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Enterococci as Increasing Bacteria in Hospitals: Why Are Infection Control Measures Challenging for This Bacteria?

  • Treatment and Prevention of Hospital Infections (D Vilar-Compte, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of the review

Enterococci are emerging threatening multidrug-resistant bacteria. Enterococcus faecium is a common pathogen associated with severe hospital-acquired infections. The goal of this report is to analyze the evolution of this nosocomial pathogen and study the state of adequate infection control measures.

Recent findings

Evolution over millions of years has allowed enterococci to develop into a persistent hospital pathogen, an environment where it thrives. Vancomycin-resistant enterococci (VRE) continues to obtain antibiotic resistance elements. Enterococci assemble multiple virulence factors. VRE intestinal colonization can promote nosocomial infections. New rapid PCR laboratory tests with high sensitivity and specificity allows for screening of Enterococci in asyptomatic carriers.

Summary

The efficient clonal dissemination of VRE has led to a potential multidrug-resistant bacteria that is a current and future threat to hospitals worldwide. The therapeutic options are few and decreasing. Healthcare-associated infection (HAI) prevention is critical in our fight against enterococci.

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References and recommended reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Murray BE. Vancomycin-resistant enterococcal infections. N Engl J Med. 2000;342(10):710–21. https://doi.org/10.1056/NEJM200003093421007.

    Article  PubMed  CAS  Google Scholar 

  2. Arias CA, Murray BE. The rise of the Enterococcus: beyond vancomycin resistance. Nat Rev Microbiol. 2012;10(4):266–78. https://doi.org/10.1038/nrmicro2761.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. •• Guzman Prieto AM, van Schaik W, Rogers MR, Coque TM, Baquero F, Corander J, et al. Global emergence and dissemination of enterococci as nosocomial pathogens: attack of the clones? Front Microbiol. 2016;7:788. https://doi.org/10.3389/fmicb.2016.00788. A review on the global threat of enterococci as nosocomial pathogens.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Willems RJ, Top J, van Santen M, Robinson DA, Coque TM, Baquero F, et al. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex. Emerg Infect Dis. 2005;11(6):821–8. https://doi.org/10.3201/eid1106.041204.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. •Pfaller MA, Mendes RE, Streit JM, Hogan PA, Flamm RK. Five-year summary of in vitro activity and resistance mechanisms of linezolid against clinically important Gram-positive cocci in the United States from the LEADER Surveillance Program (2011 to 2015). Antimicrob Agents Chemother. 2017;61(7). https://doi.org/10.1128/AAC.00609-17. The report on the evolution of the genes responsible for linezolid resistance in Enterococcus faecalis and E. faecium.

  6. •• Chiang HY, Perencevich EN, Nair R, Nelson RE, Samore M, Khader K, et al. Incidence and outcomes associated with infections caused by vancomycin-resistant enterococci in the United States: systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2017;38(2):203–15. https://doi.org/10.1017/ice.2016.254. A literature review and meta-analysis reporting the excess mortality, prolonged hospital stay, and increased costs, associated with infections caused by vancomycin-resistant enterococci.

    Article  PubMed  Google Scholar 

  7. •• Prematunge C, MacDougall C, Johnstone J, Adomako K, Lam F, Robertson J, et al. VRE and VSE bacteremia outcomes in the era of effective VRE therapy: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):26–35. https://doi.org/10.1017/ice.2015.228. A systematic review and meta-analysis of the outcomes associated with vancomycin-resistant enterococci bacteremia compared to vancomycin-sensitive enterococci bacteremia. vancomycin-resistant enterococci bacteremia is associated with increased mortality.

    Article  PubMed  Google Scholar 

  8. •• Satilmis L, Vanhems P, Benet T. Outbreaks of vancomycin-resistant enterococci in hospital settings: a systematic review and calculation of the basic reproductive number. Infect Control Hosp Epidemiol. 2016;37(3):289–94. https://doi.org/10.1017/ice.2015.301. A systematic review of hospitals outbreaks caused by vancomycin-resistant enterococci, describing heterogeneity in screening policies and confirming the epidemic nature of vancomycin-resistant enterococci.

