The emergence of enterococci as a cause of nosocomial infection.

Enterococci have traditionally been regarded as low-grade pathogens but have emerged as an increasingly important cause of nosocomial infection. The rise in hospital-acquired enterococcal infection has been in part due to the increased use of broad-spectrum antibiotics and the rising number of severely ill patients. The intrinsic resistance of enterococci to many antimicrobial agents, and the acquisition of resistance to the few antibiotics available for treatment, has led to real therapeutic difficulties. The microbiological laboratory has an important role to play in the control of enterococcal infection through surveillance, and should be able to identify antibiotic-resistant strains likely to cause a problem. Infection control measures, such as source isolation of infected or colonised patients, should be considered. The possibility that vancomycin-resistant strains of enterococci are entering the community via the food chain indicates the need for greater control of the use of glycopeptide antibiotics in animal feed.