**10. Gastrointestinal infections (GI)**

GI related enterococcal infections are opportunistic infections particularly occurring during colorectal surgery and colorectal cancer. Pre-colonization with VRE in patients can result in bacteremia following antibiotic induced disruption of gut microbiota [37]. Reg IIIy, a c type lectin is secreted by intestinal epithelial and paneth cells that removes Gram positive bacteria from the gut. Antibiotic treatment causes Reg IIIy down-regulation [38]. Therapeutic strategies have been devised to prevent intestinal colonization of resistant enterococci, introducing probiotic *E. faecalis* pheromone induced killing of drug resistant *E. faecalis* reactivating Reg IIIy introducing obligate anaerobic commensal bacteria containing *Barnesiella* species which prevents *E. faecium* gut colonization and bacteremia [39]. High collagenase producing *E. faecalis* strains have been found to be associated with colorectal anastomotic leak by activating tissue matrix metalloproteinase 9 that cleaves host extracellular matrix [40]. Enterococci produce menaquinone and extracellular superoxide in intestine. This results in high oxidative stress which is linked with colorectal cancer as high genomic instability of intestinal tumor cells as around 80% of colon cancers are caused due to genetic mutations.
