Enterococcus spp

Infections acquired from an external source are referred to as exogenous infections. These infections may occur as a result of human-to-human transmission, contact with exogenous bacterial populations in the environment, and animal contact. Resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. 

The majority (85%) of uncomplicated UTIs are caused by Escherichia coli. The remaining 15% are caused by Klebsiella spp., Staphylococcus saprophyticus, Enterococcus spp., Proteus spp., and other organisms. 

Insufficiency SO years) peripheral neuropathy Enterobacteriaceae, P. aeruginosa, Enterococcus spp., anaerobes Vancomycin PLUS (1) piperacillin/tazobactam (2) imipenem/cilastatin or meropenem (3) cefepime or ceftazidime and clindamycin or metronidazole (4) ciprofloxacin or levofloxacin and clindamycin or metronidazole... 

MRSA Enterococcus spp. Vancomycin Adult 10-15 mg/kg per dose IV every 8-12 hours Pediatric6 40 mg/kg per day IV in divided doses every 6 hours Linezolid Adult 600 mg IV/oral every 12 hours Pediatric6 10 mg/kg per dose IV/oral every 8 hours ... 

Enterococcus spp. 50% resistance to methicillin Resistance to vancomycin greater... 

Vancomycin adds broad-spectrum gram-positive coverage, but increasing emergence of vancomycin-resistant organisms (e.g., Enterococcus spp.) prompts conservative use. Thus vancomycin should be included as part of the initial therapy only in the following cases ... 

Fahr, A. M. Eigner, U. Armbrust, M. Caganic, A. Dettori, G. Chezzi, C. Bertoncini, L. Benecchi, M. Menozzi, M. G. Two-center collaborative evaluation of the performance of the BD Phoenix automated microbiology system for identification and antimicrobial susceptibility testing of Enterococcus spp. and Staphylococcus spp. J. Clin. Microbiol. 2003, 41,1135-1142. 

On the basis of log bacterial survival rates, the antibacterial activity of rifaximin was greater than that of paromomycin against Enterococcus spp., anaerobic cocci, Bac-terioides spp. and Clostridium spp. isolated in fecal samples from 20 patients with subclinical hepatic encephalopathy (fig. 4) [81]. On the other hand, E. coli dead Klebsiella spp. appeared more susceptible to paromomycin while both antibiotics showed equal potency against Proteus spp. [81]. Here again it should be pointed out that stool concentrations of rifaximin are 250-500 times higher than the MIC90 values [71], which makes the in vitro differences of activity between this and other antimicrobials meaningless from a clinical standpoint. 

To understand the role of antibiotics, it is important to understand their effects on the fecal flora. The normal flora consists of a complex bacterial population with 400-500 distinct species of bacteria (table 2a). More than 99% of the total organisms are accounted for by non-sporeforming anaerobic rods [28] the four major species are Bacteroides, bifidobacteria, eubacteria and peptostrepto-cocci [29], Other common species are Escherichia coli, Streptococcus viridans, Streptococcus salivarius and lacto-bacilli. Mette et al. [30] clarified the prevalence of species in fecal flora by listing the four most common anaerobes Bacteroides spp., Eubacterium spp., Bifidobacterium spp. and anaerobic cocci) and three common aerobes E. coli spp., Enterococcus spp. and Lactobacillus spp.) (table 2b). 

Synergistic combinations may produce better results in infections caused by Pseudomonas aeruginosa, in certain infections caused by Enterococcus spp. 

Martins da Costa P, Vaz-Pires P, Bernardo F (2006) Antimicrobial resistance in Enterococcus spp. isolated in inflow, effluent and sludge from municipal sewage water treatment plants. Water Res 40(8) 1735-1740... 

Luczkiewicz A, Jankowska K, Kurlenda J et al (2010) Identification and antimicrobial resistance of Enterococcus spp. isolated from surface water. Water Sci Technol 62(2) 466-473... 

Vancoresmycin (125) is a metabolite extacted from the mycelium of an actinomycete strain of the genus Amycolatopsin sp. It exhibited potent activity against gram-positive bacteria, including vancomycin-resistant strains such as Enterococcus spp. [191], but was inactive towards gramnegative bacteria and showed no fungal activity. The plane structure was derived from MS and NMR studies which also revealed the stereochem-... 

Pepeljnjak S, Kosalec I. 2004. Galangin expresses bactericidal activity against multiple-resistant bacteria MRSA, Enterococcus spp. and Pseudomonas aeruginosa. FEMS Microbiol Lett 240 111-116. 

Nordmann, P. et al. 2007. Superbugs in the coming new decade multidrug resistance and prospects for treatment of Staphylococcus aureus, Enterococcus spp. and Pseudomonas aeruginosa in 2010. Cun Opin. Microbiol. 10, 436 -40. 

It warrants mention that resistance to a particular antimicrobial agent in vitro may not preclude successful treatment with the drug as long as high concentrations are achieved in urine. Similarly, demonstrable susceptibility in vitro does not always guarantee a successful response to treatment. For example. Enterococcus spp. is often found to be susceptible to the potentiated sulfonamide combinations in vitro however, this pathogen is inherently resistant to these combinations in vivo (Jose-Cunilleras Hinchcliff 1999, Schott 1998). Antimicrobial therapy should be continued for at least 1 week for the treatment of lower UTIs and for 2-6 weeks for upper UTls in horses. Ideally, a voided, midstream urine sample should be submitted for bacterial culture 2-4 days after the initiation of therapy and again 1-2 weeks after treatment has been discontinued. 

Gastrointenstinal tract Enterococcus spp. Peptostreptococcus spp. Lactobacillus, Clostridium Bacteroides spp. Enteric bacilli (f. coli, Klebsiella spp.) ... 

Arizcun C, Barcina Y, Torre P (1997) Identification and characterization of proteolytic activity of Enterococcus spp. isolated from milk and Roncal and Idiazabal cheese. Int J Food Microbiol 38 17-24... 

Domig KJ, Mayer HK, Kneifel W (2003) Methods used for the isolation, enumeration, characterization and identification of Enterococcus spp. 2. Pheno- and genotypic criteria. Int J Food Microbiol 88 165-188... 

Svec P, Vancanneyt M, Seman M, Snauwaert C, Lefebvre K, Sedlacek I, Swings J (2005) Evaluation of (GTG)5-PCR for identification of Enterococcus spp. EEMS Microbiol Lett 247 59-63... 

Multiple-antibiotic-resistant enterococci—Many Enterococcus spp. are now resistant to penicillin and ampi-cillin, gentamicin or streptomycin or both, and to vancomycin. Some of these strains are snsceptible in vitro to chloramphenicol, doxycycline or flnoroqninolones, bnt clinical results with these drugs have been variable. 

Portillo, A., Ruiz-Larrea, F., Zarazaga, M., Alonso, A., Martinez, J. L., and Torres, C. (2000). Macrolide resistance genes in Enterococcus spp. Antimicrob. Agents Chemother. 44, 967-971. 

Indicated only for non-methicillin-resistant strains of Staphylococcus aureus and Staphylococcus epidermidis. Compared to other penicillins, these penicillinase-resistant penicillins lack activity against Listeria monocytogenes and Enterococcus spp. 

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