Enterococcus faecalis: Difference between revisions

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===Antimicrobial Regimen===
===Antimicrobial Regimen===
*[[Enterococcus faecalis]]
:*'''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>
::*[[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''' <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>
:::*2.1.1Strains Susceptible to [[Penicillin]], [[Gentamicin]], and [[Vancomycin]]
::::*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 '''
::::*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
:::*2.1.2Strains 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
:::*2.1.3Strains Resistant to [[Penicillin]] and Susceptible to [[Aminoglycoside]] and [[Vancomycin]]
::::*2.1.3.1β 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
:::*2.1.4Strains Resistant to [[Penicillin]], [[Aminoglycoside]], and [[Vancomycin]]
::::*Preferred regimen : ([[Imipenem]] {{or}} [[Cilastatin]] 2 g/day IV for ≥ 8weeks {{and}} [[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8weeks) {{or}} ([[Ceftriaxone sodium]] 4 g/day IV/IM for ≥ 8weeks {{and}} [[ampicillin|Ampicillin]] 12 g/day IV for ≥ 8weeks)
::*'''2.2Endocarditis in Pediatrics'''
:::*2.2.1Strains 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
:::*2.2.2Strains 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
:::*2.2.3Strains 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
::*2.2.4Strains 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


* Enterococcus faecalis
:*'''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>  
:* Bacteremia, catheter-related infection
:::*[[Ampicillin]] susceptible
::* Preferred regimen: Ampicillin 9-12 g daily IV in divided doses q4-6h for 14 days {{or}} Penicillin G 8-30 million units IV daily divided q4-6h for 14 days {{or}} Vancomycin 30 mg/kg daily IV in divided doses for 14 days  
::::*Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
 
:::*[[Ampicillin]] resistant
:* Endocarditis
::::*Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
::* Preferred regimen:
:::*[[Ampicillin]] and vancomycin resistant
::*Vancomycin resistent :
::::*Preferred regimen: [[Linezolid]] 600 mg IV q12h
:::* High level resistance to aminoglycoisdes
::*'''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>
::::*Ampicillin {{and}} (aminoglycosides {{or}} ceftriaxone)
:::*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
:::::*If penicillin allergy and cannot desensitize: Daptomycin {{and}} aminoglycoside
::*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>
:::* No high level resistance to aminoglycosides
:::*[[Penicillin]] or [[Ampicillin]] are preferred agents, [[Vancomycin]] in setting of [[penicillin]] allergy or high-level [[penicillin]] resistance.
::::*Ampicillin {{and}} (ceftriaxone {{or}} cefotaxime)
:::*For complicated skin-skin structure and intra-abdominal infection : [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
 
:* Meningitis
::* Preferred regimen: (Ampicillin 2 g q4h IV for 14 days {{or}} Penicillin G 4 million units q4h IV for 14 days) {{and}} (Gentamycin 2 mg/kg loading dose, followed by 1.7 mg/kg IV q8h {{or}} Streptomycin 7.5 mg/kg body weight q12h (evaluation of drug levels is strongly recommended) for 14 days )
:* Urinary tract infection, intra-abdominal infection, pelvic infection,  wound infection
::* 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
:* Neonatal infections
 
:*Skin and soft tissue infections (wound infection)


==Prophylaxis==
==Prophylaxis==

Revision as of 22:06, 9 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

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]
  • 2.Endocarditis
  • 2.1.Endocarditis in Adults [5]
  • 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
  • 2.2Endocarditis in Pediatrics
  • 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
  • 2.2.3.1β Lactamase–producing strain
  • 3.Meningitis[6]
  • 4.Urinary tract infections [7]
  • Intra abdominal or Wound infections [8]

Prophylaxis

Antimicrobial Regimen

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. ↑ Lua error: expandTemplate: template "citation error" does not exist.
  7. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  8. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  9. ↑ 9.0 9.1 9.2 9.3 "Public Health Image Library (PHIL)".

External links

Retrieved from "https://www.wikidoc.org/index.php?title=Enterococcus_faecalis&oldid=1117317"