title: Enterococcal endocarditis revisited.
abstract: The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Pericás
authors.affiliation: Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Zboromyrska
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Cervera
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Castañeda
authors.affiliation: Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Garcia-de-la-Maria
authors.affiliation: Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Mestres
authors.affiliation: Cardiology Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Falces
authors.affiliation: Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Quintana
authors.affiliation: Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Ninot
authors.affiliation: Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Llopis
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology Service, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Miró
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D016983:Enterococcus / Q000235:genetics / Q000472:pathogenicity; D013293:Enterococcus faecalis / Q000235:genetics; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D006801:Humans; D000069349:Linezolid / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D000667:Ampicillin; D000069349:Linezolid
keywords: Enterococcus; Gram-positive bacteria; antibiotic options; bloodstream infections; endocarditis; medical treatment