Enterococcus, an emerging pathogen.
OBJECTIVE
To review the bacterial genus Enterococcus with respect to its epidemiology, specific infections in humans, mechanisms of resistance and tolerance, and antimicrobial treatment.


METHODS
A MEDLINE search of English-language journal articles published from 1977 to 1992 was completed. Articles published prior to 1977 were identified through Index Medicus and from references appearing in the bibliographies of other journal articles. Information also was acquired from abstracts, personal communication with infectious disease specialists with active research in the area of enterococcal infection, and conference proceedings.


METHODS
In vitro data; animal models of enterococcal infection; case reports; and case-controlled, cohort, and randomized controlled trials in humans were evaluated for relevant information.


METHODS
Studies were evaluated by their methodologic strength (e.g., randomized controlled trial), reporting of clinically relevant outcomes (e.g., clinical response to antimicrobial therapy), statistical analyses, and accountability of all patients who entered the study.


RESULTS
The incidence of enterococcal infections has increased in recent years and enterococci are now the second most frequently reported nosocomial pathogens. Enterococcus faecalis is the pathogen responsible for most enterococcal infections seen today; it has been implicated as an important cause of endocarditis, bacteremia, urinary tract infections, and intraabdominal infections.


CONCLUSIONS
Enterococcal infection is of particular concern clinically because of its resistance to several antibiotics. Controlled comparative clinical trials of antimicrobial therapy in humans are lacking for several enterococcal infections. Therefore, the recommendations for antimicrobial therapy presented in this review are guidelines that reflect our current understanding of antibiotics used for enterococcal infection.
Tailor
S A
SA
Sunnybrook Health Science Centre, Toronto, Canada.
Bailey
E M
EM
Rybak
M J
MJ
D000005:Abdomen / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004697:Endocarditis, Bacterial / Q000382:microbiology; D016983:Enterococcus; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014552:Urinary Tract Infections / Q000382:microbiology
D000900:Anti-Bacterial Agents