Enterococcus faecalis: Difference between revisions

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''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.
''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==
==Historical Perspective==
Prior to 1984, enterococci were members of the genus ''[[Streptococcus]]'': thus ''E. faecalis'' was known as ''Streptococcus faecalis''.<ref name=Schleifer_1984>{{cite journal | author = Schleifer KH; Kilpper-Balz R | title = Transfer of ''Streptococcus faecalis'' and ''Streptococcus faecium'' to the genus ''Enterococcus'' nom. rev. as ''Enterococcus faecalis'' comb. nov. and ''Enterococcus faecium'' comb. nov. | journal= Int. J. Sys. Bacteriol. | year= 1984 | volume= 34 | issue= | pages= 31&ndash;34 | url= }}</ref>  
Prior to 1984, enterococci were members of the genus ''[[Streptococcus]]'': thus ''E. faecalis'' was known as ''Streptococcus faecalis''.<ref name=Schleifer_1984>{{cite journal | author = Schleifer KH; Kilpper-Balz R | title = Transfer of ''Streptococcus faecalis'' and ''Streptococcus faecium'' to the genus ''Enterococcus'' nom. rev. as ''Enterococcus faecalis'' comb. nov. and ''Enterococcus faecium'' comb. nov. | journal= Int. J. Sys. Bacteriol. | year= 1984 | volume= 34 | issue= | pages= 31&ndash;34 | url= }}</ref>


==Treatment==
==Treatment==


===Antimicrobial Regimen===
===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: ([[Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU IV q24h for 4–6 weeks) {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
::::* Alternate 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 6 weeks
:::::* Alternate 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): ([[Imipenem]] {{or}} [[Cilastatin]] 2 g/day IV for ≥ 8weeks) {{and}} [[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8 weeks
::::* Preferred regimen (2): [[Ceftriaxone sodium]] 4 g IV/IM q24h for ≥ 8weeks {{and}} [[ampicillin|Ampicillin]] 12 g IV q24h for ≥ 8 weeks
::* 2.2 '''Endocarditis in pediatrics'''
:::* 2.2.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks) {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h 4–6 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.
::::* Alternate regimen : [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
:::* 2.2.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks) {{and}} [[Streptomycin]] 20–30 mg/kg IV/IM q24h for 4–6 weeks
::::* Alternate 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
:::::* Alternate 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: [[Imipenem]]/[[Cilastatin]] 60–100 mg/kg IV q24h for ≥ 8 weeks {{and}} [[Ampicillin]] 300 mg/kg IV q24h for ≥ 8 weeks
::::* Alternate regimen: [[Ceftriaxone]] 100 mg/kg IV/IM q24h {{and}} [[Ampicillin]] 300 mg/kg IV q24h for ≥ 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


* Enterococcus faecalis
:* Bacteremia, catheter-related infection
::* Preferred regimen:
:* Endocarditis
::* Preferred regimen:
:* Meningitis
::* Preferred regimen:
:* Urinary tract infection, intra-abdominal infection, wound infection
::* Preferred regimen:
==Prophylaxis==
===Antimicrobial Regimen===
==Gallery==
==Gallery==


Latest revision as of 21:07, 30 July 2015

Enterococcus faecalis
Enterococcus faecalis as viewed through a scanning electron microscope
Enterococcus faecalis as viewed through a scanning electron microscope
Scientific classification
Kingdom: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Lactobacillales
Family: Enterococcaceae
Genus: Enterococcus
Species: E. faecalis
Binomial name
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 Perspective

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]
  • 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: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 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.
  • Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
  • 2.2.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
  • 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
  • 2.2.4 Strains resistant to penicillin, aminoglycoside, and vancomycin
  • 3. Meningitis[7]
  • 3.1 Ampicillin susceptible
  • 3.2 Ampicillin resistant
  • 3.3 Ampicillin and vancomycin resistant
  • 4. Urinary tract infections [8]
  • 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 [9]
  • 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

Gallery

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  5. ↑ 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)
  6. ↑ "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".
  7. ↑ 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.
  8. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  9. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  10. ↑ 10.0 10.1 10.2 10.3 "Public Health Image Library (PHIL)".

External links

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