Clinical aspects of multi-drug resistant enterococci

During the last few years, the prevalence of multidrug drug resistant enterococci has been steadily increasing around the world, and remarkable changes in the epidemiology of enterococcal infections have been documented. Enterococci have the most striking ability to carry and transfer multiple determinants of antimicrobial resistance along with factors that enable them to colonize the gastrointestinal tract of hospitalized individuals (which acts as a reservoir for transmission), and subsequently, cause disease. Multidrug drug-resistant enterococci transmission resembles a vector borne disease with the health care workers playing the role of the mosquito in the infection cascade. Thus, the implementation of infection control measures is one of the most important strategies to curtail dissemination of this important pathogen. Multiple antibiotics with anti-enterococcal activity have recently reached clinical practice (i.e., daptomycin, linezolid, tigecycline) whereas others are under development; however, the rapid development of resistance to these new compounds, in this versatile pathogen, compromises most of the current and future therapeutic choices available for the treatment of enterococcal infections. The clinical challenge posed by enterococci is enormous, and a response of the same magnitude requires a concerted effort between scientists and clinicians.