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Pathophys and Cause

Cause:Enterococcus faecalisand faecium, a group D strep

Pathophys:In mixed infections, often "selected out" by cephalosporins

Epidemiology

Fecal organism; increasing resistance

Signs and Symptoms

Sx:Abscesses, cellulitis, septic arthritis, UTIs

Complications

SBE

Lab and Xray

Lab:Bact:Gram-positive cocci

Treatment

Rx:Aminoglycoside plus a penicillin essential for synergy; many ß-lactamase–producing, gentamicin-resistant strains, treatable w vancomycin or ampicillin/sulbactam (Unasyn) (Ann IM 1992;116:285); but vancomycin resistance also now common (Nejm 2000;342:710), in which case can use daptomycin (Cubicin), or linezolid (Zyvox), or chloramphenicol