CURRENT ASPECTS OF ENTEROCOCCAL ENDOCARDI TIS

Enterococcus, mainly Enterococcus faecalis, is the third microorganism causing endocarditis. The mean age, more than 60 years, is slightly h igher than for bacterial endocarditis due to other microorganisms. The occurrence on a prosthetic valve is two times more frequent than for endocarditis whatever the microorganism. The portal of entry is mainly the genitourinary tract (> 30%), either a urinary tract infection, or a urinary tract procedure which occurred some weeks or months earlier . Therapy is difficult because of the less susceptibility of enterococ ci to most antibiotics. The first choice therapy remains the combinati on of a penicillin plus an aminoglycoside, in cases caused by enteroco ccal strains with a low-level aminoglycoside resistance, during 4 to 6 weeks. Glycopeptides are active, but clinical experience is limited. With such a medical treatment, eventually combined with a valve replac ement, necessary in 20-25% cases, cure is obtained in approximately 80 % cases.