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PubMed1995

Correlation between phenotypic characteristics and DNA relatedness within Enterococcus faecium strains.

We noted that a number of enterococcal strains isolated from human clinical specimens resembled Enterococcus faecium but were able to produce acid from glycerol, raffinose, and/or sorbitol, while others failed to form acid from mannitol. An additional concern was that many of these strains with atypical phenotypic characteristics also appeared to acquire vancomycin resistance. In order to determine if such atypical strains were variants of E. faecium or new Enterococcus species, 35 E. faecium or E. faecium-like strains (grouped into 10 phenotypes on the basis of the results of the following tests: capacity to form acid from glycerol, mannitol, raffinose, or sorbitol and susceptibility to vancomycin) and four strains of Enterococcus faecalis were taken from our culture collection, analyzed for their whole-cell protein profiles by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and identified to the species level by DNA-DNA reassociation experiments. All E. faecium-like strains, including four mannitol-negative variants, conformed to at least two of three DNA-DNA relatedness criteria: they were 70% or more related to the type strain of E. faecium at optimal conditions, they had less than 5% divergence within the related sequences, and they had a relatedness of 60% or greater under stringent conditions. The protein profiles of atypical strains were similar to those of typical strains and were easily distinguishable from those of E. faecalis and other enterococcal species. The five E. faecalis strains were 12 to 16% related to the E. faecium type strain. These results indicate that the phenotypic description of E. faecium should include all of these variable characteristics.

Bacterial Proteins↗
PubMed1996

Revised approach for identification and detection of ampicillin and vancomycin resistance in Enterococcus species by using MicroScan panels.

The frequency of antimicrobial agent-resistant enterococci is increasing, making accurate identification and screening for susceptibility essential. We evaluated the ability of MicroScan Positive Breakpoint Combo Type 6 panels (Dade MicroScan Inc., West Sacramento, Calif.) to identify Enterococcus species and to detect ampicillin and vancomycin resistance. A total of 398 well-characterized Enterococcus isolates from two institutions were inoculated into MicroScan panels, into conventional biochemical assays, and into ampicillin and vancomycin agar dilution media. Resistance was verified by the broth macrodilution method. MicroScan panels accurately detected resistance to ampicillin in 132 of 132 enterococcal isolates, while three isolates for which the MICs were < 16 micrograms/ml were classified incorrectly by MicroScan panels as resistant. No beta-lactamase-producing enterococci were detected. All 64 isolates showing resistance to vancomycin (MICs > or = 32 micrograms/ml) were correctly classified by MicroScan panels. Seven isolates for which the vancomycin MICs were 8 and 16 micrograms/ml were incorrectly classified as susceptible by MicroScan panels, while eight isolates for which the MICs were 4 micrograms/ml were incorrectly labeled as intermediate. Fourteen of these 15 isolates were subsequently identified as motile enterococci. Overall, there were three major errors in susceptibility testing for ampicillin and 15 minor errors for vancomycin. Conventional testing confirmed the identity of 181 Enterococcus faecalis isolates, 157 E. faecium isolates, and 60 isolates of other species; however, 56 of these 60 isolates were misidentified by the MicroScan panels. After recognition of this problem, a revised approach which included tests for pigment, motility, and sucrose fermentation was devised. In combination with these additional assays, the conventional MicroScan panels accurately identified the 56 originally misidentified isolates. In summary, the ability of MicroScan panels to detect vancomycin and ampicillin resistance in enterococci was confirmed. Our study found that the inability of MicroScan panels to identify enterococci other than E. faecalis and E. faecium can be compensated for by the addition of standard assays.

Ampicillin Resistance↗
PubMed2001

Infection of central nervous system by motile Enterococcus: first case report.

A 66-year-old man with four indwelling ventriculoperitoneal shunts for multiloculated hydrocephalus from a complicated case of meningitis a year before developed shunt infection based on a syndrome of fever, drowsiness, and cerebrospinal fluid neutrophil pleocytosis in the background of repeated surgical manipulation to relieve successive shunt blockages. The cerebrospinal fluid culture, which yielded a motile Enterococcus species, was believed to originate from the gut. This isolate was lost in storage and could not be characterized further. The patient improved with vancomycin and high-dose ampicillin therapy. He relapsed a month later with Enterococcus gallinarum shunt infection, which responded to high-dose ampicillin and gentamicin therapy. This is probably the first case report of motile Enterococcus infection of the central nervous system.

