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Enterococcal Endocarditis: Can We Win the War?

  • Cardiovascular Infections (DP Levine, Section Editor)
  • Published:
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Abstract

Treatment of enterococcal infections has long been recognized as an important clinical challenge, particularly in the setting of infective endocarditis (IE). Furthermore, the increase prevalence of isolates exhibiting multidrug resistance (MDR) to traditional anti-enterococcal antibiotics such as ampicillin, vancomycin and aminoglycosides (high-level resistance) poses immense therapeutic dilemmas in hospitals around the world. Unlike IE caused by most isolates of Enterococcus faecalis, which still retain susceptibility to ampicillin and vancomycin, the emergence and dissemination of a hospital-associated genetic clade of multidrug resistant Enterococcus faecium, markedly limits the therapeutic options. The best treatment of IE MDR enterococcal endocarditis is unknown and the paucity of antibiotics with bactericidal activity against these organisms is a cause of serious concern. Although it appears that we are winning the war against E. faecalis, the battle rages on against isolates of multidrug-resistant E. faecium.

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Disclosure

Dr. C. Arias has worked as a consultant for Pfizer, Inc and Cubist, Inc, and is an employee of the University of Texas Health Science Center. He has grants or grants pending from Pfizer, Inc; Forrest Pharmaceuticals and Theravance, Inc, and has received payment for lectures from Pfizer, Inc and Novartis, Royalties from UptoDate, payment for development of educational presentations from the University of Texas Medical Branch, travel/accommodation expenses from the Columbian Society for Infectious Diseases, 5th Symposium for Antimicrobial Resistance, Colombia, American Society for Microbiology, European Society for Clinical Microbiology and Infectious Diseases, Latin American Society for Pediatric Infectious Diseases, Latin American Society for Pediatric Infectious Diseases, European Society for Clinical Microbiology and Infectious Diseases, 6th Symposium on Antimicrobial Resistance, Colombia, Cold Spring Harbor Laboratory/Wellcome Trust, Caribbean Association of Clinical Microbiologists (CACM), Chilean Infectious Diseases Society, and the 7th Symposium on Antimicrobial Resistance, Colombia; Dr. Murray is vice president of IDSA, a consultant for Pfizer, Rib-X, Durata Therapeutics, Achaogen, The Medicines Co., and GlaxoSmithKline. She is an employee of The University of Texas Health Science Center at Houston, and has had grants or grants pending from NIH, Johnson & Johnson, Intercell, Astellas, Johnson & Johnson, Cubist, Theravance, and Forest as well as payment for lectures from Christiana Hospital, Henry Ford Hospital, The Ottawa Hospital, Medical College of Wisconsin, Memorial Sloan Kettering Cancer Center, and Palm Beach Infectious Diseases Institute, and payment for manuscript preparation from NEJM, patents from Ace, royalties from Harrison’s, payment for development of educational presentations from Grant/Downing Education, and travel/accommodations support from PPD Development, LP and Henry M. Jackson Foundation, IDSA, IDSA, Eurofins Medinet (NARSA), Ohio State University, MCM Eventi e Congressi (ISCVID), ASM, and the European Food Safety Authority Advisory Board; Dr. J. Munita reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Infectious Diseases, Center for the Study of Emerging and Reemerging Pathogens, Houston, TX, USA

    Cesar A. Arias & Barbara E. Murray

  2. Laboratory for Antimicrobial Research, University of Texas Medical School at Houston, Houston, TX, USA

    Jose M. Munita & Cesar A. Arias

  3. Laboratory of Enterococcal Research, University of Texas Medical School at Houston, Houston, TX, USA

    Barbara E. Murray

  4. Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston, Houston, TX, USA

    Barbara E. Murray

  5. Molecular Genetics and Antimicrobial Resistance Unit, Universidad El Bosque, Bogotá, Colombia

    Cesar A. Arias

  6. Clínica Alemana – Universidad del Desarrollo School of Medicine, Santiago, Chile

    Jose M. Munita

  7. University of Texas Medical School, 6431 Fannin St, Room 2.112 MSB, Houston, TX, 77030, USA

    Cesar A. Arias & Barbara E. Murray

Authors
  1. Jose M. Munita
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  2. Cesar A. Arias
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  3. Barbara E. Murray
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Correspondence to Cesar A. Arias or Barbara E. Murray.

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Munita, J.M., Arias, C.A. & Murray, B.E. Enterococcal Endocarditis: Can We Win the War?. Curr Infect Dis Rep 14, 339–349 (2012). https://doi.org/10.1007/s11908-012-0270-8

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