    Article  PubMed  Google Scholar 

  9. Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2008;197(8):1079–81. https://doi.org/10.1086/533452.

    Article  PubMed  Google Scholar 

  10. Jett BD, Huycke MM, Gilmore MS. Virulence of enterococci. Clin Microbiol Rev. 1994;7(4):462–78.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Zervos MJ, Kauffman CA, Therasse PM, Bergman AG, Mikesell TS, Schaberg DR. Nosocomial infection by gentamicin-resistant Streptococcus faecalis: an epidemiologic study. Ann Intern Med. 1987;106(5):687–91.

    Article  PubMed  CAS  Google Scholar 

  12. Murray BE, Singh KV, Markowitz SM, Lopardo HA, Patterson JE, Zervos MJ, et al. Evidence for clonal spread of a single strain of beta-lactamase-producing Enterococcus (Streptococcus) faecalis to six hospitals in five states. J Infect Dis. 1991;163(4):780–5.

    Article  PubMed  CAS  Google Scholar 

  13. Chow JW, Kuritza A, Shlaes DM, Green M, Sahm DF, Zervos MJ. Clonal spread of vancomycin-resistant Enterococcus faecium between patients in three hospitals in two states. J Clin Microbiol. 1993;31(6):1609–11.

    PubMed  PubMed Central  CAS  Google Scholar 

  14. Handwerger S, Raucher B, Altarac D, Monka J, Marchione S, Singh KV, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis. 1993;16(6):750–5.

    Article  PubMed  CAS  Google Scholar 

  15. Kim WJ, Weinstein RA, Hayden MK. The changing molecular epidemiology and establishment of endemicity of vancomycin resistance in enterococci at one hospital over a 6-year period. J Infect Dis. 1999;179(1):163–71. https://doi.org/10.1086/314564.

    Article  PubMed  CAS  Google Scholar 

  16. Stosor V, Kruszynski J, Suriano T, Noskin GA, Peterson LR. Molecular epidemiology of vancomycin-resistant enterococci: a 2-year perspective. Infect Control Hosp Epidemiol. 1999;20(10):653–9. https://doi.org/10.1086/501560.

    Article  PubMed  CAS  Google Scholar 

  17. Fridkin SK, Edwards JR, Courval JM, Hill H, Tenover FC, Lawton R, et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units. Ann Intern Med. 2001;135(3):175–83.

    Article  PubMed  CAS  Google Scholar 

  18. Maki DG, Agger WA. Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine (Baltimore). 1988;67(4):248–69.

    Article  CAS  Google Scholar 

  19. Terpenning MS, Zervos MJ, Schaberg DR, Kauffman CA. Enterococcal infections: an increasing problem in hospitalized patients. Infect Control Hosp Epidemiol. 1988;9(10):457–61.

    Article  PubMed  CAS  Google Scholar 

  20. Edmond MB, Ober JF, Weinbaum DL, Pfaller MA, Hwang T, Sanford MD, et al. Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis. 1995;20(5):1126–33.

    Article  PubMed  CAS  Google Scholar 

  21. Patterson JE, Sweeney AH, Simms M, Carley N, Mangi R, Sabetta J, et al. An analysis of 110 serious enterococcal infections: epidemiology, antibiotic susceptibility, and outcome. Medicine (Baltimore). 1995;74(4):191–200.

    Article  CAS  Google Scholar 

  22. Lucas GM, Lechtzin N, Puryear DW, Yau LL, Flexner CW, Moore RD. Vancomycin-resistant and vancomycin-susceptible enterococcal bacteremia: comparison of clinical features and outcomes. Clin Infect Dis. 1998;26(5):1127–33.

