Background: The use of vancomycin has continued to expand because of the increasing number of patients infected or colonized with methicillin-resistant Staphylococcus aureus, causing an increase in the prevalence of vancomycin-resistant Enterococcus (VRE). Methods: Review of the pertinent English language literature. Results: Vancomycin-resistant Enterococcus spp. are being identified more often in nosocomial infections of surgical patients. The biology of resistance, modes of transmission, patient risk factors, and current treatment strategies are discussed. Conclusions: The reservoir of resistance in enterococci looms as a major threat for genetic transfer and the emergence of increasing numbers of vancomycin-resistant S. aureus.