Enterococcus faecalis
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| Enterococcus faecalis as viewed through a scanning electron microscope Enterococcus faecalis as viewed through a scanning electron microscope
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| Enterococcus faecalis (Orla-Jensen 1919) Schleifer & Kilpper-Bälz 1984 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Enterococcus faecalis is a Gram-positive commensal bacterium inhabiting the gastrointestinal tracts of humans and other mammals.[1] Like other species in the genus Enterococcus, E. faecalis can cause life-threatening infections in humans, especially in the nosocomial (hospital) environment: the naturally high levels of antibiotic resistance found in E. faecalis contribute to its pathogenicity.[1]
Pathogenesis
E. faecalis can cause endocarditis, as well as bladder, prostate, and epididymal infections; nervous system infections are less common.[1][2]
E. faecalis is resistant to many commonly used antimicrobial agents (aminoglycosides, aztreonam, cephalosporins, clindamycin, the semi-synthetic penicillins nafcillin and oxacillin, and trimethoprim-sulfamethoxazole). Exposure to cephalosporins is a particularly important risk factor for colonization and infection with enterococci.
Historical
Prior to 1984, enterococci were members of the genus Streptococcus: thus E. faecalis was known as Streptococcus faecalis.[3]
Treatment
Antimicrobial Regimen
- 1.Bacteremia[4]
- Ampicillin or Penicillin susceptible : Ampicillin 2 g IV q4-6h OR (Ampicillin AND Gentamicin 1 mg/kg q8h).
- Ampicillin resistant and vancomycin susceptible or Penicillin allergy : (Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg q8h) OR Linezolid 600 mg q12h OR Daptomycin 6 mg/kg per day.
- Ampicillin and Vancomycin resistant : Linezolid 600 mg q12h OR Daptomycin 6 mg/kg IV per day
- 2.Endocarditis
- 2.1.Endocarditis in Adults [5]
- 2.1.1.Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen : (Ampicillin 12 g/day IV for 4–6weeks OR Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6weeks) AND Gentamicin sulfate 3 mg/kg/day IV/IM for 4–6 weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- 2.1.2.Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen : (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV for 4–6weeks)AND Streptomycin sulfate 15 mg/kg/day IV/IM for 4–6weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV 6weeks AND Streptomycin sulfate 15 mg/kg per 24 h IV/IM for 6weeks
- 2.1.3.Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.1.3.1.β Lactamase–producing strain
- Preferred regimen : Ampicillin-sulbactam 12 g/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM 6weeks
- Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- Intrinsic penicillin resistance : Vancomycin hydrochloride 30 mg/kg/day IV for 6weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
- 2.1.4.Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen : (Imipenem OR Cilastatin 2 g/day IV for ≥ 8weeks AND Ampicillin 12 g/day IV for ≥ 8weeks) OR (Ceftriaxone sodium 4 g/day IV/IM for ≥ 8weeks AND Ampicillin 12 g/day IV for ≥ 8weeks)
- 2.2.Endocarditis in Pediatrics
- 2.2.1.Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen : (Ampicillin 300 mg/kg/day IV for 4–6 weeks OR Penicillin 300,000U/kg/day IV for 4–6 weeks) AND Gentamicin 3 mg/kg per 24 h IV/IM 4–6 weeks
- Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.2.Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen : (Ampicillin 300 mg/kg/day IV for 4–6 weeks OR Penicillin 300,000 U/kg/day IV for 4–6 weeks) AND Streptomycin 20–30 mg/kg/day IV/IM for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg/day IV for 6weeks AND Streptomycin sulfate 15 mg/kg/day IV/IM for 6weeks
- 2.2.3.Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.2.3.1β Lactamase–producing strain
- Preferred regimen : Ampicillin-sulbactam 300 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Alternate regimen : Vancomycin 40 mg/kg/day IV for 6weeks AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- Intrinsic penicillin resistance : Vancomycin 40 mg/kg/day IV AND Gentamicin 3 mg/kg/day IV/IM for 6weeks
- 2.2.4.Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen : Imipenem/cilastatin 60–100 mg/kg/day IV for ≥ 8weeks AND Ampicillin 300 mg/kg/day IVfor ≥ 8weeks
- Alternate regimen : Ceftriaxone 100 mg/kg/day IV/IM AND Ampicillin 300 mg/kg/day IV for ≥ 8weeks
- 3.Meningitis[6]
- Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h
- Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- 4.Urinary tract infections [7]
- Preferred regimen : Nitrofurantoin 100 mg PO q6h for 5 days OR Fosfomycin 3 g PO single dose OR Amoxicillin 875 mg-1 g PO q12h for 5 days
- 5.Intra abdominal or Wound infections [8]
- Penicillin or Ampicillin are preferred agents, Vancomycin in setting of penicillin allergy or high-level penicillin resistance.