Aged↗
PubMed2025

The NagY antiterminator in Enterococcus faecalis: a novel regulatory mechanism and its impact on cell metabolism.

The Enterococcus genus is the most controversial group of lactic acid bacteria. While some strains are used as probiotics, other species, including Enterococcus faecalis, are responsible for health-related pathologies. Under conditions of infection, the N-acetylglucosamine metabolism of E. faecalis undergoes significant changes in expression, even more important than those of virulence factors. This metabolism is mediated by the nagY-nagE operon, which is regulated by the transcriptional antiterminator NagY. In this report, we focus on the regulatory mechanism of NagY and its impact on bacterial metabolism. We showed that NagY requires the interaction with the RNase III to achieve optimal induction of its own expression by cleaving the 5' untranslated region of the nagY mRNA. The NagY regulon was identified and the central role of the antiterminator in the E. faecalis metabolism was demonstrated, highlighting its importance in the opportunistic nature of the bacterium. This study provides a valuable advance in the understanding of regulation and the importance of post-transcriptional actors in E. faecalis adaptation.IMPORTANCEAs a commensal, Enterococcus faecalis colonizes the gastrointestinal tract of 31 to 80% of the intestinal microbiota in adults and is considered ubiquitous, due to its strong environmental stress resistance capabilities. However, in immunocompromised patients, the poorly understood transition from commensal to opportunistic pathogen occurs, and many studies suggest that the metabolism plays a central role in this process. In this study, we focus on the regulator NagY, which is involved in the metabolism of N-acetylglucosamine, an important carbon source for bacterial pathogens in the human host. We characterized a novel regulatory mechanism involving the NagY antiterminator and the ribonuclease RNase III. In addition, we identified the target genes of the regulator, through which we were able to demonstrate that NagY has a strong impact on the metabolism of &#x3b2;-glucosides. Overall, this work highlights the importance of regulation of the bacterial metabolic adaptation in the host.

Enterococcus faecalis↗
PubMed2003

Evaluation of recreational health risk in coastal waters based on enterococcus densities and bathing patterns.

We constructed a simulation model to compute the incidences of highly credible gastrointestinal illness (HCGI) in recreational bathers at two intermittently contaminated beaches of Orange County, California. Assumptions regarding spatial and temporal bathing patterns were used to determine exposure levels over a 31-month study period. Illness rates were calculated by applying previously reported relationships between enterococcus density and HCGI risk to the exposure data. Peak enterococcus concentrations occurred in late winter and early spring, but model results showed that most HCGI cases occurred during summer, attributable to elevated number of exposures. Approximately 99% of the 95,010 illness cases occurred when beaches were open. Model runs were insensitive to 0-10% swimming activity assumed during beach closure days. Comparable illness rates resulted under clustered and uniform bather distribution scenarios. HCGI attack rates were within federal guidelines of tolerable risk when averaged over the study period. However, tolerable risk thresholds were exceeded for 27 total days and periods of at least 6 consecutive days. Illness estimates were sensitive to the functional form and magnitude of the enterococcus density-HCGI relationships. The results of this study contribute to an understanding of recreational health risk in coastal waters.

California↗
PubMed2004

Clonal dissemination of VanA-type glycopeptide-resistant Enterococcus faecalis between hospitals of two cities located 100 km apart.

Nosocomial dissemination of glycopeptide-resistant enterococci represents a major problem in hospitals worldwide. In Brazil, the dissemination among hospitals in the city of São Paulo of polyclonal DNA profiles was previously described for vancomycin-resistant Enterococcus faecium. We describe here the dissemination of VanA phenotype E. faecalis between two hospitals located in different cities in the State of São Paulo. The index outbreak occurred in a tertiary care university hospital (HCUSP) in the city of São Paulo and three years later a cluster caused by the same strain was recognized in two patients hospitalized in a private tertiary care hospital (CMC) located 100 km away in the interior of the state. From May to July 1999, 10 strains of vancomycin-resistant E. faecalis were isolated from 10 patients hospitalized in the HCUSP. The DNA genotyping using pulsed-field gel electrophoresis (PFGE) showed that all isolates were originated from the same clone, suggesting nosocomial dissemination. From May to July 2002, three strains of vancomycin-resistant E. faecalis were isolated from two patients hospitalized in CMC and both patients were colonized by the vancomycin-resistant Enterococcus in skin lesions. All isolates from CMC and HCUSP were highly resistant to vancomycin and teicoplanin. The three strains from CMC had minimum inhibitory concentration >256 micro g/ml for vancomycin, and 64 (CMC 1 and CMC 2) and 96 micro g/ml (CMC 3) for teicoplanin, characterizing a profile of VanA resistance to glycopeptides. All strains had the presence of the transposon Tn1546 detected by PCR and were closely related when typed by PFGE. The dissemination of the E. faecalis VanA phenotype among hospitals located in different cities is of great concern because E. faecalis commonly colonizes the gastrointestinal tract of patients and healthy persons for periods varying from weeks to years, which, together with the persistence of vancomycin-resistant Enterococcus in hospital rooms after standard cleaning procedures, increases the risk of the dissemination and reservoir of the bacteria.

