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PubMed1996

[Enterococci; increase in infection rate and antibiotic resistance].

Enterococci (mainly Enterococcus faecalis and E. faecium) are increasingly isolated as causative agents of infections, notably in hospitalised patients. Most infections are urinary tract infections, septicaemia and endocarditis. Dutch figures indicate that 10.8% of all bacteria isolated in seven regional microbiological laboratories were enterococci; the samples came not only from hospital infections. Of the isolates 34% were from faecal samples, 14% from urinary tract samples and 14% from genital organ samples. Antibiotic resistance is an increasing problem. Enterococci are moderately resistant to the antibiotics commonly used to treat Gram positive infections. The infections may be treated with (high dose) penicillin and (or) in combination with an aminoglycoside or with a glycopeptide. Unrestricted use of antibiotics increases the risk of resistance. Recently enterococci have been isolated which are resistant to ampicillin, gentamycin and vancomycin: such infections are virtually untreatable.

Drug Resistance, Microbial↗
PubMed1996

[Current aspects of the fecal flora of the newborn without antibiotherapy during the first 7 days of life: Enterobacteriaceae, enterococci, staphylococci].

Last years, il became obvious that the colonization pattern described in 1976-1978 was no more valid: early colonization by Enterobacteriaceae at the 2-3 rd day of life in all newborns, with constant presence of antibioresistant strainseven in non treated newborns. To establish the new pattern of colonization, the same quantitative method of dilution and culture on selective media was used daily from day 1 to day 7 (5 days only for M). The number of Enterobacteriaceae, enterococci and staphylococci was determined in the stools of 10 newborns in the Maternity unit (= M) (term 40 weeks +/- 1, birth weight 3,356 g +/- 383), 10 in the Premature nursery (= P) (term 34.9 weeks +/- 1, birth weight 2,457 g +/- 676), and 14 in the Neonatal intensive care unit (= R) (term 35.2 weeks +/- 3.8, birth weight 2,457 g +/- 763). The results establish that colonization by Enterobacteriaceae is no more constant at D3. It could be demonstrated only in 8/10 M, 1/10 P, and 6/14 R (statistically different - p < 0.01 - between M and P). At D5, 9/10 M, 5/10 P, 10/14 R, and at D7, 6/10 P and 10/14 R were colonized. Resistant Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae) could be found in only 3/10 M, 4/10 P and 6/14 R. Enterococci could be found in 1 newborn M, 2 P and 7 newborns R. Staphylococci appeared earlier: all newborns M, P and R were colonized at D2, 4 and 5 respectively. These bacteria were coagulase negative, associated with Staphylococcus aureus in 3 P. Our hypothesis is that late colonization with Enterobacteriaceae and enterococci is due to the improvement of hygiene procedures and due to the decontaminating effect of antibiotics in other treated newborns (Enterobacteriaceae by 3 rd generation cephalosporin and enterococci by pharyngeal vancomycin).

Anti-Bacterial Agents↗
PubMedDate not supplied

A clinical study of the role of enterococci as sole agents of wound and tissue infection.

Patients who had enterococci isolated from wounds or tissues were identified from laboratory records. The charts of patients with pure cultures of enterococci were reviewed to determine the degree of clinically significant infection. We found that the frequency of infections in patients with pure cultures of enterococci was not significantly different from the frequency of infections in a control series of patients with negative cultures, but that it was significantly different from the frequency of infections in a series of patients with pure cultures of Staphylococcus aureus. Our conclusion that enterococci are not by themselves significant pathogens in wound or tissue infections is supported by a few experimental studies of other authors.

Humans↗
PubMed1996

Selective medium for screening for vancomycin-resistant enterococci in faeces.

