Enterococcus: Difference between revisions
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Enterococcus
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* [[Vancomycin]] is usually reliable (except for [[Enterococcus gallinarum]] and [[Enterococcus casseliflavus]]) |
* [[Vancomycin]] is usually reliable (except for [[Enterococcus gallinarum]] and [[Enterococcus casseliflavus]]) |
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* [[Ampicillin]] is preferred for susceptible strains |
* [[Ampicillin]] or [[amoxicillin]] is preferred for susceptible strains |
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** [[Piperacillin]] is effective, as well, but not [[cloxacillin]] |
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* Inherent resistance to [[cephalosporins]] |
* Inherent resistance to [[cephalosporins]] |
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* Resistant to [[ertapenem]], but ampicillin-susceptible strains are often susceptible to [[imipenem]] and (less reliably) to [[meropenem]] |
* Resistant to [[ertapenem]], but ampicillin-susceptible strains are often susceptible to [[imipenem]] and (less reliably) to [[meropenem]][[CiteRef::fraenkel2006in]][[CiteRef::10.1093/jac/39.2.149]] |
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===VRE=== |
===VRE=== |
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Latest revision as of 14:45, 14 November 2025
Background
Microbiology
- Genus of facultative anaerobic, non-spore-forming, alpha- or gamma-hemolytic, catalase negative, Gram-positive cocci
- Grows on bile esculin agar
- PYR positive
- Most are Lancefield group D
- Commensal gut flora
- Increasing antibiotic resistance
Species
- Enterococcus faecalis
- More common (90-95%)
- More commonly genitourinary source
- More susceptible to antibiotics
- Enterococcus faecium
- Less common (5-10%)
- More commonly gastrointestinal source
- Less susceptible to antibiotics
- Most common VRE
- Enterococcus avium
- Enterococcus gallinarum
- Enterococcus casseliflavus
- Enterococcus hirae, a rare zoonotic pathogen from chickens that can cause bacteremia and endocarditis
Vancomycin Resistance
- Vancomycin binds to d-Ala-d-Ala pentapeptids, interfering with cell wall synthesis
- VanA: most common. Mutation to d-Ala-d-Lac, leading to high resistance to glycopeptides.
- VanB: more common in E. faecium in Australia
- VanC: chromosomal resistance on E. gallinarum and E. casseliflavus
Management
- Vancomycin is usually reliable (except for Enterococcus gallinarum and Enterococcus casseliflavus)
- Ampicillin or amoxicillin is preferred for susceptible strains
- Piperacillin is effective, as well, but not cloxacillin
- Inherent resistance to cephalosporins
- Resistant to ertapenem, but ampicillin-susceptible strains are often susceptible to imipenem and (less reliably) to meropenem12
VRE
- Daptomycin, doxycycline, linezolid, tedizolid, oritavancin, quinupristin-dalfopristin (for E. faecium)
- For VanC isolates, ampicillin or penicillin is preferred, and daptomycin susceptibility is often retained3
References
- ^ Carl-Johan Fraenkel, Måns Ullberg, Sverker Bernander, Evalena Ericson, Peter Larsson, Johan Rydberg, Eva Törnqvist, Åsa Melhus. In vitro activities of three carbapenems against recent bacterial isolates from severely ill patients at Swedish hospitals. Scandinavian Journal of Infectious Diseases. 2006;38(10):853-859. doi:10.1080/00365540600684371.
- ^ James H. Jorgensen, Sharon A. Crawford, Cynthia C. Kelly, Jan E. Patterson. In VitroActivity of Daptomycin against Vancomycin-Resistant Enterococci ofVarious Van Types and Comparison of Susceptibility TestingMethods. Antimicrobial Agents and Chemotherapy. 2003;47(12):3760-3763. doi:10.1128/aac.47.12.3760-3763.2003.
