Division of Infectious Diseases Department of Medicine, Henry Ford Health System, 2799 West Grand Blvd, Detroit, MI, 48226, USA,
Curr Infect Dis Rep. 2013 Aug;15(4):320-8. doi: 10.1007/s11908-013-0348-y.
Enteroccocal infective endocarditis is a major challenge to clinicians. There are an increasing number of reports of nosocomial acquisition and multidrug-resistant strains complicating management. The therapy of choice for enterococcal endocarditis remains ampicillin and gentamicin; however, high levels of aminoglycoside resistance, vancomycin-resistance, and toxicity of gentamicin with prolonged therapy have necessitated the use of other options in some patients. When the combination of cell wall drug and aminoglycoside cannot be used, the optimal regimen is not well established, due to limited information from clinical trials. There is thus an urgent need to better understand pathogenesis, resistance mechanisms, and optimal management strategies. Clinicians need to explore both antimicrobial and nonantimicrobial strategies for management, including evaluation of those at risk, early diagnosis, appropriate combination, and infection prevention.
肠球菌感染性心内膜炎对临床医生来说是一个重大挑战。越来越多的医院获得性和耐多药菌株的报告使治疗变得复杂。肠球菌心内膜炎的治疗选择仍然是氨苄西林和庆大霉素;然而，由于氨基糖苷类药物耐药性水平高、万古霉素耐药性以及庆大霉素长期治疗的毒性，一些患者需要使用其他药物。当不能使用细胞壁药物和氨基糖苷类药物的联合治疗时，由于临床试验提供的信息有限，最佳方案尚未确定。因此，迫切需要更好地了解发病机制、耐药机制和最佳管理策略。临床医生需要探索包括评估高危人群、早期诊断、适当联合以及感染预防在内的抗菌和非抗菌治疗策略。
