Grant: Project Grant

Enterococci are gram positive bacteria which cause important human disease. They are major causes of infections involving the urinary tract and the liver and bile ducts. When enterococci get into the blood stream (bacteremia) they can cause deep seated and life threatening infections, including infections of the bones (osteomyelitis) and heart valves (endocarditis). Enterococci are the number three cause of endocarditis worldwide and the number one cause of endocarditis complicating certain types of artificial heart valves. Despite how common enterococcal infections are, there has never been a high quality randomized controlled trial focused on these organisms. For serious infections like endocarditis, much of the evidence on which we base treatment decisions is dogmatic, dates back over 50 years, and is of low quality. Building directly on the infrastructure and experience of Canada's involvement in the largest randomized controlled trial ever conducted for another gram positive bacteria (Staphylococcus aureus), we will efficiently expand to create an international platform that allows for investigation of all forms of enterococcal bloodstream infection with an initial focus on the most serious form: endocarditis, in order to generate high-quality data, inform the management, and improve outcomes for this lethal pathogen.