Enterococcus sp. is a common, gram-positive bacteria that can normally be found in the bowel and female genital tract. These bacteria can be spread by fecal-oral transmission, contact with infected body fluids or contact with contaminated surfaces.
Clinical infections caused by Enterococcus include urinary tract infections, bacteremia, bacterial endocarditis, diverticulitis, and meningitis. Sensitive strains of these bacteria can be treated with ampicillin and vancomycin. The most important feature of this genus is their high level of antibiotic resistance.
Enterococcus species are hardy, facultative anaerobic organisms that can survive and grow in many environments. In the laboratory, enterococci are distinguished by their morphologic appearance on Gram stain and culture (gram-positive cocci that grow in chains) and their ability to:
(1) hydrolyze esculin in the presence of bile,
(2) grow in 6.5% sodium chloride,
(3) demonstrate pyrrolidonyl arylamidase and leucine aminopeptidase,
(4) react with group D antiserum.
Before they were assigned their own genus, they were known as group D streptococci.
Enterococcus faecalis and Enterococcus faecium are the most prevalent species cultured from humans, accounting for more than 90% of clinical isolates. Other enterococcal species known to cause human infection include:
Enterococcus avium
Enterococcus gallinarum
Enterococcus casseliflavus
Enterococcus durans
Enterococcus raffinosus
Enterococcus mundtii
Enterococcus faecium
Vancomycin-resistant enterococci (VRE) have caused hospital outbreaks worldwide, and the vancomycin-resistance gene (vanA) has crossed genus boundaries to methicillin-resistant Staphylococcus aureus. Spread of VRE, therefore, represents an immediate threat for patient care and creates a reservoir of mobile resistance genes for other, more virulent pathogens. .
Enterococcus faecium has become an important nosocomial [hospital-acquired] pathogen, especially in immunocompromised patients, creating serious limitations in treatment options because of cumulative resistance to antimicrobial agents. In the United States, the emergence of nosocomial E. faecium infections was characterized by increasing resistance to ampicillin in the 1980s and a rapid increase of vancomycin resistance in the next decade. The emergence of vancomycin-resistant E. faecium (VREF) in the United States illustrates the transmission capacities of bacteria and the possibility of a postantibiotic era for nosocomial infections in critically ill patients.
The global epidemiology of VREF is not well understood. In the United States, prevalences of colonization and infection are high among hospitalized patients, but a community reservoir of VREF in healthy persons or animals seems to be absent. In contrast, in Europe, colonization and infection rates within hospitals remain low, although colonization among healthy persons and animals is prevalent.
Enterococcus faecalis
Enterococcus faecalis is a commensal bacteria inhabiting the intestinal tracts of both humans and animals. Enterococcus faecalis is known to be capable of causing life-threatening infections in humans, particularly in the nosocomial [hospital] environment. The existence of enterococci in such a dual role is facilitated, at least in part, by its intrinsic and acquired resistance to virtually all antibiotics currently in use.
Enterococci are resistant to many commonly used antimicrobial agents (aminoglycosides, aztreonam, cephalosporins, clindamycin, the semi-synthetic penicillins nafcillin and oxacillin, and trimethoprim-sulfamethoxazole). Exposure to cephalosporins is a particularly important risk factor for colonization and infection with enterococci. Thus, the era in which safe and effective cephalosporins became widely available has also been an era of enterococcal ascendance.
E. faecalis can cause endocarditis, as well as bladder, prostate, and epididymal and nervous system infections.
Enterococcal Infections
Multiple-Drug Resistant Enterococci
Overview of Vanocomycin-resistant Enterococci (VRE)
