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'''''Enterococcus faecium''''' is a [[gram positive]] [[bacterium]] in the genus ''[[Enterococcus]]''. It can be a [[commensal]] (a non-harmful coexistence), in the human intestine, but it may also be a [[pathogen]] causing disease. Antibiotic resistant ''Enterococcus faecium'' is often referred to as 'VRE', [[Vancomycin-Resistant Enterococcus]].
{{Taxobox
===Antimicrobial regimen===
| regnum = [[Bacteria]]
* [[Enterococcus faecium]]
| phylum = [[Firmicutes]]
:*'''1.Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
| classis = [[Bacilli]]
::*[[Ampicillin]] or [[Penicillin]] susceptible : [[Ampicillin]] 2 g IV q4-6h {{or}} ([[Ampicillin]] {{and}} [[Gentamicin]] 1 mg/kg q8h).
| ordo = [[Lactobacillales]]
::*[[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.
| familia = [[Enterococcaceae]]
::*[[Ampicillin]] and [[Vancomycin]] resistant : [[Linezolid]] 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg IV per day
| genus = ''[[Enterococcus]]''
:*'''2.Endocarditis'''  
| species = '''''E. faecium'''''
::*2.1.Endocarditis in Adults <ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>
| binomial = ''Enterococcus faecium''
:::*Strains Susceptible to [[Penicillin]], [[Gentamicin]], and [[Vancomycin]]
| binomial_authority = (Orla-Jensen 1919)<br />Schleifer & Kilpper-Bälz 1984
::::*Preferred regimen : ([[Ampicillin|Ampicillin]] 12 g/day IV for 4–6weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU/day IV for 4–6weeks) {{and}} [[Gentamicin|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 '''
__NOTOC__
::::*Alternate regimen : [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
{{CMG}}
:::*Strains Susceptible to [[Penicillin]], [[Streptomycin]], and [[Vancomycin]] and Resistant to [[Gentamicin]]
::::*Preferred regimen : ([[Ampicillin]] 12 g/day IV for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV for 4–6weeks){{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 4–6weeks
::::*Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV 6weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg per 24 h IV/IM for 6weeks
:::*Strains Resistant to [[Penicillin]] and Susceptible to [[Aminoglycoside]] and [[Vancomycin]]
::::*β Lactamase–producing strain
::::*Preferred regimen : [[Ampicillin-sulbactam]] 12 g/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM 6weeks
::::*Alternate regimen : [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
::::*Intrinsic [[penicillin]] resistance : [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
:::*Strains Resistant to [[Penicillin]], [[Aminoglycoside]], and [[Vancomycin]]
::::*Preferred regimen : [[Linezolid]] 1200 mg/day IV/PO ≥8weeks {{or}} [[Quinupristin]]-[[Dalfopristin]]22.5 mg/kg/day IV ≥8weeks
::*2.2.Endocarditis in Pediatrics
:::*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
:::*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|Vancomycin hydrochloride]] 40 mg/kg/day IV for 6weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 6weeks
:::*Strains Resistant to [[Penicillin]] and Susceptible to [[Aminoglycoside]] and [[Vancomycin]]
::::*β 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
:::*Strains Resistant to [[Penicillin]], [[Aminoglycoside]], and [[Vancomycin]]
::::*Preferred regimen : [[Linezolid]] 30 mg/kg/day IV/PO ≥ 8weeks {{or}} [[Quinupristin]]-[[Dalfopristin]]22.5 mg/kg/day IV ≥ 8weeks


:*'''3.Meningitis'''<ref name="pmid15494903">{{vcite2 journal |vauthors=Tunkel AR, Hartman BJ, Kaplan SL, et al. |title=Practice guidelines for the management of bacterial meningitis |journal=Clin. Infect. Dis. |volume=39 |issue=9 |pages=1267–84 |year=2004 |pmid=15494903 |doi=10.1086/425368 |url= |issn=}}</ref>   
==Overview==
::*[[Ampicillin]] susceptible
'''''Enterococcus faecium''''' is a [[Gram-positive]], alpha-hemolytic or nonhemolytic [[bacterium]] in the genus ''[[Enterococcus]]''.<ref name=Sherris>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th | pages = 294–5 | publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref> It can be [[commensal]] (innocuous, coexisting organism) in the human intestine, but it may also be [[pathogen]]ic, causing diseases such as neonatal [[meningitis]] or endocarditis.
:::*Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
 