Anti-Bacterial Agents↗
PubMed2004

Determination of antibiotic resistance and resistance plasmids of clinical Enterococcus species.

To determine the antibiotic resistance pattern and resistance plasmids, we studied 23 antibiotic-resistant clinical isolates of Enterococcus spp. which caused infection in Bayindir-Ankara Hospital, Turkey. Biochemical and physiological identification tests were applied by the Vitek system and compared with the results of protein profiles by SDS-PAGE. From 23 isolates, 20 were identified as E. faecalis, 2 as E. faecium and 1 as E. gallinarum. Twenty four antibiotics belong to 10 different groups were used in susceptibility tests. Multiple antibiotic resistance was determined in 10 of 23 Enterococcus spp. Overall resistance to the used antibiotics was 47.3% and low level resistance was 16.6%. Among the isolates tested, 8.7% demonstrated high level gentamicin resistance, 17.4% demonstrated high level streptomycin resistance, and 43.5% demonstrated penicillin resistance. High level vancomycin resistant Enterococcus spp. rate was 34.8%, and 60.9% exhibited low level resistance to vancomycin and teicoplanin. They contain plasmids which varied in numbers between 1 and 11 and the plasmid sizes ranged from 2.08 to 56.15 kb. In curing experiments with acriflavine, two different plasmids were shown in different molecular sizes of 33.49 and 13.6 kb while the first determined glycopeptide and penicillin resistance, the second one determined either glycopeptide or penicillin resistance in two different E. faecalis strains. On the other hand, a 22.58 kb plasmid, determining kanamycin resistance, was detected in an E. faecium strain. After the curing experiments, an elimination of 37.17 and 44.47 kDa protein bands was shown in E. faecium EFA1 and E. faecalis EFA13 in SDS-PAGE, respectively. This survey indicates the increase of antibiotic-resistant enterococci, especially to vancomycin in our hospital isolates.

Anti-Bacterial Agents↗
PubMed1992

Aminoglycoside-resistant Streptococcus and Enterococcus species isolated from bovine mammary secretions.

A total of 117 isolates representing four Streptococcus species and 20 isolates representing two Enterococcus species from bovine mammary secretions were examined for resistance to streptomycin, kanamycin, and gentamicin. Resistance to streptomycin (85.4%) was most prevalent, followed by kanamycin (19%) and gentamicin (2.2%). Minimum inhibitory concentration of streptomycin for most organisms examined ranged from 16 to 250 micrograms/ml. For kanamycin, the minimum inhibitory concentration for most organisms was .5 to 62.5 micrograms/ml. Minimum inhibitory concentration for gentamicin was lower than for kanamycin. Two strains each of Streptococcus uberis and Enterococcus faecalis had minimum inhibitory concentration for streptomycin of greater than 2000 micrograms/ml, and two strains of E. faecalis had similar minimum inhibitory concentration for kanamycin. The minimum bactericidal concentration for all organisms was one to four times higher than minimum inhibitory concentration. None of the organisms evaluated was found to carry plasmids. Transfer of antibiotic resistance in plasmid-free strains was not achieved by mobilization with the aid of plasmid pAD1, indicating the absence of conjugative transposons. These data suggest that expression of aminoglycoside resistance of Streptococcus and Enterococcus species of bovine origin is likely due to factors other than plasmids or conjugative transposons.

Animals↗
PubMed2005

Application of oligonucleotide microarrays for bacterial source tracking of environmental Enterococcus sp. isolates.

