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Clinical Microbiology Reviews, October 2000, p. 513-522, Vol. 13, No. 4
0893-8512/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Relationships between Enterococcal Virulence and Antimicrobial Resistance

L. M. Mundy,1,* D. F. Sahm,2 and M. Gilmore3

Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri1; MRL Laboratories, Reston, Virginia2; and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma3

Enterococci have become a vexing problem in clinical medicine because of their ability to infect patients who are typically receiving antibiotic therapy for unrelated underlying illness. Moreover, the infections have become extremely difficult to manage because of the accumulation of antibiotic resistances among enterococci. The ability of enterococci to cause disease is an intrinsic property of the organism or possibly subpopulations within enterococcal species. The probability of an infection's becoming established, however, is almost certainly in part a function of the enterococcal burden. By altering endogenous bacterial flora, antibiotic therapy promotes increased colonization by antibiotic-resistant organisms. Therefore, antibiotic resistance and intrinsic virulence both contribute to disease, but in separate and complementary ways. We review the virulence of enterococci, as distinct from the acquisition of antimicrobial resistance genes, and identify current gaps in our understanding of enterococcal virulence and the basis for disease.

* Corresponding author. Mailing address: Division of Infectious Diseases, 660 S. Euclid, Campus Box 8051, St. Louis, MO 63110. Phone: (314) 454-8354. Fax: (314) 454-5392. E-mail: lmundy{at}imgate.wustl.edu.

Clinical Microbiology Reviews, October 2000, p. 513-522, Vol. 13, No. 4
0893-8512/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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