Infections caused by vancomycin-resistant enterococci (VRE) are becoming increasingly prevalent throughout the world. Control measures include detection and isolation of carriers of VRE. A selective medium to detect faecal carriage of VRE is described. The medium has a high productivity ratio (90.4%) for VRE with VanA resistance phenotype, a moderate productivity ratio (79.2%) for VRE with VanB resistance phenotype, and a relatively low productivity ratio (65.5%) for VRE with VanC resistance phenotype. There was no breakthrough of vancomycin-susceptible enterococci. The medium selected the growth of all three types of VRE, which were used to spike faecal specimens. In a limited clinical trial, six faecal specimens of carriers and contacts were screened using the selective medium. Vancomycin-resistant enterococci (Enterococcus faecalis, VanA phenotype) were detected in four of the specimens. In all four specimens the growth of VRE was nearly pure and easily identifiable.

Anti-Bacterial Agents↗
PubMed1990

The epidemiology of enterococci.

The enterococci are emerging as a significant cause of nosocomial infections, accounting for approximately 10% of hospital acquired infections. They are found as normal inhabitants of the human gastrointestinal tract, but may also colonize the oropharynx, vagina, perineal region and soft tissue wounds of asymptomatic patients. Until recently, evidence indicated that most enterococcal infections arose from patients' own endogenous flora. Recent studies, however, suggest that exogenous acquisition may occur and that person-to-person spread, probably on the hands of medical personnel, may be a significant mode of transmission of resistant enterococci within the hospital. The use of broad-spectrum antibiotics, especially cephalosporins, is another major factor in the increasing incidence of enterococcal infections. These findings suggest that barrier precautions, as applied with other resistant nosocomial pathogens, along with more judicial use of antibiotics may be beneficial in preventing nosocomial spread of resistant enterococci.

Cross Infection↗
PubMed1990

Movable genetic elements and antibiotic resistance in enterococci.

The enterococci possess genetic elements able to move from one strain to another via conjugation. Certain enterococcal plasmids exhibit a broad host range among gram-positive bacteria, but only when matings are performed on solid surfaces. Other plasmids are more specific to enterococci, transfer efficiently in broth, and encode a response to recipient-produced sex pheromones. Transmissible non-plasmid elements, the conjugative transposons, are widespread among the enterococci and determine their own fertility properties. Drug resistance, hemolysin, and bacteriocin determinants are commonly found on the various transmissible enterococcal elements. Examples of the different systems are discussed in this review.

Amino Acid Sequence↗
PubMed1979

Presumptive identification of enterococci from other D streptococci by a rapid sodium chloride tolerance test.

Ability of enterococci to cause severe disease in humans and their relative resistance to chemotherapeutic agents necessitate their differentiation from other group D streptococci. We developed and evaluated a medium that differentiates enterococci from other group D streptococci within 4 to 24 hours. The 410 clinical isolates used in this study consisted of 328 strains of enterococci and 82 strains of other group D streptococci. The method showed 100 percent sensitivity and specificity with the conventional sodium chloride test. It is simple, reliable, and rapid.

Bacteriological Techniques↗
PubMed2004

Antibiotic resistance and virulence factors among clinical and food enterococci isolated in Slovakia.

The resistance to antibiotics and the distribution of virulence factors in enterococci isolated from traditional Slovak sheep cheese bryndza was compared with strains from human infections. The occurrence of 4 enterococcal species was observed in 117 bryndza-cheese isolates. The majority of strains were identified as E. faecium (76 %) and E. faecalis (23 %). Several strains of E. durans and 1 strain of E. hirae were also present. More than 90 % of strains isolated from 109 clinical enterococci were E. faecalis, the rest belonged to E. faecium. The resistance to 6 antimicrobial substances (ampicillin, ciprofloxacin, higher concentration of gentamicin, nitrofurantoin, tetracycline and vancomycin) was tested in clinical and food enterococci. A higher level of resistance was found in clinical than in food strains and E. faecium had a higher resistance than E. faecalis; no resistance to vancomycin was detected. The occurrence of 3 virulence-associated genes, cylA (coding for hemolysin), gelE (coding for gelatinase) and esp (coding for surface protein) was monitored. Differences were found in the distribution of cylA gene between clinical and bryndza-cheese E. faecalis strains; in contrast to clinical strains (45 %), cylA gene was detected in 22 % of food isolates. The distribution of 2 other virulence factors, gelE and esp, was not significantly different in the two groups of E. faecalis strains. cylA and gelE genes were not detected in E. faecium but more than 70 % of clinical E. faecium were positive for esp, even thought none of the 79 E. faecium cheese isolates contained this gene.

