Healthcare-associated pathogens, spread from patient-to-patient by the hands of healthcare workers. Has emerged as the leading cause of multidrug-resistant enterococcal infections

Also found in the GI tract of animals and insects, beach sands, freshwater and marine water sediments, soil, aquatic and terrestrial vegetation

The rise in these pathogens are also from increased antibiotic resistance in clinical isolates of enterococci. For example, enterococci with resistance to vancomycin (VRE); strains that are resistant to VRE can often show resistance to penicillin and high-level resistance (HLR) to aminoglycosides. And resistance is emerging to newer agents used to treat VRE infections

Enterococci can cause a variety of infections, some infections come accompanied by other microorganisms which make it difficult to determine if enterococci play a main or minor role in the infection or simply bystanders

Types of infections:

• Urinary tract

• Intra-abdominal, pelvic, and soft tissue

• Bacteremia

• Endocarditis

Older adults with diseases like: diabetes mellitus, malignancy, heart disease have a high mortality rate, as high as 75% if infected with E. faecium bacteremia.

Treatment can include surgery to remove infected heart valve (in the case of enterococcal endocarditis)

Four interventions to control the spread of VRE (which in turn would minimize the spread of enterococci):

• Molecular testing of patients at highest risk for carriage

• Decontaminating hands of healthcare workers using an antiseptic-containing preparation before and after patient contact

• Wearing gloves and gowns and cohorting colonized and/or infected patients

• Thorough cleaning of rooms occupied by patient with VRE

Other control initiatives:

• Antimicrobial stewardship

• Education of healthcare workers

• Identification, accurate and routine susceptibility testing from clinical microbiology laboratories