Enterococcus: Difference between revisions
From IDWiki
Enterococcus
(Imported from text file) Â |
(→â€: added VanC comment)  |
||
| (25 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
| ⚫ | |||
| ⚫ | |||
| − | == Identification == |
||
| + | ===Microbiology=== |
||
| − | * Facultative anaerobic, non-spore-forming, gamma-hemolytic, Gram positive diplococci |
||
| + | *Genus of facultative anaerobic, non-spore-forming, [[Hemolysis pattern::α-hemolytic|alpha-]] or [[Hemolysis pattern::γ-hemolytic|gamma-hemolytic]], catalase [[Catalase::negative]], [[Stain::Gram-positive]] [[Shape::coccus|cocci]] |
||
| ⚫ | |||
| + | *Grows on bile esculin agar |
||
| + | *[[PYR test|PYR]] positive |
||
| + | *Most are Lancefield group D |
||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| + | *[[Enterococcus faecalis]] |
||
| ⚫ | |||
| ⚫ | |||
| + | **More commonly genitourinary source |
||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| + | **More commonly gastrointestinal source |
||
| ⚫ | |||
| ⚫ | |||
| + | *[[Enterococcus gallinarum]] |
||
| + | *[[Enterococcus casseliflavus]] |
||
| + | *[[Enterococcus hirae]], a rare zoonotic pathogen from chickens that can cause [[bacteremia]] and [[endocarditis]] |
||
| + | ===Vancomycin Resistance=== |
||
| − | * ''E.'' ''faecalis'' |
||
| + | |||
| ⚫ | |||
| + | *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. |
||
| − | * ''E. faecium'' |
||
| + | *'''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=== |
||
| + | |||
| + | *[[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'') |
||
| + | *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> |
||
| + | |||
| + | {{DISPLAYTITLE:''Enterococcus''}} |
||
| + | [[Category:Gram-positive cocci]] |
||
Latest revision as of 12:06, 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.
