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PubMed2004

Community-acquired urinary tract infection caused by vancomycin-resistant Enterococcus faecalis clinical isolate.

We present a case of urinary tract infection caused by vancomycin-resistant Enterococcus faecalis. The patient is a 62-year-old woman showing no recent admittances. The isolated microorganism was identified by MicroScan (DADE) and API (BioMerieux) and susceptibility was assessed by disk diffusion, E-test and broth microdilution. The isolate was identified as Enterococcus faecalis and showed high MIC for vancomycin (>128 mg/l) and teicoplanin (8 mg/l) but was susceptible to ampicillin. The transmission routes of vancomycin-resistant enterococci in the community and their clinical implications remain uncertain. Healthy carriers have already been described in several countries but this case report represents an unusual finding.

Community-Acquired Infections↗
PubMed2004

Purpura fulminans due to Enterococcus faecalis.

We report a case of a 73 year old man who developed purpura fulminans due to Enterococcus faecalis sepsis. The patient was treated successfully with oral linezolid. Early diagnosis of the microbial etiology of purpura fulminans is important. If Enterococcus faecalis is found as the causal organism, appropriate antimicrobial therapy may be used.

Aged↗
PubMed2005

Potential use of a host associated molecular marker in Enterococcus faecium as an index of human fecal pollution.

Several genotypic and phenotypic microbial source tracking (MST) methods have been proposed and utilized to differentiate groups of microorganisms, usually indicator organisms, for the purpose of tracking sources of fecal pollution. Targeting of host-specific microorganisms is one of the approaches currently being tested. These methods are useful as they circumvent the need to isolate individual microorganisms and do not require the establishment of reference databases. Several studies have demonstrated that the presence and distribution of Enterococcus spp. in feces seems to be influenced by the host species. Here, we present a method for detection of genetic sequences in culturable enterococci capable of identifying human sources of fecal pollution in the environment. The human fecal pollution marker designed in this study targets a putative virulence factor, the enterococcal surface protein (esp), in Enterococcus faecium. This gene was detected in 97% of sewage and septic samples but was not detected in any livestock waste lagoons or in bird or animal fecal samples. Epidemiological studies in recreational and groundwaters have shown enterococci to be useful indicators of public health risk for gastroenteritis. By identifying the presence of human fecal pollution, and therefore the possible presence of human enteric pathogens, this marker allows for further resolution of the source of this risk.

DNA, Bacterial↗
PubMed2005

Long-term (56-week) oral administration of probiotic Enterococcus faecium M-74 decreases the expression of sICAM-1 and monocyte CD54, and increases that of lymphocyte CD49d in humans.

OBJECTIVES: To study the effects of long-term probiotic [Enterococcus faecium (EF) M-74 strain] application in humans with respect to adhesion molecules, both soluble forms (sICAM-1, sPECAM-1) and their expression on leukocytes. METHODS: Double-blinded randomized and placebo controlled study lasting for 60 weeks. A single capsule containing either 2x10(9) of bacteria EF M-74 with 50 microg of organically bound selenium (E-group) or placebo (P-group) was given to volunteers. Peripheral blood was analyzed for the expression of particular adhesive molecules. RESULTS AND CONCLUSIONS: We observed significant changes in CAMs expression in terms of a decrease in sICAM-1, CD54 on monocytes and CD11b on lymphocytes after one-year administration of Enterococcus faecium M-74 in humans. Anti-adhesion-aimed therapeutic modalities may provide the future approach to prevention and treatment of cardiovascular diseases. Application of probiotics may be part of such strategies. (Tab. 2, Fig. 6, Ref. 41.)

Administration, Oral↗
PubMed2005

[Flow cytometric analysys of Enterococcus faecalis pAD1(-) strains response to cAD1 pheromone].

