Infecciones por enterococos

Abstract

Enterococci are facultative anaerobic gram-positive bacteria that are arranged in chains or pairs. The most relevant species are Enterococcus faecalis and Enterococcus faecium. They are normal colonizers of the digestive system. They can survive on surfaces and in hospital settings for an extended period of time. Frequent contact with hospitals, comorbidities, prior antibiotic use, and presence of medical devices are associated with a greater risk of infection. They can give rise to multiple clinical syndromes and are more common in healthcare-associated infections than community infections. Of note are urinary tract infections, intra-abdominal infections, venous catheter-related bacteremias, endocarditis, meningitis, and surgical wound infections. The presence of endocarditis must be evaluated in all enterococci bacteremias; the NOVA and DENOVA scores are useful for doing so. Enterococcus faecalis tend to be sensitive to ampicillin, which is the treatment of choice. In cases of endocarditis or complicated bacteremia, it is recommended to combine them with ceftriaxone or gentamicin. Enterococcus faecium tend to be resistant to ampicillin and the treatment of choice is vancomycin. Treatment of vancomycin-resistant enterococci is not well-defined and represents a challenge; the main options are daptomycin at high doses or linezolid. Adequate control of the source of the infection is fundamental in the management of enterococcal infections.