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Enterococcus faecalis: Infections, transmission, and treatment

In some cases, this bacterium can also be found in the mouth or vaginal tract.

In healthy people, or when present in normal amounts, Enterococcus does not usually cause a problem.

But if it spreads to other areas of the body, it may cause life-threatening infections. People in hospital settings or who have underlying health conditions are at a higher risk of developing an infection.

While there are 17 or more species of Enterococcus, only two are commonly found in humans: E. faecalis and E. faecium.

This article focuses on E. faecalis, its associated infections, how it is transmitted, and treatment options.

What is Enterococcus faecalis?

Until 1984, E. faecalis was known as Streptococcus faecalis. Scientists previously categorized the bacteria as part of the genus Streptococcus.

According to the Centers for Disease Control and Prevention (CDC), E. faecalis is responsible for approximately 80 percent of cases of human infection.

The bacteria can cause infection in people when it enters wounds, blood, or urine. People with weakened immune systems are particularly at risk, such as those who:

  • have weak immunity due to disease or surgery
  • are undergoing cancer treatment
  • are on dialysis
  • are receiving an organ transplant
  • have HIV or AIDS
  • have had a root canal

People in hospital settings are particularly vulnerable to E. faecalis infection because hospitalized patients tend to have reduced immunity. The common use of intravascular and urinary catheter devices can also contribute to the spread of infection, as these instruments frequently harbor the E. faecalis bacteria.

E. faecalis is believed to be one of the top three leading causes of hospital-acquired infection.

E. faecalis contributes to a number of infections in people, some of which can be life-threatening.

The bacteria may cause:

  • bacteremia, the presence of bacteria in the blood
  • abdominal and pelvic infections
  • urinary tract infections
  • oral infections, particularly with root canals
  • septicemia, or blood poisoning
  • wound infections
  • endocarditis, an infection of the lining of the heart
  • enterococcal meningitis, an uncommon form of meningitis

Symptoms of E. faecalis infection depend on the location of the infection. They can include:

  • fatigue
  • painful urination
  • stomach cramping
  • vomiting

Due to its drug-resistant mechanisms, Enterococcus infection poses a significant treatment challenge to healthcare professionals.

Before treatment, healthcare providers often take samples of the bacteria from patients. They profile the sample’s susceptibility to various types of treatment including ampicillin, penicillin, and vancomycin.

An uncomplicated infection can often be treated with a single antibiotic. If there’s no antibiotic resistance, ampicillin is the preferred medication.

Other drug options include:

  • ampicillin with sulbactam
  • daptomycin
  • linezolid
  • nitrofurantoin
  • tigecycline
  • vancomycin

More severe infections can include sepsis, endocarditis, or meningitis. These infections may need to be treated with a combination of a cell wall-active agent and a class of antibiotics known as aminoglycosides.

Cell wall-active agents are antibiotics that target the bacterial cell wall, inhibiting cell growth. Examples include ampicillin, vancomycin, and aminoglycosides, which include gentamicin and streptomycin.

For a more serious infection, treatment can last several weeks.


Enterococcal infections commonly occur in people who are already ill. This can make it difficult to determine if the bacterial infection is responsible for any subsequent illness or death.

Some research suggests that the outlook for people with E. faecalis infection is linked to their health status, not the presence of bacterial strains.

Other studies have found that patients with an infection caused by strains of vancomycin-resistant Enterococcus had a higher mortality rate than those with strains susceptible to the antibiotic.

Infections caused by antibiotic-resistant bacteria tend to result in longer hospital stays, higher health care costs, and higher mortality rates when compared with infections from antibiotic-susceptible bacteria.

Good hygiene practices are the best way to prevent the transmission of E. faecalis infection.

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