Animals↗
PubMed2000

Prevalence of vancomycin-resistant enterococci in Europe.

The aim of the present study was to determine the prevalence of vancomycin-resistant enterococci (VRE) in Europe. Overall, 49 laboratories in 27 countries collected 4,208 clinical isolates of enterococci. Species identification, susceptibility testing, and van gene determination by polymerase chain reaction were performed in a central laboratory. Overall, 18 vanA and 5 vanB isolates of VRE were found. The prevalence of vanA VRE was highest in the UK (2.7%), while the prevalence of vanB VRE was highest in Slovenia (2%). Most vanA and vanB VRE were identified as Enterococcus faecium. Most VRE isolates originated from the patient's urogenital tract, skin, or digestive tract. VRE were equally distributed among clinical departments, with no clear preponderance in any single patient group. A total of 71 isolates containing the vanC gene were identified. The prevalence of vanC VRE was highest in Latvia and Turkey, where rates were 14.3 and 11.7%, respectively. Two-thirds of these isolates were identified as Enterococcus gallinarum and one-third as Enterococcus casseliflavus; the majority of these isolates were cultured from feces. Almost all isolates were obtained from hospitalized patients, mostly children. The highest prevalence of high-level gentamicin-resistant enterococci was seen in Turkey and Greece. In general, the distribution of this resistance type seemed unrelated to the occurrence of VRE. The prevalence of vanA/ vanB VRE in Europe is still low; the majority of the VRE isolates exhibit the vanC genotype and colonize the gastrointestinal tract of hospitalized children.

Adolescent↗
PubMed2004

Drug resistance in fecal enterococci in Hong Kong.

Our purpose was to estimate the rate of carriage of vancomycin-resistant enterococci (VRE) in hospitalized patients in a district hospital and in healthy subjects in the community in Hong Kong. Rectal swabs were collected from all patients admitted to the intensive care unit, and stool specimens were collected from all patients presenting with suspected antibiotic-associated diarrhea over a 2-month period. Stool specimens were also collected from healthy subjects in the community. Specimens were enriched and cultured on selective media for the isolation of enterococci. All isolates were identified, and their minimum inhibitory concentration for vancomycin was determined. Susceptibility to other antibiotics was investigated. Samples yielded 125 isolates of enterococci, the majority of isolates being Enterococcus faecalis (75) and E. faecium (35). Nine of 11 strains of E. gallinarum and 2 of 2 strains of E. casseliflavus isolated from hospitalized patients were intermediately resistant to vancomycin, but no strains highly resistant to vancomycin were isolated. Resistance to other drugs, including the fluoroquinolones, was present, and a high-level resistance to gentamicin and streptomycin was found in 37% and 46% of strains, respectively. Colonization with VRE remains low in Hong Kong. This result is supported by the low level of isolation of VRE from infections in the region and may be attributable to low levels of vancomycin use. High-level aminoglycoside resistance and fluoroquinolone resistance are common, and continued monitoring for VRE is suggested.

Adolescent↗
PubMed2007

Bacteriocin activity of enterococci from rabbits.

The antimicrobial spectrum of bacteriocin-producing enterococcal isolates from rabbits faeces, the biochemical characterization of bacteriocins, and their molecular mass and the presence of structural genes for bacteriocin production were investigated. Among enterococci selected from rabbit faeces, six strains of Enterococcus faecium (EF2019, EF1819, EF2119, EF1839, EF529, EF24/10) showed inhibitory activity against the indicators E. avium EA5, Listeria innocua LMG13568 and Listeria monocytogenes CCM4699 and against other enterococci and staphylococci tested. The molecular mass of bacteriocin-like substances ranged from 3 to 10 kDa. The presence of the structural genes for enterocins (ent) A, P and L50B was detected in all enterococci tested. However, no strain possessed the gene for ent B. E. faecium EF2019 showed the broadest inhibitory activity. A proteinaceous substance produced by the EF2019 strain was partially purified. This is a thermostable substance that is stable at pH 4.0, 7.0 and 9.0. Its production starts in the early logarithmic growth phase and culminates in the late logarithmic growth phase of the EF2019 strain. Partially purified bacteriocin (PPB) EF2019 added to the growing strain L. innocua LMG13568 (after 4 h) inhibited its growth as early as 1 h after addition with a decrease of 1.5 log cycles (5 h of cultivation). This effect was extended up to 24 h. The bacteriocinogenic E. faecium EF2019 strain and/or bacteriocin EF2019 could be utilized against contaminant bacteria, e.g. in rabbitries. More detailed studies under in vitro and in vivo conditions are in progress.

