VRE are often carried by medical personnel and can spread from patient to patient. Changing resistance patterns will necessitate changes in antibiotic therapy for patients with enterococcal infections. Traditionally, ampicillin has been the drug of choice for enterococcal urinary tract infections. Deep tissue and bloodstream infections have traditionally been treated with ampicillin and gentamicin, with vancomycin, or with vancomycin and gentamicin. Infections caused by strains that are highly resistant to aminoglycosides can be treated with vancomycin.
Infections caused by vancomycin-resistant strains are the most difficult to treat.
Some strains are sensitive to experimental agents such as teicoplanin or quinupristin-dalfopristin, but early clinical results have been disappointing. In all cases, removal of infected indwelling catheters and foreign bodies and drainage of septic foci are essential. It is also essential to limit the spread of VRE by intensive surveillance, infection-control measures, and prudent use of vancomycin and other antibiotics.