    Article  PubMed  CAS  Google Scholar 

  23. Lautenbach E, Bilker WB, Brennan PJ. Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality. Infect Control Hosp Epidemiol. 1999;20(5):318–23. https://doi.org/10.1086/501624.

    Article  PubMed  CAS  Google Scholar 

  24. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309–17. https://doi.org/10.1086/421946.

    Article  PubMed  Google Scholar 

  25. McBride SJ, Upton A, Roberts SA. Clinical characteristics and outcomes of patients with vancomycin-susceptible Enterococcus faecalis and Enterococcus faecium bacteraemia—a five-year retrospective review. Eur J Clin Microbiol Infect Dis. 2010;29(1):107–14. https://doi.org/10.1007/s10096-009-0830-5.

    Article  PubMed  CAS  Google Scholar 

  26. Hayakawa K, Marchaim D, Martin ET, Tiwari N, Yousuf A, Sunkara B, et al. Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia. Antimicrob Agents Chemother. 2012;56(5):2452–8. https://doi.org/10.1128/AAC.06299-11.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. McCracken M, Wong A, Mitchell R, Gravel D, Conly J, Embil J, et al. Molecular epidemiology of vancomycin-resistant enterococcal bacteraemia: results from the Canadian Nosocomial Infection Surveillance Program, 1999-2009. J Antimicrob Chemother. 2013;68(7):1505–9. https://doi.org/10.1093/jac/dkt054.

    Article  PubMed  CAS  Google Scholar 

  28. •• Ong DS, Bonten MJ, Safdari K, Spitoni C, Frencken JF, Witteveen E, et al. Epidemiology, management, and risk-adjusted mortality of ICU-acquired enterococcal bacteremia. Clin Infect Dis. 2015;61(9):1413–20. https://doi.org/10.1093/cid/civ560. Appropriate management of enterococcal bacteremia in the intensive care unit setting.

    Article  PubMed  Google Scholar 

  29. Falk PS, Winnike J, Woodmansee C, Desai M, Mayhall CG. Outbreak of vancomycin-resistant enterococci in a burn unit. Infect Control Hosp Epidemiol. 2000;21(9):575–82. https://doi.org/10.1086/501806.

    Article  PubMed  CAS  Google Scholar 

  30. Christiansen KJ, Tibbett PA, Beresford W, Pearman JW, Lee RC, Coombs GW, et al. Eradication of a large outbreak of a single strain of vanB vancomycin-resistant Enterococcus faecium at a major Australian teaching hospital. Infect Control Hosp Epidemiol. 2004;25(5):384–90. https://doi.org/10.1086/502410.

    Article  PubMed  Google Scholar 

  31. Mascini EM, Troelstra A, Beitsma M, Blok HE, Jalink KP, Hopmans TE, et al. Genotyping and preemptive isolation to control an outbreak of vancomycin-resistant Enterococcus faecium. Clin Infect Dis. 2006;42(6):739–46. https://doi.org/10.1086/500322.

    Article  PubMed  CAS  Google Scholar 

  32. Singh N, Leger MM, Campbell J, Short B, Campos JM. Control of vancomycin-resistant enterococci in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2005;26(7):646–9. https://doi.org/10.1086/502595.

    Article  PubMed  Google Scholar 

  33. Gordts B, Van Landuyt H, Ieven M, Vandamme P, Goossens H. Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. J Clin Microbiol. 1995;33(11):2842–6.

    PubMed  PubMed Central  CAS  Google Scholar 

  34. Wells CL, Juni BA, Cameron SB, Mason KR, Dunn DL, Ferrieri P, et al. Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients. Clin Infect Dis. 1995;21(1):45–50.

    Article  PubMed  CAS  Google Scholar 

  35. Weinstein JW, Roe M, Towns M, Sanders L, Thorpe JJ, Corey GR, et al. Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital. Infect Control Hosp Epidemiol. 1996;17(1):36–41.

