Table 2. Key points.

• Vancomycin-resistant enterococci (VRE) colonization is, at many centers, common and increasing in frequency. • VRE colonization surveillance is not a standard practice at all centers but is recommended in the presence of ongoing strain transmission. • Patients colonized with VRE, especially with its dominance in the intestinal microbiome, have a high rate of development of VRE bacteremia (VREB), and this is most likely to occur during receipt of broad-spectrum antibiotics. • VREB is associated with excess mortality, but attributable mortality appears to be limited, indicating that it may be a surrogate marker of mortality, which is more related to the presence of comorbidities. • While the presence of colonization is a predictor of risk of VREB, there is no evidence that therapy directed at VRE in patients with persisting fever and negative cultures improves outcomes. • Daptomycin and linezolid are the current mainstays of therapy for VREB; emergence of isolates with reduced susceptibility to both agents may pose future challenges to treatment • In patients with persisting bacteremia despite appropriate monotherapy, a combination of daptomycin with a β-lactam antibiotic, such as ampicillin, can be considered.