Enterococcus: Difference between revisions
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Enterococcus
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*[[Is treated by::Daptomycin]], [[Is treated by::doxycycline]], [[Is treated by::linezolid]], [[Is treated by::tedizolid]], [[Is treated by::oritavancin]], [[Is treated by::quinupristin-dalfopristin]] (for ''E. faecium'') |
*[[Is treated by::Daptomycin]], [[Is treated by::doxycycline]], [[Is treated by::linezolid]], [[Is treated by::tedizolid]], [[Is treated by::oritavancin]], [[Is treated by::quinupristin-dalfopristin]] (for ''E. faecium'') |
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*For VanC isolates, [[ampicillin]] or [[penicillin]] is preferred, and [[daptomycin]] susceptibility is often retained<ref>Jorgensen JH, Crawford SA, Kelly CC, Patterson JE. In vitro activity of daptomycin against vancomycin-resistant enterococci of various Van types and comparison of susceptibility testing methods. ''Antimicrob Agents Chemother''. 2003 Dec;47(12):3760-3. doi: [https://doi.org/10.1128%2FAAC.47.12.3760-3763.2003 10.1128/AAC.47.12.3760-3763.2003]. PMID: [https://pubmed.ncbi.nlm.nih.gov/14638478 14638478]; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC296189/ PMC296189].</ref> |
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{{DISPLAYTITLE:''Enterococcus''}} |
{{DISPLAYTITLE:''Enterococcus''}} |
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Revision as of 16:06, 7 November 2022
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 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 is preferred for susceptible strains
- Inherent resistance to cephalosporins
- Resistant to ertapenem, but ampicillin-susceptible strains are often susceptible to imipenem and (less reliably) to meropenem
VRE
- Daptomycin, doxycycline, linezolid, tedizolid, oritavancin, quinupristin-dalfopristin (for E. faecium)
- For VanC isolates, ampicillin or penicillin is preferred, and daptomycin susceptibility is often retained[1]
- ↑ Jorgensen JH, Crawford SA, Kelly CC, Patterson JE. In vitro activity of daptomycin against vancomycin-resistant enterococci of various Van types and comparison of susceptibility testing methods. Antimicrob Agents Chemother. 2003 Dec;47(12):3760-3. doi: 10.1128/AAC.47.12.3760-3763.2003. PMID: 14638478; PMCID: PMC296189.
