ABSTRACT
This chapter focuses on the important trends in enterococcal antimicrobial resistance, particularly glycopeptide resistance, their clinical impact, and strategies for effective treatment, prevention, and control. Enterococci possess a broad array of constitutive, nontransferable resistance mechanisms against a variety of antimicrobials, which both reduces baseline therapeutic options and magnifies the effect of superimposed acquired resistance traits. Enterococci are quite capable of promulgating systemic inflammatory response, severe sepsis, and septic shock and have been a frequent inciting blood pathogen in recent sepsis trials. Enterococcal isolates from a respiratory specimen, and skin, wound, or musocal surfaces almost always represent colonization. Although the majority of enterococci exhibit in vitro susceptibility to trimethoprim/sulfamethoxazole their ability to utilize exogenous folate in vivo precludes the clinical utility of trimethoprim-sulfamethoxazole and other agents which impair folate synthesis. The majority of enterococcal infections are not proven to require bactericidal treatment and can be managed successfully with a single effective agent.