In an effort towards adapting new and defensible methods for assessing and managing the risk posed by microbial pollution, we evaluated the utility of oligonucleotide microarrays for bacterial source tracking (BST) of environmental Enterococcus sp. isolates derived from various host sources. Current bacterial source tracking approaches rely on various phenotypic and genotypic methods to identify sources of bacterial contamination resulting from point or non-point pollution. For this study Enterococcus sp. isolates originating from deer, bovine, gull, and human sources were examined using microarrays. Isolates were subjected to Box PCR amplification and the resulting amplification products labeled with Cy5. Fluorescent-labeled templates were hybridized to in-house constructed nonamer oligonucleotide microarrays consisting of 198 probes. Microarray hybridization profiles were obtained using the ArrayPro image analysis software. Principal Components Analysis (PCA) and Hierarchical Cluster Analysis (HCA) were compared for their ability to visually cluster microarray hybridization profiles based on the environmental source from which the Enterococcus sp. isolates originated. The PCA was visually superior at separating origin-specific clusters, even for as few as 3 factors. A Soft Independent Modeling (SIM) classification confirmed the PCA, resulting in zero misclassifications using 5 factors for each class. The implication of these results for the application of random oligonucleotide microarrays for BST is that, given the reproducibility issues, factor-based variable selection such as in PCA and SIM greatly outperforms dendrogram-based similarity measures such as in HCA and K-Nearest Neighbor KNN.

Animals↗
PubMed2004

Cloning of the bile salt hydrolase (bsh) gene from Enterococcus faecium FAIR-E 345 and chromosomal location of bsh genes in food enterococci.

Enterococcus faecium strain FAIR-E 345 isolated from food was shown to possess bile salt hydrolase (Bsh) activity in a plate screening assay and by high-performance liquid chromatography analysis. The bsh gene was cloned and sequenced. DNA sequence analysis revealed that it encoded a protein of 324 amino acids, with pI 4.877. A bsh gene probe was prepared from the cloned bsh gene and was used for probing plasmid and total genomic DNA of Bsh-positive enterococci isolated from food to determine the genomic location of their bsh genes. This probe was able to detect the bsh gene among total genomic DNA preparations but not from plasmid preparations of 10 plasmid-bearing Enterococcus strains. However, the probe could detect the bsh gene from total genomic DNA preparations of 12 Enterococcus strains that did not contain detectable plasmid DNA. In no cases did the probe hybridize with plasmid DNA preparations, suggesting that the bsh gene among enterococci is probably generally chromosomally encoded. This presumptive chromosomal location of bsh genes among food enterococci suggests that transfer of this trait by conjugative plasmids is unlikely.

Amidohydrolases↗
PubMed1992

Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers.

OBJECTIVES: To describe an epidemic of vancomycin-resistant Enterococcus faecium causing bacteremia and bacteriuria, to identify the source of infection, to delineate risk factors associated with acquisition of the organism, and to determine antibiotic sensitivities for the organism. DESIGN: Investigation of an epidemic, including a case-control study. SETTING: Medical-surgical intensive care unit and ward in a university medical center. PATIENTS: Nine patients infected or colonized with vancomycin-resistant Enterococcus faecium and 20 noninfected controls. MEASUREMENTS: Clinical data, environmental surveillance cultures, and in-vitro microbiologic studies. RESULTS: Colonization or infection by vancomycin-resistant E. faecium was associated with an increased duration of treatment with ceftazidime, 13.2 compared with 4.6 days, and a greater number of nonisolated days of hospitalization in the intensive care unit, 19.9 compared with 6.4 days for infected and noninfected patients, respectively (P less than 0.05). Environmental surveillance cultures recovered the organism repeatedly from the rectal probe handles of three electronic thermometers used exclusively on nonisolated patients in the intensive care unit. Restriction endonuclease analysis of plasmid DNA showed that all clinical and environmental isolates were identical. Infection control measures, including isolation of colonized or infected patients and removal of the rectal thermometer probes suspected to be responsible for transmission, resulted in termination of the outbreak. In-vitro, time-kill studies showed that the combination of ciprofloxacin, rifampin, and gentamicin resulted in bactericidal activity against the organism. CONCLUSIONS: This nosocomial outbreak of infection due to a highly vancomycin-resistant strain of Enterococcus is the first epidemic in which an electronic thermometer has been implicated as the vehicle of transmission for an infectious agent.

Adolescent↗
PubMed1998

[Gentamicin resistance of enterococcus genus strains isolated from clinical material].

