Enterococci are not reliably killed by penicillin/ampicillin at typically achieved blood and tissue levels.

• Accordingly, penicillin or ampicillin is combined with an aminoglycoside (gentamicin) for serious infection.

• In patients who have penicillin allergy, vancomycin may be used in combination with gentamicin.

•  ost enterococcal strains are steptomycin resistant and high-level resistance to gentamicin has become common.

• In strains resistant to all aminoglycosides, high-dose/ long-duration treatment with peinicillin or ampicillin is recommended.

• Enterococci may be resistant to penicillins (either by ß-lactamase production or due to alteration of penicillin-binding proteins (PBPs).

• For enterococcal infections by isolates resistant to ß-lactam antibiotics, the combination vancomycin + gentamicin is recommended.

• Vancomycin-resistant enterococci is also common.

• No standard therapy infection by enterococcal isolates resistant to both ß-lactam antibiotics and vancomycin.

• Group D Streptococcal Infections:

  • Main nonenterococcal group D streptococcal infections are due to Streptococcus bovis. S. bovis is sensitive to ß-lactam antibiotics.

  • Penicillin, as a single agent, is the drug of choice in treating infections cause by S. bovis.

Wessels, M.R., Streptococcal and Enterococcal Infections, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, p. 890-891