Enterococci are normal flora of the human GI tract and sometimes found in the anterior urethra. Historically, enterococci were considered part of the streptococci genus but now are separated despite similarities, such as group D classification and causing subacute disease. Frequently affected patients are older males who have undergone genitourinary manipulations or younger females who have had obstetric procedures. Although enterococci are a less common cause of IE, there are two predominant species: Enterococcus faecium and Enterococcus faecalis. E. faecalis is the most common and the more susceptible of the strains. However, enterococci overall are more intrinsically resistant, with enterococcal IE representing one of the most problematic gram-positive infections to treat and cure. Frequently, enterococci display resistance to multiple antibiotics, including penicillins, vancomycin, aminoglycosides, and some of the newer agents (e.g., linezolid or quinupristin/dalfopristin).3

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