The occurrence of High Level Gentamicin Resistance (HLGR) was tested among the strains of Enterococcus genus isolated from material potent to microbiological laboratory. The investigation included 184 strains of enterococci, and among them 178 strains of Enterococcus faecalis (96.7%) and 6 strains of Enterococcus faecium (3.3%). HLGR was detected with disks-diffusion method with disks containing 120 micrograms of gentamicin. The screen method with MHA-2 containing 500 mg/l of gentamicin in doubtful results was used. The resistance to high concentration of gentamicin was detected in 29 strains of enterococci (15.76%). The highest percentage of HLGR was proved among strains of enterococci isolated from pyogenic material of hospitalised patients (27.3%).

Anti-Bacterial Agents↗
PubMed1999

[Drug resistance of 100 clinical strains of Enterococcus spp].

The aim of this study was to evaluate the drug susceptibility of 100 Enterococcus spp. strains isolated from patients hospitalized in State Clinical Hospital No 1 in Warsaw. All strains were identified (API 20 STREP) and their susceptibility to antibiotics was tested (ATB STREP) in automatic ATB system. Additionally, PYRase activity, beta-lactamase production (in nitrocefin test), MICs for vancomycin and teicoplanin (E test), HLAR--high level aminoglycoside resistance and susceptibility to vancomycin, teicoplanin, piperacillin and piperacillin/tazobactam (disc diffusion method) were determined. E. faecalis ATCC 29212 was used as the control strain. Fifty E. faecalis, 45 E. faecium, 2 E. casseliflavus, 2 E. durans and 1 E. avium strain were cultured. All strains were PYRase-positive and beta-lactamase-negative. Ten isolates demonstrated intermediate susceptibility to vancomycin (6--E. faecalis and 4--E. faecium). One E. faecalis strain was intermediately susceptible to both glycopeptides. One E. casseliflavus strain showed low-level resistance to vancomycin, but this strain was susceptible to teicoplanin--phenotype Van C. HLAR strains were found among 31 E. faecalis and 40 E. faecium strains. 48 E. faecalis strains were susceptible to piperacillin and 49 to piperacillin/tazobactam. Whereas, 41 E. faecium were resistant to both these drugs. Thirty six per cent of isolates were resistant to penicillin and ampicillin, 73% to erythromycin, 87% to tetracycline, 89% to lincomycin and 56% to nitrofurantoin. Some discrepancies were noticed between the results of different methods applied for susceptibility testing--ATB system, E test and disc diffusion. These discrepancies concerned HLAR detection and susceptibility to glycopeptides determination. The best methods were: disc-diffusion for HLAR detection and E test for determination of resistance to vancomycin and teicoplanin. Increasing resistance to antimicrobial agents is observed in clinical Enterococcus spp. isolates cultured in our laboratory, especially in E. faecium strains. It is necessary to control the dissemination of multiresistant Enterococcus spp. strains in hospital wards.

Aminoglycosides↗
PubMed2003

[Integrative therapy for postoperative intractable enterococcus faecium infections].

OBJECTIVE: To assess the treatment of patients with infection of enterococcus faecium after surgery who failed to respond to antibiotics. METHODS: Five patients after surgery were proved to have Enterococcus faecium infection by bacterial culture. They were treated by sensitive antibiotics but failed. Comprehensive treatment prescribed included immunoenhancements, enteral nutrition, and traditional Chinese medicines. RESULTS: Four patients were discharged from the hospital after recovery, and was cared else where after 1 month treatment. CONCLUSION: Comprehensive treatment is a better way to treat patients with refractory enterococcus faecium infection after surgery.

Aged↗
PubMed2004

Identification of a new peptide deformylase gene from enterococcus faecium and establishment of a new screening model targeted on PDF for novel antibiotics.

OBJECTIVE: To identify a new peptide deformylase (PDF) gene (Genebank Accession AY238515) from Enterococcus faecium and to establish a new screening model targeted on PDF. METHODS: A new PDF gene was identified by BLAST analysis and PCR and was subsequently over-expressed in the prokaryotic expression host E. coli B121(DE3). Over-expressed protein was purified for enzymatic assay by metal affinity chromatography and a new screening model was established for novel antibiotics. RESULT: A new PDF gene of Enterococcus faecium was identified successfully. Ten positive samples were picked up from 8000 compound library and the microbial fermentation broth samples. CONCLUSION: A new PDF of gene Enterococcus faecium was first identified and the model had a high efficacy. Positive samples screened may be antibacterial agents of broad spectrum.

