Enterococcus: Difference between revisions

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Background

Microbiology

Facultative anaerobic, non-spore-forming, alpha- or gamma-hemolytic, catalase-negative, Gram-positive cocci"cocci" is not in the list (coccus, bacillus, coccobacillus, diplococcus, spirochete, curved, pleomorphic, yeast, mold) of allowed values for the "Shape" property.
Grows on bile esculin agar
PYR positive
Most are Lancefield group D
Commensal gut flora
Increasing antibiotic resistance

Species

E. faecalis
- More common (90-95%)
- More commonly genitourinary source
- More susceptible to antibiotics
E. faecium
- Less common (5-10%)
- More commonly gastrointestinal source
- Less susceptible to antibiotics
- Most common VRE
E. gallinarum
E. casseliflavus

Vacomycin 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

VRE

Daptomycin, doxycycline, linezolid, tedizolid, oritavancin, quinupristin-dalfopristin (for E. faecium)

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.
^ 10.1093/jac/39.2.149
^ 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.

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
-* Facultative anaerobic, non-spore-forming, [[Hemolysis pattern::α-hemolytic|alpha-]] or [[Hemolysis pattern::γ-hemolytic|gamma-hemolytic]], [[Catalase test::catalase-negative]], [[Stain::Gram-positive]] [[Cellular shape::cocci]]
-* Grows on bile esculin agar
-* Most are Lancefield group D
-* Commensal gut flora
-* Increasing antibiotic resistance
+*Facultative anaerobic, non-spore-forming, [[Hemolysis pattern::α-hemolytic|alpha-]] or [[Hemolysis pattern::γ-hemolytic|gamma-hemolytic]], [[Catalase test::catalase-negative]], [[Stain::Gram-positive]] [[Cellular shape::cocci]]
-=== Species ===
+*Grows on bile esculin agar
-* ''E. faecalis''
+*[[PYR test|PYR]] positive
-** More common (90-95%)
+*Most are Lancefield group D
-** More commonly genitourinary source
+*Commensal gut flora
-** More susceptible to antibiotics
+*Increasing antibiotic resistance
-* ''E. faecium''
-** Less common (5-10%)
-** More commonly gastrointestinal source
-** Less susceptible to antibiotics
-** Most common VRE
-* ''E. gallinarum''
-* ''E. casseliflavus''
-=== Vacomycin Resistance ===
+===Species===
-* 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''
+*''E. faecalis''
-== Management ==
+**More common (90-95%)
-=== VRE ===
+**More commonly genitourinary source
-* [[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'')
+**More susceptible to antibiotics
+*''E. faecium''
+**Less common (5-10%)
+**More commonly gastrointestinal source
+**Less susceptible to antibiotics
+**Most common VRE
+*''E. gallinarum''
+*''E. casseliflavus''
+===Vacomycin 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==
+===VRE===
+*[[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'')
 {{DISPLAYTITLE:''Enterococcus'' species}}