Enterococcus faecalis is a species of bacteria that is naturally found in the intestines. While it tends to be harmless in that environment, it has the potential to cause a serious infection if it spreads to other areas of the body.

Enterococci are a type of bacteria that live in your gastrointestinal (GI) tract. There are at least 18 different species of these bacteria. Enterococcus faecalis (E. faecalis) is one of the most common species.

These bacteria also live in the mouth and vagina. They’re very resilient, so they can survive in hot, salty, or acidic environments.

E. faecalis normally lives harmlessly in your intestines. However, if it spreads to other parts of your body, it can cause a more serious infection.

The bacteria can get into your blood, urine, or a wound during surgery. From there, it can spread to different sites, causing more serious infections, including sepsis, endocarditis, and meningitis.

E. faecalis bacteria don’t usually cause problems in healthy people. But people with underlying health conditions or a weakened immune system are more likely to get sick. These infections often spread in hospitals.

In recent years, there’s been an increase in drug-resistant E. faecalis strains. Today, many antibiotics don’t work against infections caused by these bacteria.

E. faecalis infections pass from person to person due to poor hygiene. Because these bacteria are found in feces, people can transmit the infection if they don’t wash their hands after using the bathroom.

The bacteria can get into food or onto surfaces such as doorknobs, telephones, and computer keyboards. From there, they can spread to other people.

E. faecalis often spreads through hospitals if healthcare workers don’t wash their hands. Improperly cleaned catheters, dialysis ports, and other medical devices can also carry E. faecalis.

Thus, people who have an organ transplant, kidney dialysis, or cancer treatment are at increased risk for developing infections due to immune suppression or contamination through their catheters.

Symptoms depend on which type of infection you have. They can include:

  • fever
  • chills
  • fatigue
  • headache
  • abdominal pain
  • pain or burning when you urinate
  • nausea
  • vomiting
  • diarrhea
  • fast breathing or shortness of breath
  • chest pain when you breathe
  • stiff neck
  • swollen, red, tender, or bleeding gums

Related infections

E. faecalis causes a few different types of infections in people:

  • Bacteremia: This is when bacteria get into the blood.
  • Endocarditis: This is an infection of the heart’s inner lining, called the endocardium. E. faecalisand other types of enterococci bacteria cause up to 10 percent of these infections.
  • Meningitis: This is inflammation of the membranes surrounding the brain and spinal cord.
  • Periodontitis: This serious gum infection damages the bones that hold your teeth in place. It’s often found in people who’ve had a root canal.
  • Urinary tract infections: These infections affect organs like the bladder, urethra, and kidneys.
  • Wound infections: You can get an infection if bacteria get into an open cut, such as during surgery.

Most of the time people acquire these infections in hospitals.

E. faecalis infections are treated with antibiotics. One challenge is that these bacteria have become resistant to many types of antibiotics. This means that some antibiotics no longer work against these bacteria.

To make sure you get the right antibiotic, your doctor might take a sample of the bacteria. That sample will be tested in a lab to see which antibiotic works best against it.

Ampicillin is the preferred antibiotic used to treat E. faecalis infections.

Other antibiotic options include:

  • daptomycin
  • gentamicin
  • linezolid
  • nitrofurantoin
  • streptomycin
  • tigecycline
  • vancomycin

E. faecalis is sometimes also resistant to vancomycin. Strains that don’t respond to vancomycin are called vancomycin-resistant enterococcus (VRE). In this case, linezolid or daptomycin are treatment options.

More severe infections, such as endocarditis or meningitis, are treated with a combination of antibiotics.

Researchers have found the most effective treatment for E. faecalis endocarditis to be a combination of two types of antibiotics: aminoglycosides and dual beta-lactam therapy. These have also been found to be less damaging to the kidneys than other treatments.

Researchers are investigating other antibiotics that might be more effective against E. faecalis.

To prevent E. faecalis infections:

  • Wash your hands with warm water and soap throughout the day. Always wash after you use the bathroom and before you prepare or eat food. If you don’t have access to soap and water, use an alcohol-based hand sanitizer.
  • Don’t share personal items with anyone — especially people you know are sick. This includes forks and spoons, toothbrushes, or towels.
  • Wipe down shared items like TV remotes, doorknobs, and telephones with an antibacterial disinfectant.
  • When you’re in the hospital, make sure healthcare workers wash their hands or wear clean gloves when they care for you.
  • Ask that all thermometers, blood pressure cuffs, catheters, IVs, and other devices that are used in your treatment be disinfected.
  • If you have congenital heart disease or a prosthetic valve for cardiac valve repair, you’ll likely require antibiotics prior to dental or other surgical procedures as prophylaxis.

E. faecalis has become resistant to many types of antibiotics. Antibiotic-resistant infections are harder to treat. People who get infected when they are already sick have a poorer outlook.

Practicing good hygiene can help prevent E. faecalis infections.