Amidohydrolases↗
PubMed2005

[Enterococcus faecalis in vaginal smear of women who have been treated with antibiotics].

This investigation had an aim to establish the incidence of Enterococcus faecalis in vaginal smears and its correlation with antibiotics used for the treatment of genital and extragenital diseases, as well. By this prospective study 300 women in reproductive period have been involved. An average age was 34.5 years and 282 of them are married. They have been divided in 4 groups, 75 in every group. First group consisted women who have not been treated by an antibiotic in last 6 months; second group--women who have been treated due to infections of genital tract; third group--women were treated for unspecific colpitis and last one group were women treated for extragenital infections. A special designated questionnaire has been used to collect data from patients. A vaginal smears for microbiology examination has been taken at the Gynecological Clinic and Clinic for Infective diseases of The University Clinical Center Tuzla from patients of group I, II and IV and at the Outpatient Clinic from patients of group III. Enterococcus faecalis has been found in 112 patients (37.33%); in first group in 13 (17.33%) cases, in second group in 26 (34.66%), in third group 39 (52%), and in last group in 34 (45.33%) patients, which significantly different. Investigation on sensitivity showed a minimal sensitivity on Penicillin and Streptomycin and no resistance on Vancomycin. In conclusion, it could be said that Enterococcus faecalis was found in 17.33% patients who has not been treated by antibiotics and in 44% who used antibiotics, which differ significantly (p<0.01).

Adult↗
PubMed2005

[Identification of Enterococcus sp. isolated from raw milk samples coming from the metropolitan area of Costa Rica and evaluation of its antibiotic sensibility pattern].

Bacteria from the genus Enterococcus sp. were isolated and identified from nonpasteurized milk samples obtained from the Costa Rican Metropolitan Area, in order to evaluate its sensitivity pattern to common use antibiotics. One hundred five milk samples were collected from suppliers of a national dairy industry. The initial isolation was done in EVA (Ethyl violet agar). Isolated colonies were initially characterized phenotypically as Enterococcus sp. using biochemical tests, species' identification was done using the Api 20 Strep kit. The different Enterococci species were tested for their antibiotic sensitivity using the plate diffusion method; the minimal inhibition concentration (MIC) to vancomycin was determined using E test. 38% of the milk samples were positive for Enterococcus; 48 different strains were isolated, where E. faecalis corresponded to 71%, E. faecium to 19%, E. durans to 4%, E. gallinarum to 4% and E. avium to 2%. The geographical distribution analysis of the species isolated did not show significant statistical differences according to the origin of the samples. All isolates identified showed an important resistance rate to the antibiotics tested. The aminoglycoside family showed the lower resistance rate, the resistance to eritromicin, tetracycline and chloranphenicol was lower than 50% and all strains were sensitive to bacitracin. An 8% resistance rate to vancomycin was determined. No relationship between the resistance rate of samples and the province of origin was found, but it is important to emphasize that the strains resistant to vancomycin came from Cartago, one of the Costa Rican regions with highest milk production.

Animals↗
PubMed2006

[Status and drug resistance surveillance of enterococcus infection in patients with severe hepatitis].

OBJECTIVE: To analyze the infection status and the drug resistance of enterococci in patients with severe hepatitis to guide future treatment. METHODS: All bacteria from infected patients with severe hepatitis were cultured with BacT/Alert120 automation instrument (Aksu) and identified with Vitek-AMS60 (Biomerieux). Drug sensitivities of the isolated enterococci were tested with 11 antibacterial agents. RESULTS: Among the 112 isolated enterococci, Enterococcus faecalis was the most preponderant bacterium, and the second was E. faecium. Their isolation rates were 79.5% and 14.3%, respectively. 57.1% of all the enterococci were found in the ascetic fluid of patients with severe hepatitis. Fifty-eight (51.8%) isolated enterococci were found to be high level aminoglycoside resistant (HLAR), 19 (17.0%) enterococci were ampicillin-resistant enterococcus (ARE) and 7 (6.3%) were both HLAR and ARE. The susceptive rates of the enterococci to vancomycin and teicoplanin were very high, namely 96.4% and 100%, respectively. No vancomycin or teicoplanin resistant enterococci were found, but 4 enterococci were mildly sensitive to vancomycin. CONCLUSION: Enterococcus faecalis is the most prevalent species isolated in severe hepatitis patients infected with enterococcal infection. From our study, vancomycin and teicoplanin are the drugs of first choice to treat those infections.

Aminoglycosides↗