Animals↗
PubMedDate not supplied

In vitro activity of LY333328, a new glycopeptide, against extracellular and intracellular vancomycin-resistant enterococci.

The objectives of the study were to observe the activity of LY333328, a new semisynthetic glycopeptide, compared to that of vancomycin against six strains of Enterococcus faecium and Enterococcus faecalis, including four vancomycin-resistant strains. Bacteria ingested by polymorphonuclear leukocytes (PMN) as well as extracellular bacteria were studied using a colony count method. The activity against intracellular bacteria was tested with the drugs present in the extracellular medium, as well as after preincubating the PMN and removal of the drugs. LY333328 is active against the tested enterococci, regardless of their susceptibility to vancomycin, with MICs of 1-2 mg/l. It is bacteriostatic against extracellular enterococci at concentrations of 2 microg/ml and above regardless of their resistance to vancomycin. After 4 h incubation at 10 MIC, vancomycin-resistant strains of E. faecium and E. faecalis located intracellularly were reduced by 55% and 90%, respectively. Even after preincubation and removal of the drug, LY333328 had an effect at 10 MIC with a 20-30% reduction in the inoculum. The results suggest that in contrast to vancomycin, LY333328 is active against intracellular vancomycin-resistant enterococci, particularly E. faecalis, even after removal of the extracellular drug.

Anti-Bacterial Agents↗
PubMed1988

Histamine formation by enterococci isolated from home-made goat cheeses.

A survey was made of the histamine-producing capability of enterococci isolated from goat cheeses. The strains, 130 Streptococcus faecium and 106 S. faecalis, were grown in Trypticase Soy Broth Histidine medium (TSBH) at 35 degrees C for 24 h and the histamine formed was determined by fluorometry. Forty-one (31.5%) of the S. faecium strains and 2 (1.9%) of the S. faecalis strains produced histamine. The largest amount detected was 4.0 micrograms histamine/ml TSBH. Compared with the amounts of histamine produced by some Gram-negative bacteria, the histamine production by enterococci seems to be low. Under the present conditions the enterococci seem to have no relevance from a histamine intoxication point of view.

Animals↗
PubMed1993

Comparative evaluation of two methods of enumerating enterococci in foods: collaborative study.

Two methods of enumerating enterococci in foods were compared in a collaborative study. Thirteen laboratories tested four blind duplicate samples containing different levels of enterococci and two negative control samples. Freeze-dried mixtures of bacteria were used as simulated food samples. The freeze-dried samples were reconstituted and either spread directly on the surface of Slanetz and Bartley medium (SB) and incubated at 44 degrees C for 48 h or preincubated in tryptone soya agar at 37 degrees C for 2 h before being overlaid by SB and incubated at 37 degrees C for a further 46 h. The numbers CFU of enterococci recovered by the two methods were not significantly different except for one sample where the 37 degrees C method gave a somewhat higher recovery. The 44 degrees C method was less time-consuming and less laborious.

Animals↗
PubMed1992

Antibiotic-resistant enterococci.

Enterococci have emerged as an important cause of nosocomial infection. Successful antibiotic treatment of serious enterococcal infection usually depends on the synergistic bactericidal effect achieved by the combination of a cell wall-active agent, such as ampicillin or a glycopeptide, and an aminoglycoside. However, the prevalence of enterococci resistant to one or more of these antibiotics is increasing, and has resulted in serious therapeutic difficulties. The mechanisms of antibiotic resistance, and the epidemiology, laboratory diagnosis and management of infection with antibiotic-resistant enterococci are discussed.