    Article  PubMed  CAS  Google Scholar 

  36. Donskey CJ, Chowdhry TK, Hecker MT, Hoyen CK, Hanrahan JA, Hujer AM, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med. 2000;343(26):1925–32. https://doi.org/10.1056/NEJM200012283432604.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Byers KE, Anglim AM, Anneski CJ, Farr BM. Duration of colonization with vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol. 2002;23(4):207–11. https://doi.org/10.1086/502036.

    Article  PubMed  Google Scholar 

  38. Donskey CJ, Hoyen CK, Das SM, Helfand MS, Hecker MT. Recurrence of vancomycin-resistant Enterococcus stool colonization during antibiotic therapy. Infect Control Hosp Epidemiol. 2002;23(8):436–40. https://doi.org/10.1086/502081.

    Article  PubMed  Google Scholar 

  39. Montecalvo MA, Jarvis WR, Uman J, Shay DK, Petrullo C, Rodney K, et al. Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting. Ann Intern Med. 1999;131(4):269–72.

    Article  PubMed  CAS  Google Scholar 

  40. Chang CM, Wang LR, Lee HC, Lee NY, Wu CJ, Ko WC. Characterisation of vancomycin-resistant enterococci from hospitalised patients at a tertiary centre over a seven-year period. J Hosp Infect. 2010;74(4):377–84. https://doi.org/10.1016/j.jhin.2009.10.025.

    Article  PubMed  Google Scholar 

  41. Price CS, Paule S, Noskin GA, Peterson LR. Active surveillance reduces the incidence of vancomycin-resistant enterococcal bacteremia. Clin Infect Dis. 2003;37(7):921–8. https://doi.org/10.1086/377733.

    Article  PubMed  Google Scholar 

  42. Perencevich EN, Fisman DN, Lipsitch M, Harris AD, Morris JG Jr, Smith DL. Projected benefits of active surveillance for vancomycin-resistant enterococci in intensive care units. Clin Infect Dis. 2004;38(8):1108–15. https://doi.org/10.1086/382886.

    Article  PubMed  Google Scholar 

  43. Shadel BN, Puzniak LA, Gillespie KN, Lawrence SJ, Kollef M, Mundy LM. Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications. Infect Control Hosp Epidemiol. 2006;27(10):1068–75. https://doi.org/10.1086/507960.

    Article  PubMed  Google Scholar 

  44. Faron ML, Ledeboer NA, Buchan BW. Resistance mechanisms, epidemiology, and approaches to screening for vancomycin-resistant enterococcus in the health care setting. J Clin Microbiol. 2016;54(10):2436–47. https://doi.org/10.1128/JCM.00211-16.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24(5):362–86. https://doi.org/10.1086/502213.

    Article  PubMed  Google Scholar 

  46. Popiel KY, Miller MA. Evaluation of vancomycin-resistant enterococci (VRE)-associated morbidity following relaxation of VRE screening and isolation precautions in a tertiary care hospital. Infect Control Hosp Epidemiol. 2014;35(7):818–25. https://doi.org/10.1086/676860.

    Article  PubMed  Google Scholar 

  47. Kampmeier S, Knaack D, Kossow A, Willems S, Schliemann C, Berdel WE, et al. Weekly screening supports terminating nosocomial transmissions of vancomycin-resistant enterococci on an oncologic ward—a retrospective analysis. Antimicrob Resist Infect Control. 2017;6:48. https://doi.org/10.1186/s13756-017-0206-z.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Montecalvo MA, Jarvis WR, Uman J, Shay DK, Petrullo C, Horowitz HW, et al. Costs and savings associated with infection control measures that reduced transmission of vancomycin-resistant enterococci in an endemic setting. Infect Control Hosp Epidemiol. 2001;22(7):437–42. https://doi.org/10.1086/501931.

    Article  PubMed  CAS  Google Scholar 

  49. Fisher D, Pang L, Salmon S, Lin RT, Teo C, Tambyah P, et al. A successful vancomycin-resistant enterococci reduction bundle at a Singapore hospital. Infect Control Hosp Epidemiol. 2016;37(1):107–9. https://doi.org/10.1017/ice.2015.251.

