THE NOSOCOMIAL TRANSMISSION OF ENTEROCOCCI

Enterococci have become a significant cause of nosocomial infections i n the past two decades. Moreover, acquisition of new resistance traits such as aminoglycoside resistance, beta-lactamase production, high-le vel resistance to penicillins due to penicillin-binding protein change s and glycopeptide resistance has dramatically limited therapeutic opt ions for disease caused by these organisms. Although hospital-associat ed enterococcal infections were previously thought to be derived from endogenous flora, recent epidemiologic studies, assisted in some insta nces by the application of new molecular techniques, have identified b oth intra- and inter-hospital spread of strains of enterococci. These studies have indicated that person-to-person transmission via the hand s of health care personnel may occur and have implicated inanimate obj ects as a possible source of enterococcal infection. It has also been shown that a major risk factor for nosocomial acquisition of enterococ ci is the use of antibiotics, presumably because enterococci are resis tant to many of the commonly used antimicrobial regimens. With the inf ormation currently available, there can be little doubt that nosocomia l infections due to enterococci will continue to be important in the f uture. Rapid identification of patients infected or colonized by multi -resistant enterococci, strict adherence to infection control practice s, and prudent use of antibiotics all seem necessary to control and pr event nosocomial infections due to enterococci.