What Are Enterococcal Infections?

Medically Reviewed by Carol DerSarkissian, MD on May 28, 2023
3 min read

Everyone has bacteria that live in their intestines and genital tract. In fact, your body has trillions of bacteria at any one point in time. They help with bodily functions like digesting food and they also impact your mood.

One type of important bacteria is called enterococci, which includes more than 17 different species. They’re found in the intestines of nearly every animal on earth. 

Only a few types of enterococci bacteria cause clinical infections in humans, including Enterococcus faecalis (also called E. faecalis) and Enterococcus faecium (or E. faecium).

Such infections can often be difficult to treat, as ordinary doses of antibiotics typically aren’t strong enough to effectively treat them. In other words, the bacteria are highly drug-resistant.

Enterococcus faecalis (also called E. faecalis) is one of the most common species of Enterococci and is the leading cause of enterococcal infections. However, researchers aren’t sure what factors lead to a higher presence of this bacteria in certain people and body parts.

What researchers do know is that enterococci are able to survive in a wide variety of conditions and environments, including extremely high and low temperatures. In addition to your gut, E. faecalis bacteria also live in your mouth and vagina.

Additionally, the unique elements of E. faecalis make it so that many antibiotics don’t work to fight against the infection. Such antibiotics include:

  • Penicillin
  • Ampicillin
  • Piperacillin
  • Imipenem
  • Vancomycin

Each year in the United States, Enterococci are the culprit for 110,000 urinary tract infections (UTIs), 40,000 wound infections, 25,000 cases of bacteremia, and 1,100 cases of endocarditis. Most of these infections take place in hospitals. 

Here’s some more information on each infection:


A UTI is an infection of any part of your urinary system, which includes your bladder, kidneys, uterus, and urethra. If you’re a woman, you have a higher risk of getting a UTI. The symptoms include:

  • A strong and ongoing need to urinate, or pee
  • A burning feeling when urinating
  • Frequently passing only small amounts of urine
  • Cloudy, red, pink, or cola-colored urine
  • Lower abdominal pain

Wound Infections

Wound infections occur when cuts, scrapes, animal bites, sutured wounds, and puncture wounds get infected, which typically happens 24 to 72 hours after the event. Signs of wound infections include:

  • Pus
  • A red area or streak that’s spreading
  • Increased pain and swelling
  • A fever
  • A swollen lymph node

Wound infections caused by E. faecalis are harder to treat than those caused by other types of bacteria. The following factors are associated with higher chances of death, especially in developing countries:

  • A longer hospital stay
  • A repeated surgical procedure
  • Prior antibiotic therapy
  • An ICU stay


Bacteremia happens when a bacterial infection spreads to your bloodstream. Many different kinds of infections lead to bacteremia, including those caused by E. faecalis, such as UTIs or wound infections.

The symptoms of bacteremia include:

  • Fever and chills
  • Nausea and/or vomiting
  • Loss of appetite
  • Trouble breathing
  • Fast heart rate
  • Lightheadedness
  • Skin rashes
  • Confusion or loss of consciousness


Endocarditis, which is also called heart valve infection, occurs when bacteria spread through your blood and attached to the inner lining of your heart and the surface of its valves.

Symptoms of endocarditis include:

  • Flu-like symptoms, such as a fever, chills, achiness, or night sweats
  • A new heart murmur
  • Tiny bumps on your hands or feet
  • Spots on the whites of your eyes or roof of your mouth

E. faecalis often spreads in hospitals. This is mainly because hospitalized patients often have weakened immune systems. For the most part, the bacteria are transmitted by people who work at the hospital, some of whom carry the E. faecalis in their gut. Other times, enterococci are transmitted through medical devices.

Hospitals that have strict cleaning, isolation, disinfection, and sterilization protocols in place are far less likely to experience enterococci infections.

Infections caused by E. faecalis are challenging to get rid of because the bacteria are resistant to many antibiotics.

One course of treatment involves combining a wall-active drug — such as penicillin, ampicillin, amoxicillin, piperacillin, or vancomycin — with what’s called an aminoglycoside — such as gentamicin or streptomycin. However, skin infections and endocarditis often require different combinations. UTIs, on the other hand, are typically much easier to treat. Your doctor will likely only need to prescribe a single antibiotic like ampicillin.