::*[[Ampicillin]] resistant
Vancomycin-resistant ''E. faecium'' is often referred to as [[vancomycin-resistant Enterococcus|VRE]].<ref name="pmid16477546">{{cite journal |author=Mascini EM, Troelstra A, Beitsma M |title=Genotyping and preemptive isolation to control an outbreak of vancomycin-resistant Enterococcus faecium |journal=Clin. Infect. Dis. |volume=42 |issue=6 |pages=739–46 |date=March 2006 |pmid=16477546 |doi=10.1086/500322?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov|display-authors=etal}}</ref>
:::*Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
 
::*[[Ampicillin]] and [[vancomycin]] resistant
Some strains of ''E. faecium'' are used as [[probiotic]]s in both animals,<ref>http://www.purinaveterinarydiets.com/Product/FortiFloraCatNutritionalSupplements.aspx</ref> and humans.<ref name="pmid24815298">{{Cite journal  | last1 = Sisson | first1 = G. | last2 = Ayis | first2 = S. | last3 = Sherwood | first3 = RA. | last4 = Bjarnason | first4 = I. | title = Randomised clinical trial: A liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome--a 12 week double-blind study. | journal = Aliment Pharmacol Ther | volume = 40 | issue = 1 | pages = 51–62 |date=Jul 2014 | doi = 10.1111/apt.12787 | PMID = 24815298 }}</ref>
:::*Preferred regimen: [[Linezolid]] 600 mg IV q12h
 
:*'''4.Urinary tract infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
==Genome sequences==
::*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
Genomes listed below are from the [http://img.jgi.doe.gov/ Integrated Microbial Genomes] website.
:*'''5.Intra abdominal or Wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
 
::*[[Penicillin]] or [[Ampicillin]] are preferred agents, [[Vancomycin]] in setting of [[penicillin]] allergy or high-level [[penicillin]] resistance.
'''The 22 sequenced ''Enterococcus faecium'' genomes'''
::*For complicated skin-skin structure and intra-abdominal infection : [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
{| class="wikitable"
{{bacteria-stub}}
|-
{{WikiDoc Sources}}
! Strain !! ST !! CC17 !! Country !! Year
|-
| 1,231,408 || 582 || Yes || NA || NA
|-
| 1,231,501 || 52 || No || NA || NA
|-
| Com15 || 583 || No || USA (MA) || 2006
|-
| 1,141,733 || 327 || No || NA || NA
|-
| 1,230,933 || 18 || Yes || NA || NA
|-
| 1,231,410 || 17 || Yes || NA || NA
|-
| 1,231,502 || 203 || Yes || NA || NA
|-
| Com12 || 107 || No || USA (MA) || 2006
|}
 
==Treatment==
 
===Antimicrobial Regimen===
:* 1. '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
::* 1.1 '''Ampicillin or penicillin susceptible'''
:::* Preferred regimen (1): [[Ampicillin]] 2 g IV q4-6h
:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
::* 1.2 '''Ampicillin resistant and vancomycin susceptible or penicillin allergy'''
:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
:::* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h
:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV q24h.
::* 1.3 '''Ampicillin and vancomycin resistant'''
:::* Preferred regimen (1): [[Linezolid]] 600 mg IV q12h
:::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg IV q24h
:* 2. '''Endocarditis'''<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = 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. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref>{{Cite web | title =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| url =http://circ.ahajournals.org/content/111/23/e394.full.pdf+html}}</ref>
::* 2.1 '''Endocarditis in adults'''
:::* 2.1.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
::::* Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU IV q24h for 4–6 weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 4–6 weeks
::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
:::* 2.1.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
::::* Preferred regimen (1): ([[Ampicillin]] 12 g IV q24h for 4–6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
::::* Preferred regimen (2): [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV q24h for 4–6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
:::* 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 IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
:::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
::::* 2.1.3.2 '''Intrinsic penicillin resistance'''
:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
:::* 2.1.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin''' 
::::* Preferred regimen (1): [[Linezolid]] 1200 mg IV/PO q24h ≥ 8 weeks
::::* Preferred regimen (2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg IV q24h ≥ 8 weeks
::* 2.2 '''Endocarditis in pediatrics'''
:::* 2.2.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
::::* Preferred regimen (1): [[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h 4–6 weeks
 
