Enterococcus spp have emerged as important pathogens in
urinary tract infection (UTI), especially in hospitalized patients. Resistance to multiple
antibiotics, including
vancomycin, has become common, particularly in
infections involving Enterococcus faecium. The management of UTIs caused by Enterococcus spp has become challenging given the presence of underlying comorbidities in these patients and the limited therapeutic options available to treat multidrug-resistant (MDR) Enterococcus. Routine
therapy for asymptomatic
bacteriuria with MDR-Enterococcus is not recommended. Removal of indwelling
urinary catheters should be considered. Appropriate
antibiotic therapy selection should be guided by urine culture and susceptibility results. Data are limited on the treatment of UTIs caused by MDR-Enterococcus. Potential oral agents active against MDR-Enterococcus that may be considered for acute uncomplicated UTI include
nitrofurantoin,
fosfomycin, and
fluoroquinolones. Potential parenteral agents for the treatment of
pyelonephritis and complicated UTIs caused by MDR-Enterococcus include
daptomycin,
linezolid, and quinipristin-
dalfopristin.
Aminoglycosides or
rifampin may be considered as adjunctive
therapy in serious
infections.