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Therapeutic approach to difficult-to-treat multidrug-resistant enterococcal infections

Adrianna M Turner1, Paul Kinsella1,2, William R Miller3,4,5

  • 1Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.

Antimicrobial Agents and Chemotherapy
|September 11, 2025
PubMed

Insights

Difficult-to-treat enterococcal infections from resistant bacteria like Enterococcus faecium and Enterococcus faecalis present major challenges. More clinical data are needed to guide effective treatment strategies for these severe infections.

Area of Science:

  • Infectious Diseases
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Multidrug-resistant (MDR) Enterococcus faecium and Enterococcus faecalis cause difficult-to-treat (DTR) infections.
  • Limited treatment options and high failure rates characterize these infections.
  • A shortage of new antimicrobial agents exacerbates the clinical challenge.

Purpose of the Study:

  • To review current evidence on managing DTR enterococcal infections.
  • To inform optimal drug selection and dosing strategies.
  • To identify research gaps in treating severe enterococcal infections.

Main Methods:

  • Systematic review of existing literature.
  • Synthesis of in vitro data on synergistic antibiotic combinations.
  • Analysis of clinical outcomes for DTR enterococcal infections.

Main Results:

  • Limited robust clinical data currently guide therapy for severe DTR enterococcal infections.
  • Understanding of resistance mechanisms and synergistic combinations is advancing.
  • Effective management strategies require further clinical validation.

Conclusions:

  • DTR enterococcal infections pose a significant and ongoing threat.
  • Robust clinical data are crucial for establishing best practices.
  • Further research is essential to improve patient outcomes for these challenging infections.
Keywords:
Enterococcusdifficult-to-treat infectionvancomycin resistance

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