    Article  PubMed  Google Scholar 

  50. Huang SS, Rifas-Shiman SL, Pottinger JM, Herwaldt LA, Zembower TR, Noskin GA, et al. Improving the assessment of vancomycin-resistant enterococci by routine screening. J Infect Dis. 2007;195(3):339–46. https://doi.org/10.1086/510624.

    Article  PubMed  CAS  Google Scholar 

  51. Ledeboer NA, Das K, Eveland M, Roger-Dalbert C, Mailler S, Chatellier S, et al. Evaluation of a novel chromogenic agar medium for isolation and differentiation of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis isolates. J Clin Microbiol. 2007;45(5):1556–60. https://doi.org/10.1128/JCM.02116-06.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Perry JDA. Decade of development of chromogenic culture media for clinical microbiology in an era of molecular diagnostics. Clin Microbiol Rev. 2017;30(2):449–79. https://doi.org/10.1128/CMR.00097-16.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  53. van Belkum A, Chatellier S, Girard V, Pincus D, Deol P, Dunne WM Jr. Progress in proteomics for clinical microbiology: MALDI-TOF MS for microbial species identification and more. Expert Rev Proteomics. 2015;12(6):595–605. https://doi.org/10.1586/14789450.2015.1091731.

    Article  PubMed  CAS  Google Scholar 

  54. •• Holzknecht BJ, Hansen DS, Nielsen L, Kailow A, Jarlov JO. Screening for vancomycin-resistant enterococci with Xpert(R) vanA/vanB: diagnostic accuracy and impact on infection control decision making. New Microbes New Infect. 2017;16:54–9. https://doi.org/10.1016/j.nmni.2016.12.020. The value of rapid PCR tests for the screening of vancomycin-resistant enterococci.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. • Diekema DJ. Rising stakes for health care-associated infection prevention: implications for the clinical microbiology laboratory. J Clin Microbiol. 2017;55(4):996–1001. https://doi.org/10.1128/JCM.02544-16. The importance of reducing the rate of healthcare-associated infections with the help of the clinical microbiology laboratory.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Hospital Infection Control Practices Advisory C. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol. 1995;16(2):105–13.

    Article  Google Scholar 

  57. Austin DJ, Bonten MJ, Weinstein RA, Slaughter S, Anderson RM. Vancomycin-resistant enterococci in intensive-care hospital settings: transmission dynamics, persistence, and the impact of infection control programs. Proc Natl Acad Sci U S A. 1999;96(12):6908–13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  58. Malik RK, Montecalvo MA, Reale MR, Li K, Maw M, Munoz JL, et al. Epidemiology and control of vancomycin-resistant enterococci in a regional neonatal intensive care unit. Pediatr Infect Dis J. 1999;18(4):352–6.

    Article  PubMed  CAS  Google Scholar 

  59. Ostrowsky BE, Trick WE, Sohn AH, Quirk SB, Holt S, Carson LA, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med. 2001;344(19):1427–33. https://doi.org/10.1056/NEJM200105103441903.

    Article  PubMed  CAS  Google Scholar 

  60. Fridkin SK, Lawton R, Edwards JR, Tenover FC, McGowan JE Jr, Gaynes RP, et al. Monitoring antimicrobial use and resistance: comparison with a national benchmark on reducing vancomycin use and vancomycin-resistant enterococci. Emerg Infect Dis. 2002;8(7):702–7. https://doi.org/10.3201/eid0807.010465.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Harbarth S, Cosgrove S, Carmeli Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci. Antimicrob Agents Chemother. 2002;46(6):1619–28.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. Lai KK, Fontecchio S, Melvin Z, Baker SP. Impact of alcohol-based, waterless hand antiseptic on the incidence of infection and colonization with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. Infect Control Hosp Epidemiol. 2006;27(10):1018–24. https://doi.org/10.1086/507916.

