Enterococcal endocarditis

Ten to twenty percent of all cases of bacterial endocarditis are caused by enterococci. The enterococci are penicillin-resistant group D streptococci that can be distinguished from other streptococci by certain biochemical reactions, including growing the bile or 6.5% sodium chloride. In patients with enterococcal endocarditis, the portal of entry often is the genitourinary tract. Therapy is difficult; combination chemotherapy with penicillin G or ampicillin and an aminoglycoside is required. Although specimen streptomycin is preferred, occasional strains of enterococci are resistant to this agent, and gentamicin must be substituted. The minimal duration of therapy is 4 weeks.