Therapeutic approach to difficult-to-treat multidrug-resistant enterococcal infections

Difficult-to-treat (DTR) enterococcal infections, particularly those caused by multidrug-resistant Enterococcus faecium and Enterococcus faecalis , pose significant clinical challenges due to limited treatment options and high rates of treatment failure, compounded by a paucity of new antimicrobial agents in the development pipeline. Despite advances in understanding resistance mechanisms and in vitro synergistic antibiotic combinations, robust clinical data to guide therapy for severe or DTR enterococcal infections remain limited. This review synthesizes available evidence to inform optimal management strategies, including drug selection and dosing, while highlighting areas needing further research. Given the ongoing threat posed by multidrug-resistant enterococci, we emphasize the importance of gathering robust clinical data to guide best practices for managing these difficult-to-treat infections.