Conjugative plasmids transfer in Enterococcus faecalis is inducted by sex pheromones. The pheromone is excreted by recipient cells and induces expression of aggregation protein AS in donor cells. This protein is involved in formation of matting aggregates. Use of flow cytometry and anti-As monoclonal antibodies allowed collect of interesting data pheromone response. However, according to our knowledge, no study focused on unspecific influence on particular pheromone for plasmid-free recipient strains. Six pAD1 (-) and tree pAD1 (+) Enterococcus faecalis stains were cultivated for 18h in BHI, with and without cAD1 pheromone (Sigma, Germany), respectively. The bacteria were washed, stained with carboksyfluorescein (FCDA, and analyzed by flow cytometry in FACS BD scan cytometr. Relative fluorescence and size of aggregation was used to compare influence on particular strains. Surprisingly, the results shows divergence in fluorescence, size of aggregates and degree of correlation between fluorescence of aggregates and their sizes among pAD1(-) strains, allowing for distinguish of two groups. Three of studied strains have higher fluorescence than pAD (+) stains. Correlation between fluorescence and size of aggregates, significant higher than in pAD1(+) stains, decrease from r = 0.88 to r=0.74 in reaction to cAD1. The strains if other group fluorize with lower intensity than pAD1 (+). Furthermore, 30.4% pAD1 (-) of second group have no detectable fluorescence. In contrast to pAD1 (-) ) strains of the first group and pA1 (+) strains, low (r=0.55) correlation between fluorescence and size of aggregates of group II increase up to r=0.74 after incubation with cAD1 pheromone. Previous study of these pAD1 (-) strains, currently assigned to group II, shown their low frequency of collecting aph2" gene encoded on other conjugative plasmid, pMG. According to these results, such flow cytometric analysis may be used to predict ability of strain to collect unrelated conjugative plasmid.

Enterococcus faecalis↗
PubMed2006

[A novel plasmid-mediated aminoglycosides-modifying enzyme gene, aph (2'')-Ie, in a strain of high-level gentamicin resistant Enterococcus casseliflavus].

OBJECTIVE: To identify the aminoglycoside resistance gene in the high-level gentamicin resistant (HLGR) enterococcus and its transmission mechanism. METHODS: A HLGR strain, HZ95, of Enterococcus casseliflavus was screened by agar dilution method. The aminoglycoside activation enzyme genes were screened by PCR. The PCR products underwent purification, cloned, and sequenced. Plasmids were extracted and underwent Southern hybridization. Plasmid-mediated aminoglycoside modifying enzymes were cloned. The resistance of the HZ05 strain to different antimicrobial agents was determined by K-B method or agar dilution method. RESULTS: A new aminoglycosides-modifying enzyme, APH (2'')-Ie, leading to HLGR, was found in the plasmid of the HZ95 bacteria. The aph (2'')-Ie gene and partial sequence of a streptomycin adenylyltransferase gene (str) were contained in the 8.7-kb cloned fragment, and the transposase gene (tnpA) was on the upper stream. The aph (2'')-Ie gene was located on the 16-kb plasmid with the amino acid sequence 96.1% homologous with chromosome-mediated APH (2'')-Id aminoglycoside-modifying enzyme. CONCLUSION: HLGR can be caused by a new plasmid-mediated aminoglycosides-modifying enzyme, APH (2'')-Ie, which can be transmitted among plasmids or chromosome with other resistant genes through transposase.

Anti-Bacterial Agents↗
PubMed1991

[A case of metastatic Enterococcus faecalis endophthalmitis].

We reported a case of successful treatment of early-stage metastatic endophthalmitis caused by Enterococcus faecalis with vitrectomy and lensectomy. The case was a 50-year-old male with poorly controlled diabetes. Following T-tube drainage for a necrotic cholecystitis operation, he developed iridocyclitis in both eyes as well as fever. At the time of his first visit to our clinic, his right eye had already lost light perception. His left eye had visual acuity recognizing of hand movement, marked uveitis, complicated cataract, and dense vitreous opacity. As gram positive cocci were isolated from the aspirated vitreous, we conducted lensectomy and vitrectomy under irrigation of antibiotics. With systemic postoperative antibiotics and human immunoglobulin, the patient showed remarkable improvement in his ocular fundus. By 60 days after the operation, the visual acuity of his left eye recovered to 4/20. Metastatic Enterococcus faecalis endophthalmitis has almost nerve been reported in Japan. The diagnosis and treatment of this disease with a reference to the above findings were discussed.

Endophthalmitis↗
PubMed1990

Microbiological study of Enterococcus faecium SF68: post-antibiotic effect and growth curves.

We studied the microbiological characteristics of Enterococcus faecium SF 68 (an oral vaccine) assessing post-antibiotic effect of ampicillin and growth curves in different media. Results showed a good resistance of the microorganism tested which has important implications in clinical practice. The growth ability of Enterococcus faecium SF 68 was similar on all media tested.

