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.
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.
