Enterococci are gram-positive cocci that inhabit the gastrointestinal tract of many organisms, including humans. Enterococci are increasingly appreciated as causative agents of infections of the urinary tract, bloodstream, endocardium, abdomen, biliary tract, burn wounds and indwelling foreign devices [28,35]. The species E. faecalis causes 79% of all enterococcal infections, with E. faecium causing most of the rest [19].Beta-hemolytic E. faecalis isolates produce a toxin which is able to lyse eukaryotic as well as kill bacterial cells, and is therefore termed cytolysin [4,13]. An association between the expression of cytolysin and enterococcal virulence was first demonstrated by the observation that 60% of clinical E. faecalis isolates were cytolytic, while only 17% of isolates derived from the feces of healthy individuals were cytolysin positive [22]. Among 190 U.S. isolates analyzed between 1984 and 1987, 44.7% were hemolytic. Of gentamicin-resistant isolates within this collection, 91.2% were also hemolytic, while only 18.8% of gentamicin-sensitive strains were hemolytic [18]. A fivefold higher risk of death within 3 weeks from the onset of bacteremia was noted when the clinical outcome of infection with hemolytic gentamicin-resistant strains was compared to that due to non-hemolytic gentamicin-sensitive strains [18].The connection between cytolysin production and mortality has been confirmed in animal disease models [21,34]. The cytolysin lyses mouse erythrocytes, macrophages and polymorphonuclear neutrophils [34], which may enable the infecting bacteria to obtain nutrients and escape immune clearance. An endophthalmitis system was developed to study the molecular pathogenesis of infection caused by cytolysin-producing strains. These studies unambiguously demonstrated organotoxicity attributable to the cytolysin [27,48]. Epidemiological data from geographically diverse centers [18,22], as well as the results from multiple animal studies [21,27,34,48] highlight the role of cytolysin as a virulence factor in enterococcal diseases.The dual nature of the cytolysin as hemolysin and bacteriocin A "streptolysin" from a Lancefield group D streptococcus was characterized by Todd in 1934 [49]. Strains expressing this factor were described as being "pseudo-hemolytic", since beta-hemolysis was easily detectable on blood agar plates, but hemolytic activity could not be detected in liquid media such as serum or Hewitt's broth. Subsequently, erythrocytes from various species were found to exhibit differing levels of susceptibility to lysis. Red blood cells from rabbit, human and horse were observed to be sensitive, while those from sheep or goose were less suceptible or completely resistant [1]. This observation is of clinical significance because sheep blood is incorporated into many commercial blood agar plates, which can result in the misidentification of cytolysin-producing E. faecalis strains as non-hemolytic.Independent of the study of the hemolytic phenotype was the description of an "inhibitory factor" produced by...