    Article  PubMed  Google Scholar 

  63. Yoonchang SW, Peck KR, Kim OS, Lee JH, Lee NY, Oh WS, et al. Efficacy of infection control strategies to reduce transmission of vancomycin-resistant enterococci in a tertiary care hospital in Korea: a 4-year follow-up study. Infect Control Hosp Epidemiol. 2007;28(4):493–5. https://doi.org/10.1086/513024.

    Article  PubMed  Google Scholar 

  64. Climo MW, Sepkowitz KA, Zuccotti G, Fraser VJ, Warren DK, Perl TM, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med. 2009;37(6):1858–65. https://doi.org/10.1097/CCM.0b013e31819ffe6d.

    Article  PubMed  CAS  Google Scholar 

  65. Harris AD, Pineles L, Belton B, Johnson JK, Shardell M, Loeb M, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA. 2013;310(15):1571–80. https://doi.org/10.1001/jama.2013.277815.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  66. Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev. 2014;27(4):665–90. https://doi.org/10.1128/CMR.00020-14.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  67. Barnes SL, Morgan DJ, Harris AD, Carling PC, Thom KA. Preventing the transmission of multidrug-resistant organisms: modeling the relative importance of hand hygiene and environmental cleaning interventions. Infect Control Hosp Epidemiol. 2014;35(9):1156–62. https://doi.org/10.1086/677632.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Uttley AH, George RC, Naidoo J, Woodford N, Johnson AP, Collins CH, et al. High-level vancomycin-resistant enterococci causing hospital infections. Epidemiol Infect. 1989;103(1):173–81.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  69. Weems JJ Jr, Lowrance JH, Baddour LM, Simpson WA. Molecular epidemiology of nosocomial, multiply aminoglycoside resistant Enterococcus faecalis. J Antimicrob Chemother. 1989;24(2):121–30.

    Article  PubMed  CAS  Google Scholar 

  70. Johnson AP, Uttley AH, Woodford N, George RC. Resistance to vancomycin and teicoplanin: an emerging clinical problem. Clin Microbiol Rev. 1990;3(3):280–91.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  71. Centers for Disease C, Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR Morb Mortal Wkly Rep. 1993;42(30):597–9.

    Google Scholar 

  72. Gonzales RD, Schreckenberger PC, Graham MB, Kelkar S, DenBesten K, Quinn JP. Infections due to vancomycin-resistant Enterococcus faecium resistant to linezolid. Lancet. 2001;357(9263):1179. https://doi.org/10.1016/S0140-6736(00)04376-2.

    Article  PubMed  CAS  Google Scholar 

  73. Herrero IA, Issa NC, Patel R. Nosocomial spread of linezolid-resistant, vancomycin-resistant Enterococcus faecium. N Engl J Med. 2002;346(11):867–9. https://doi.org/10.1056/NEJM200203143461121.

    Article  PubMed  Google Scholar 

  74. Dobbs TE, Patel M, Waites KB, Moser SA, Stamm AM, Hoesley CJ. Nosocomial spread of Enterococcus faecium resistant to vancomycin and linezolid in a tertiary care medical center. J Clin Microbiol. 2006;44(9):3368–70. https://doi.org/10.1128/JCM.00850-06.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  75. Ramsey AM, Zilberberg MD. Secular trends of hospitalization with vancomycin-resistant enterococcus infection in the United States, 2000-2006. Infect Control Hosp Epidemiol. 2009;30(2):184–6. https://doi.org/10.1086/593956.

    Article  PubMed  Google Scholar 

  76. Hegstad K, Mikalsen T, Coque TM, Werner G, Sundsfjord A. Mobile genetic elements and their contribution to the emergence of antimicrobial resistant Enterococcus faecalis and Enterococcus faecium. Clin Microbiol Infect. 2010;16(6):541–54. https://doi.org/10.1111/j.1469-0691.2010.03226.x.