::::* Preferred regimen (2): [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h 4–6 weeks
::::* Alternative regimen: [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
:::* 2.2.2 '''Strains Susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
::::* Preferred regimen (1): [[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{and}} [[Streptomycin]] 20–30 mg/kg IV/IM q24h for 4–6 weeks
 
::::* Preferred regimen (2): [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks {{and}} [[Streptomycin]] 20–30 mg/kg IV/IM q24h for 4–6 weeks
::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
:::* 2.2.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
::::* 2.2.3.1 '''β Lactamase–producing strain''' 
:::::* Preferred regimen: [[Ampicillin-sulbactam]] 300 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
:::::* Alternative regimen: [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
::::* 2.2.3.2 '''Intrinsic penicillin resistance'''
::::* Preferred regimen: [[Vancomycin]] 40 mg/kg IV q24h {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
:::* 2.2.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg IV/PO q24h ≥ 8 weeks
::::* Preferred regimen (2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg IV q24h ≥ 8 weeks
:* 3. '''Meningitis'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }}</ref>   
::* 3.1 '''Ampicillin susceptible'''
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
::* 3.2 '''Ampicillin resistant'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
::* 3.3 '''Ampicillin and vancomycin resistant'''
:::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
:* 4. '''Urinary tract infections'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
::* Preferred regimen (1): [[Nitrofurantoin]] 100 mg PO q6h for 5 days  
::* Preferred regimen (2): [[Fosfomycin]] 3 g PO single dose
::* Preferred regimen (3): [[Amoxicillin]] 875 mg to 1 g PO q12h for 5 days
:* 5. '''Intra abdominal or wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
::* Preferred regimen (1): [[Penicillin]]  
::* Preferred regimen (2): [[Ampicillin]]
::* Alternative regimen (penicillin allergy or high-level penicillin resistance): [[Vancomycin]]
::* Alternative regimen (for complicated skin-skin structure and intra-abdominal infection): [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
 
== References ==
{{reflist|2}}
 
== Further reading ==
{{cite journal|last1=Sadowy|first1=E|last2=Luczkiewicz|first2=A|title=Drug-resistant and hospital-associated Enterococcus faecium from wastewater, riverine estuary and anthropogenically impacted marine catchment basin.|journal=BMC microbiology|date=14 March 2014|volume=14|pages=66|doi=10.1186/1471-2180-14-66|pmid=24629030|url=http://www.biomedcentral.com/1471-2180/14/66|accessdate=12 November 2014}}
 
{{Gram-positive bacterial diseases}}
 
[[Category:Enterococcus|faecium]]
[[Category:Infectious Disease Project]]

Latest revision as of 14:38, 31 July 2015

style="background:#Template:Taxobox colour;"|Template:Taxobox name
style="background:#Template:Taxobox colour;" | Scientific classification
Kingdom: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Lactobacillales
Family: Enterococcaceae
Genus: Enterococcus
Species: E. faecium
Binomial name
Enterococcus faecium
(Orla-Jensen 1919)
Schleifer & Kilpper-Bälz 1984

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Enterococcus faecium is a Gram-positive, alpha-hemolytic or nonhemolytic bacterium in the genus Enterococcus.[1] It can be commensal (innocuous, coexisting organism) in the human intestine, but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.

Vancomycin-resistant E. faecium is often referred to as VRE.[2]

Some strains of E. faecium are used as probiotics in both animals,[3] and humans.[4]

Genome sequences

Genomes listed below are from the Integrated Microbial Genomes website.