- For complicated skin-skin structure and intra-abdominal infection : Tigecycline 100 mg IV single dose and 50 mg IV q12h
Prophylaxis
Antimicrobial Regimen
Gallery
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![SEM depicts a small group of Gram-positive Enterococcus faecalis bacteria. From Public Health Image Library (PHIL). [9]](/images/d/d5/Enterococcus08.jpeg)
SEM depicts a small group of Gram-positive Enterococcus faecalis bacteria. From Public Health Image Library (PHIL). [9]
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![Enterococcus faecalis cultured on an agar plate, testing for drug sensitivity in an anaerobic environment. From Public Health Image Library (PHIL). [9]](/images/7/7c/Enterococcus05.jpeg)
Enterococcus faecalis cultured on an agar plate, testing for drug sensitivity in an anaerobic environment. From Public Health Image Library (PHIL). [9]
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![SEM depicts Gram-positive Enterococcus faecalis sp. bacteria. From Public Health Image Library (PHIL). [9]](/images/c/ca/Enterococcus02.jpeg)
SEM depicts Gram-positive Enterococcus faecalis sp. bacteria. From Public Health Image Library (PHIL). [9]
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![Quantitative difference in hemolytic reactivity seen on BAP with group-D Streptococci (left wedge), group-B Streptococci (middle wedge), and group-A Streptococci (right wedge) bacteria. From Public Health Image Library (PHIL). [9]](/images/f/f5/Group_A_streptococcus04.jpeg)
Quantitative difference in hemolytic reactivity seen on BAP with group-D Streptococci (left wedge), group-B Streptococci (middle wedge), and group-A Streptococci (right wedge) bacteria. From Public Health Image Library (PHIL). [9]
![SEM depicts a small group of Gram-positive Enterococcus faecalis bacteria. From Public Health Image Library (PHIL). [9]](/index.php/File:Enterococcus08.jpeg)
![Enterococcus faecalis cultured on an agar plate, testing for drug sensitivity in an anaerobic environment. From Public Health Image Library (PHIL). [9]](/index.php/File:Enterococcus05.jpeg)
![SEM depicts Gram-positive Enterococcus faecalis sp. bacteria. From Public Health Image Library (PHIL). [9]](/index.php/File:Enterococcus02.jpeg)
![Quantitative difference in hemolytic reactivity seen on BAP with group-D Streptococci (left wedge), group-B Streptococci (middle wedge), and group-A Streptococci (right wedge) bacteria. From Public Health Image Library (PHIL). [9]](/index.php/File:Group_A_streptococcus04.jpeg)
References
- ↑ 1.0 1.1 1.2 Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. pp. 294&ndash, 5. ISBN 0-8385-8529-9.
- ↑ Pelletier LL (1996). Microbiology of the Circulatory System. in: Baron's Medical Microbiology (Baron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. ISBN 0-9631172-1-1.
- ↑ Schleifer KH; Kilpper-Balz R (1984). "Transfer of Streptococcus faecalis and Streptococcus faecium to the genus Enterococcus nom. rev. as Enterococcus faecalis comb. nov. and Enterococcus faecium comb. nov". Int. J. Sys. Bacteriol. 34: 31&ndash, 34.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
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- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ 9.0 9.1 9.2 9.3 "Public Health Image Library (PHIL)".