The emerging clinical relevance of Enterococcus gallinarum: A roadmap for future research and diagnostics

Enterococcus gallinarum is an underdiagnosed yet clinically significant opportunistic pathogen exhibiting growing concerns in antimicrobial resistance and pathogenicity. Initially regarded as a commensal of the gastrointestinal tract, E. gallinarum has emerged as a causative agent of life-threatening infections such as bacteremia, meningitis, endocarditis, and peritonitis, particularly in immunocompromised individuals. A key factor in the pathogenicity of E. gallinarum is its ability to form biofilms, a mechanism that enhances its resistance to antibiotics (vancomycin resistance) and host immune responses. The bacterium's genetic adaptability, efflux pumps, and enzyme-mediated resistance further complicate treatment regimens, necessitating alternative therapeutic strategies. Given the increasing prevalence of multidrug-resistant enterococci, enhanced surveillance, precise diagnostic techniques, and innovative therapeutic approaches are critical to managing E. gallinarum infections. Transmission via contaminated poultry, seafood, and environmental vectors underscores its zoonotic potential, necessitating stringent food safety protocols. Current therapeutic strategies are failing due to rising resistance limits. Innovative approaches like nanoparticles, bacteriophage therapy, plant-derived compounds and immunomodulatory agents show promise in overcoming resistance and biofilm-related challenges. Artificial Intelligence and computational biology-driven drug discovery offer novel avenues for precision targeting. Diagnostic hurdles, including misidentification and underreporting, highlight the need for advanced molecular techniques and surveillance. Future research should focus on targeted therapies and vaccine development to mitigate the clinical burden of this pathogen. This review delves into the epidemiology, pathogenesis, virulence factors, drug resistance mechanisms and novel treatment modalities of E. gallinarum.