The 22 sequenced Enterococcus faecium genomes

Strain ST CC17 Country Year
1,231,408 582 Yes NA NA
1,231,501 52 No NA NA
Com15 583 No USA (MA) 2006
1,141,733 327 No NA NA
1,230,933 18 Yes NA NA
1,231,410 17 Yes NA NA
1,231,502 203 Yes NA NA
Com12 107 No USA (MA) 2006

Treatment

Antimicrobial Regimen

  • 1. Bacteremia[5]
  • 1.1 Ampicillin or penicillin susceptible
  • 1.2 Ampicillin resistant and vancomycin susceptible or penicillin allergy
  • 1.3 Ampicillin and vancomycin resistant
  • Preferred regimen (1): Linezolid 600 mg IV q12h
  • Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
  • 2.1 Endocarditis in adults
  • 2.1.1 Strains susceptible to penicillin, gentamicin, and vancomycin
  • Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
  • Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
  • Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
  • Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
  • Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
  • 2.1.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
  • 2.1.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin
  • 2.1.3.1 β Lactamase–producing strain
  • 2.1.3.2 Intrinsic penicillin resistance
  • 2.1.4 Strains resistant to penicillin, aminoglycoside, and vancomycin
  • 2.2 Endocarditis in pediatrics
  • 2.2.1 Strains susceptible to penicillin, gentamicin, and vancomycin
  • Preferred regimen (1): Ampicillin 300 mg/kg IV q24h for 4–6 weeks AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
  • Preferred regimen (2): Penicillin 0.3 MU/kg IV q24h for 4–6 weeks AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
  • Alternative regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
  • Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
  • Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
  • Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
  • 2.2.2 Strains Susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
  • Preferred regimen (1): Ampicillin 300 mg/kg IV q24h for 4–6 weeks AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
  • 2.2.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin
  • 2.2.3.1 β Lactamase–producing strain
  • 2.2.3.2 Intrinsic penicillin resistance
  • Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
  • 2.2.4 Strains resistant to penicillin, aminoglycoside, and vancomycin
  • 3. Meningitis[8]
  • 3.1 Ampicillin susceptible
  • 3.2 Ampicillin resistant
  • 3.3 Ampicillin and vancomycin resistant
  • 4. Urinary tract infections[9]
  • Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
  • Preferred regimen (2): Fosfomycin 3 g PO single dose
  • Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days
  • 5. Intra abdominal or wound infections [10]
  • Preferred regimen (1): Penicillin
  • Preferred regimen (2): Ampicillin
  • Alternative regimen (penicillin allergy or high-level penicillin resistance): Vancomycin
  • Alternative regimen (for complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

References

  1. ↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 294–5. ISBN 0-8385-8529-9.
  2. ↑ Mascini EM, Troelstra A, Beitsma M; et al. (March 2006). "Genotyping and preemptive isolation to control an outbreak of vancomycin-resistant Enterococcus faecium". Clin. Infect. Dis. 42 (6): 739–46. doi:10.1086/500322?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov. PMID 16477546.
  3. ↑ http://www.purinaveterinarydiets.com/Product/FortiFloraCatNutritionalSupplements.aspx
  4. ↑ Sisson, G.; Ayis, S.; Sherwood, RA.; Bjarnason, I. (Jul 2014). "Randomised clinical trial: A liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome--a 12 week double-blind study". Aliment Pharmacol Ther. 40 (1): 51–62. doi:10.1111/apt.12787. PMID 24815298.
  5. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  6. ↑ 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 |month= ignored (help)
  7. ↑ "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".
  8. ↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
  9. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  10. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

Further reading

Sadowy, E; Luczkiewicz, A (14 March 2014). "Drug-resistant and hospital-associated Enterococcus faecium from wastewater, riverine estuary and anthropogenically impacted marine catchment basin". BMC microbiology. 14: 66. doi:10.1186/1471-2180-14-66. PMID 24629030. Retrieved 12 November 2014.

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