Enterococcus: Difference between revisions
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Enterococcus
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* [[Ampicillin]] is preferred for susceptible strains |
* [[Ampicillin]] is preferred for susceptible strains |
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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 ( |
* Resistant to [[ertapenem]], but ampicillin-susceptible strains are often susceptible to [[imipenem]] and (less reliably) to [[meropenem]] |
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===VRE=== |
===VRE=== |
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Revision as of 17:35, 19 July 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
- 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
- E. 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 E. gallinarum and E. 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)
References
- ^ 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.