Cross Infection↗
PubMedDate not supplied

Evaluation of in vitro antimicrobial activity of lomefloxacin against staphylococci, enterococci, Enterobacteriaceae, and Pseudomonas aeruginosa.

In vitro antimicrobial activity of lomefloxacin and other antibiotics (norfloxacin, beta-lactams, cotrimoxazole, netilmicin, and miokamycin) was evaluated against 317 clinical isolates including Staphylococcus aureus, enterococci, Enterobacteriaceae, and Pseudomonas aeruginosa. Lomefloxacin showed a high in vitro activity against a wide variety of bacterial species. Against Enterobacteriaceae, lomefloxacin displayed the highest activity (MIC90S, less than or equal to 1 microgram/ml), and it was usually more active than ampicillin and netilmicin, and often more active than cotrimoxazole. Lomefloxacin showed a good antimicrobial activity also against both methicillin-susceptible and methicillin-resistant S. aureus, as it was able to inhibit 90% of staphylococcal strains at a concentration less than or equal to 2 micrograms/ml. Against enterococci and P. aeruginosa, lomefloxacin was usually less active (MIC90S, 8 micrograms/ml). As compared to norfloxacin, lomefloxacin displayed an overall similar activity against staphylococci and enterococci, but appeared less active against Gram-negative bacteria. Bactericidal activity of lomefloxacin against E. coli, when assayed by a novel method, proved to be high, and results indicate that an oral dose of 200 mg of lomefloxacin should exert a very high bactericidal activity against E. coli in urinary tract infections, even in those sustained by large bacterial populations.

4-Quinolones↗
PubMedDate not supplied

Time-kill kinetic studies of ampicillin/sulbactam for beta-lactamase-producing enterococci.

beta-Lactamase-producing (Bla+) enterococci have now been reported from several geographic areas. Most of these strains also demonstrate high-level aminoglycoside resistance, making therapy of serious infections due to Bla+ enterococci difficult. Using time-kill kinetic studies, we evaluated the activity of ampicillin-sulbactam (Am/SB) against five clinical Bla+ Enterococcus faecalis isolates from three geographically distinct areas. Am at fourfold minimum inhibitory concentrations (MIC) concentrations did not achieve bactericidal activity as determined by time-kill kinetic studies. Am/SB achieved 99.9% reduction in growth at 24 hr at twofold MIC concentrations without an aminoglycoside in four of five strains. SB alone had little independent activity against any of the strains, but synergy of killing was achieved in all five strains with a combination of Am + SB. No synergy was shown in a Bla- control strain. Am/SB may be useful for serious infections due to Bla+ enterococci.

Ampicillin↗
PubMed1993

Species identification and determination of high-level aminoglycoside resistance among enterococci. Comparison study of sterile body fluid isolates, 1985-1991.

Enterococcus spp. have become the third most common cause of nosocomial infections. High-level aminoglycoside resistance (HLR), an important clinical concern, has been associated with some species of the enterococci. We evaluated the Vitek and API 20S systems for species identification and the Vitek for the detection of HLR. Enterococci from nosocomial infections (208 strains) at the University of Iowa Hospital (1985-1991) were tested by Vitek, API 20S, and reference methods. The error rate for species identification was 6.7% for the API 20S and 5.8% for the Vitek Gram-positive identification (GPI) cards. Both systems tended to incorrectly identify other enterococcal species as Enterococcus faecium. HLR was found in Enterococcus faecalis and E. faecium isolates only. The highest rates of HLR to streptomycin alone (17.9%) and with gentamicin (13.5%) was observed among E. faecalis strains, and to gentamicin alone (7.3%) was found among E. faecium isolates. No apparent differences in HLR rates were found from year-to-year over the 7-year enterococcus sample interval. Susceptibility errors for Vitek were among the streptomycin tests only. Our results demonstrated acceptable performance by the Vitek cards for enterococcal species identification and the detection of HLR. API 20S also provided an acceptable ability to speciate the enterococci within its data base, however, both systems must be improved by adding other clinical important Enterococcus species.

Aminoglycosides↗