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Therapy of enterococcal infections.

G M Eliopoulos1, C T Eliopoulos

  • 1Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|February 1, 1990
PubMed
Summary

Treating enterococcal infections often requires combining cell wall-active drugs with aminoglycosides. For highly resistant strains, treatment options are limited, with some patients potentially benefiting from ampicillin, penicillin, or vancomycin alone.

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Pharmacology

Background:

  • Enterococci exhibit tolerance to cell wall-active antimicrobial agents.
  • Bactericidal therapy for enterococcal infections typically necessitates combination with aminoglycosides.
  • High-level gentamicin resistance is prevalent in some enterococcal isolates.

Purpose of the Study:

  • To review treatment strategies for enterococcal infections, particularly those caused by aminoglycoside-resistant strains.
  • To evaluate the efficacy of different antimicrobial combinations against enterococci.
  • To identify optimal therapeutic approaches for serious enterococcal infections.

Main Methods:

  • Literature review of studies on enterococcal antimicrobial resistance and treatment.

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  • Analysis of treatment outcomes for various drug combinations.
  • Assessment of antimicrobial susceptibility testing data for enterococcal isolates.

    • Main Results:

    • For enterococci without high-level aminoglycoside resistance, combinations of cell wall-active agents (penicillin, ampicillin, vancomycin) with streptomycin or gentamicin are effective.
    • A significant proportion of isolates display high-level gentamicin resistance.
    • A subset of highly gentamicin-resistant isolates may remain susceptible to streptomycin, allowing for combination therapy.
    • For strains resistant to both streptomycin and gentamicin, no predictably bactericidal agent or combination is established.

    Conclusions:

    • Treatment of serious enterococcal infections requires careful consideration of aminoglycoside resistance patterns.
    • Streptomycin can be a viable alternative in combination therapy for certain gentamicin-resistant strains.
    • For enterococci highly resistant to both aminoglycosides, ampicillin, penicillin, or vancomycin monotherapy may offer therapeutic benefit, though optimal treatment remains uncertain.