Ampicillin↗
PubMed1995

[Microbial resistance to formaldehyde. III> Dependence of the microbial effect on Staphylococcus aureus, Enterococcus faecium and spores of Bacillus stearothermophilus on temperature].

Temperature dependence of microbicidal efficacy of formaldehyde was examined with suspension tests (pH 7.0). Test germs were Staphylococcus aureus, Enterococcus faecium and spores of Bacillus stearothermophilus. The methodology was nearly the same as in previous investigations (5, 7). At given exposure periods and temperatures formaldehyde concentrations necessary to produce a microbicidal effect of log (N/N0) = -4.0 (concentrations of equal efficacy) were determined. N and N0 represent the numbers of colony-forming units in suspensions with and without formaldehyde, respectively. On rectangular graphic representation with the reciprocal value of absolute temperature on the abscissa and with the logarithm of the formaldehyde concentration on the ordinate, the formaldehyde concentrations of equal efficacy fitted straight lines. Lines referring to different exposure periods nearly paralleled each other. With increasing exposure periods the steepness of the lines decreased slightly. This effect was most pronounced with Staphylococcus aureus as a test germ. The ratio of formaldehyde concentrations of equal efficacy for exposure periods of 120 minutes at 20 degrees C and 30 degrees C, respectively, was 3.1:1 with Staphylococcus aureus, and 2.8:1 with Enterococcus faecium. The corresponding ratio obtained with spores of Bacillus stearothermophilus and referring to 60 degrees C and 70 degrees C, respectively, was 3.6:1. The logarithms of these ratios decreased with temperature in the same measure as the pertinent absolute temperatures increased. On the basis of the previously presented three-dimensional model of the relations between concentration, period of action and efficacy of microbicidal agents, it could be shown that deviations of the results from a linear and parallel course reflect an inconstant concentration exponent. When low formaldehyde concentration, long exposure period and "high" temperature coincide, the efficacy of formaldehyde is lower than calculated for a linear and parallel course of the relation.

Drug Resistance, Microbial↗
PubMed1994

[Enterococcus sp. resistance, a growing problem. Epidemiologic study (1987-1993)].

BACKGROUND: Infectious processes caused by Enterococcus species currently constitute a growing problem due to the rapid appearance of resistances and the scarce existing therapeutic alternatives. The patterns of in vitro resistance to ampicillin, vancomycin and gentamycin were therefore studied in addition to their evolution over time of the isolates of Enterococcus sp. identified in the Salamanca University Hospital from 1987-1993. METHODS: Data were obtained from a computerized system of epidemiologic surveillance of infection in in-patients on the basis of microbiologic information. Sensitivity tests were performed by the disc-plate diffusion method of the National Clinical Committee for Laboratory Standards. RESULTS: Global resistance was 2.1% to vancomycin versus 8.3% to ampicillin with most of the isolates being resistant to gentamycin. The frequency of appearance of resistance increased over time with 19.6% of the strains found to be resistant to ampicillin (p < 0.05; CI 95%, 1987-1988: 12.2-24.3%) in 1993 and from 1991-1992 2.7% were found to be resistant to vancomycin. The strains from patients from the medical area were more resistant to ampicillin (p < 0.05; CI 95%, 0.8-7.4%) and vancomycin (p < 0.05; CI 95%, 0.2-3.9%) than those corresponding to patients from the surgical area. Greater resistance was identified to ampicillin and vancomycin in the isolates from urine and wound exudates. Patients under the age of 1 year were significantly less resistant to ampicillin (p < 0.05; CI 95%, with respect to the group from 21 to 40 years: 1.6-13.9%) and vancomycin with the greatest resistance being found from 41 to 60 years of age. E. faecalis (2.9% resistance) was more resistant to vancomycin and E. faecium was more resistant to ampicillin (27.8% resistant strains) (p < 0.05: CI 95%, 3.2-33.6%). CONCLUSIONS: Over time there has been a rapid increase in the number of enterococci resistant to ampicillin while, to date, vancomycin shows good activity against these bacteria.

Adolescent↗
PubMed1994

[Immunomodulator action of living, nonpathogenic Enterococcus faecalis bacteria from humans].