    Article  PubMed  CAS  Google Scholar 

  77. Miller WR, Munita JM, Arias CA. Mechanisms of antibiotic resistance in enterococci. Expert Rev Anti-Infect Ther. 2014;12(10):1221–36. https://doi.org/10.1586/14787210.2014.956092.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  78. Munita JM, Bayer AS, Arias CA. Evolving resistance among Gram-positive pathogens. Clin Infect Dis. 2015;61(Suppl 2):S48–57. https://doi.org/10.1093/cid/civ523.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  79. Arias CA, Murray BE. Emergence and management of drug-resistant enterococcal infections. Expert Rev Anti-Infect Ther. 2008;6(5):637–55. https://doi.org/10.1586/14787210.6.5.637.

    Article  PubMed  CAS  Google Scholar 

  80. Arias CA, Murray BE. Antibiotic-resistant bugs in the 21st century—a clinical super-challenge. N Engl J Med. 2009;360(5):439–43. https://doi.org/10.1056/NEJMp0804651.

    Article  PubMed  CAS  Google Scholar 

  81. Arias CA, Contreras GA, Murray BE. Management of multidrug-resistant enterococcal infections. Clin Microbiol Infect. 2010;16(6):555–62. https://doi.org/10.1111/j.1469-0691.2010.03214.x.

    Article  PubMed  CAS  Google Scholar 

  82. O'Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015;8:217–30. https://doi.org/10.2147/IDR.S54125.

    Article  PubMed  PubMed Central  Google Scholar 

  83. •• Miller WR, Murray BE, Rice LB, Arias CA. Vancomycin-resistant enterococci: therapeutic challenges in the 21st century. Infect Dis Clin North Am. 2016;30(2):415–39. https://doi.org/10.1016/j.idc.2016.02.006. The appropriate treatment for vancomycin-resistant enterococci by clinicians, a review by experts in the study of enterococcal infections.

    Article  PubMed  Google Scholar 

  84. •• Lebreton F, Manson AL, Saavedra JT, Straub TJ, Earl AM, Gilmore MS. Tracing the enterococci from paleozoic origins to the hospital. Cell. 2017;169(5):849–61 e13. https://doi.org/10.1016/j.cell.2017.04.027. The evolution of enterococci, from its origin to the present form as a frequent nosocomial pathogen.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Authors and Affiliations

  1. Hospital Civil de Guadalajara, “Fray Antonio Alcalde”, Guadalajara, Mexico

    Rayo Morfin-Otero MD, Hector R. Perez-Gomez MD, Esteban Gonzalez-Diaz MD, Sergio Esparza-Ahumada MD & Eduardo Rodriguez-Noriega MD

  2. Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico

    Rayo Morfin-Otero MD, Hector R. Perez-Gomez MD, Esteban Gonzalez-Diaz MD, Sergio Esparza-Ahumada MD & Eduardo Rodriguez-Noriega MD

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  1. Rayo Morfin-Otero MD
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  2. Hector R. Perez-Gomez MD
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  3. Esteban Gonzalez-Diaz MD
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  4. Sergio Esparza-Ahumada MD
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  5. Eduardo Rodriguez-Noriega MD
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Correspondence to Rayo Morfin-Otero MD.

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Dr. Rayo Morfin-Otero, Hector R. Perez-Gomez, Esteban Gonzalez-Diaz, Sergio Esparza-Ahumada, and Eduardo Rodriguez-Noriega declare that they have no conflicts of interest.

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This article is part of the Topical Collection on Treatment and Prevention of Hospital Infections

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Morfin-Otero, R., Perez-Gomez, H.R., Gonzalez-Diaz, E. et al. Enterococci as Increasing Bacteria in Hospitals: Why Are Infection Control Measures Challenging for This Bacteria?. Curr Treat Options Infect Dis 10, 129–142 (2018). https://doi.org/10.1007/s40506-018-0166-8

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