Enterococcal mechanisms of resistance against cell wall-active agents

It is clear that enterococcal mechanisms of resistance against cell wall-active agents have become increasingly important. These mechanisms are complex and most likely related to the stringent response and dormancy. Neither newer investigational antimicrobial agents such as fluoroquinolones nor older agents such as tetracyclines, alone or in combination, have been shown to be effective substitutes for the combination of a penicillin and an aminoglycoside against enterococci. This current lack of alternative therapy reemphasizes the importance of enterococcal mechanisms of resistance against cell wall-active agents.