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Chapter 10 : Enterococcal Disease, Epidemiology, and Treatment

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Abstract:

Enterococci are associated with a variety of different clinical syndromes, including bacteremias, endocarditis, and urinary tract infections. The emergence of resistance has made clinicians keenly aware of this organism, previously considered a nonpathogen except in certain circumstances. Molecular methods have helped delineate the epidemiology of enterococci with resistance to vancomycin (VRE) and demonstrate nosocomial acquisition and transmission among patients. The risk of serious VRE infection is increased among patients with neutropenia and transplant recipients, as well as among patients receiving antimicrobial therapy. Both the severity of mucositis and concomitant infection with are associated with increased risk for VRE bacteremia among neutropenic patients. Infection control efforts and prudent use of antimicrobials are essential to limiting nosocomial spread of VRE. Treatment of serious enterococcal disease requires a synergistic combination of a cell wall agent and an aminoglycoside. The few antimicrobial agents that are available to treat VRE are often ineffective or poorly tolerated, making treatment of a serious infection challenging. Given the limitations of antimicrobial therapy, removal of infected foci, such as intravenous catheters, and drainage of abscesses are important adjunctive measures. Newer antimicrobial agents, such as quinupristin/dalfopristin and linezolid, have proven efficacious in the treatment of VRE although resistance has already been reported. Eventually, decolonization with drugs such as ramoplanin may help eliminate the gastrointestinal (GI) reservoir for VRE.

Citation: Malani P, Kauffman C, Zervos M. 2002. Enterococcal Disease, Epidemiology, and Treatment, p 385-408. In Gilmore M, Clewell D, Courvalin P, Dunny G, Murray B, Rice L (ed), The Enterococci. ASM Press, Washington, DC. doi: 10.1128/9781555817923.ch10
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