The enterococcus has become an important nosocomial pathogen, reported
by the National Nosocomial Infections Surveillance System as the thir
d most common pathogen associated with bloodstream infections and the
second most commonly isolated pathogen overall, It is now more frequen
tly recognized as a cause of superinfection in the surgical patient, a
s the possible result of the frequent use of ineffective antimicrobial
s for prophylaxis and treatment, Both of these findings are due, in pa
rt, to the intrinsic antimicrobial resistance of the enterococci, Of g
reater concern is the ready ability of this organism to acquire resist
ance traits, During the past 5 years, the appearance and rapid dissemi
nation of strains with high-level resistance to vancomycin, ampicillin
, gentamicin, and streptomycin have been reported; in some cases, no e
ffective antimicrobial therapy was available to patients infected with
these strains, Enterococci, in addition to their intrinsic and acquir
ed tolerance to beta-lactams, have acquired the ability to inactivate
penicillin and ampicillin via beta-lactamase production, Prompt recogn
ition of such multiresistant enterococci, the implementation of effect
ive infection control precautions, and rational use of antimicrobials
may limit or even prevent the spread of such strains in the hospital s
etting.