Immunomodulating Effect of Living Nonpathogenic Enterococcus faecalis Originated from Humans Symbioflor 1 is a pharmaceutical preparation, consisting of a suspension of living nonpathogenic Enterococcus faecalis (E. faecalis). The effect on the liberation of cytokines of E. faecalis was investigated in in-vitro experiments with human peripheral mononuclear blood cells revealing the following results: 1. E. faecalis stimulates the liberation of interleukin 1 (IL-1 beta) and interleukin-6 (IL-6) in a dose-dependent manner; the E. faecalis induced liberation of IL-1 beta and IL-6 is inhibited by dexamethasone (Dm) but not by cyclosporin A (CsA). 2. E. faecalis stimulates the liberation of gamma-interferon (IFN-gamma) in a dose-dependent manner, which is inhibited by both Dm and CsA. 3. Phytohemagglutinin (PHA)-induced liberation of gamma-IFN and interleukin-2 (IL-2) is inhibited by E. faecalis in a dose-dependent manner. The relevancy to clinical trials of the in vitro results is discussed.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Regulation of enzymes of the first and last stage of lysine biosynthesis in Streptococcus bovis and Enterococcus faecium].

Regulation of aspartate kinase and diaminopimelate decarboxylase activities in Streptococcus bovis and Enterococcus faecium cell-free extracts was studied. The levels of synthesis of aspartate kinase and diaminopimelate decarboxylase in both microorganisms are growth-dependent. The synthesis of these enzymes is depressed by lysine, but the activity of aspartate kinase is induced by addition of this amino acid and threonine to the reaction system. Meso-diaminopimelate dehydrogenase activity was not found in the extracts of Streptococcus bovis and Enterococcus faecium. The data excludes the possibility of lysine formation via six enzyme reactions.

Aspartate Kinase↗
PubMed1993

[Comparison of ATB STREP, AMS-Vitek GPS-TA, and disk diffusion for the detection of a high level of aminoglycoside resistance in Enterococcus spp].

BACKGROUND: The absence of the synergic effect between beta-lactam and aminoglucoside versus Enterococcus is predicted by the presence of a high level of resistance to aminoglucoside. There are several commercial systems which include wells for the performance of this determination for streptomycin and gentamicin. METHODS: A comparative study of two commercial systems, Vitek GPS-TA and ATB STREP (Biomérieux) and disk diffusion versus the Mueller-Hinton agar dilution method used as a method of reference. Two hundred ninety strains of Enterococcus spp. from blood, wounds, pus, fluids from paracentesis and urine were studied. RESULTS: By the reference method, 17 presented high level of resistance only to gentamicin, 45 only to streptomycin, 46 to both and 182 were sensitive to the two antibiotics. The sensitivity of ATB STREP, Vitek GPS-TA and disk diffusion was respectively for high level of resistance to gentamicin of 96.8, 100 and 100% and specificity of 99.5, 99.1 and 96.5%. For high level of resistance to streptomycin sensitivity was 78.2, 100 and 100% and specificity 96, 79.4 and 72.4% respectively. CONCLUSIONS: The authors consider the three methods valid for the determination of high level of resistance to gentamicin, presenting excellent correlation between the results of the reference methods. However, for high level of resistance to streptomycin with ATB STREP 1/5 of the resistant strains would not be detected due to low sensitivity. With Vitek GPS-TA and disk diffusion, although excellent sensitivity was presented, a high percentage of false positives were obtained due to low specificity, thus the authors recommend that before a results of resistance be decided the same should be confirmed by another alternative method (agar dilution, macrodilution in tubes or death-time curve).

Diffusion↗
PubMed1995

[Detection of antibiotic resistance in Enterococcus sp. Comparison of GPS-TA (BioMérieux-Vitek), Uniscept MIC-3 (bioMérieux-Vitek) and conventional methods].

BACKGROUND: The treatment of severe enterococcus infections requires synergism of a beta-lactamic or glycopeptide and a aminoglycoside, but when resistance to first one or high-level resistance to aminoglycosides are present, synergism would be lost. We compared the adequacy of two commercially available systems to detect antibiotic resistance. METHODS: We studied 158 isolates of Enterococcus sp., with high-level resistance to gentamicin (40 isolates) and streptomycin (89 isolates), resistance to ciprofloxacin (34 isolates), resistance to ampicillin (7 isolates) and with intermediate susceptibility to vancomycin (3 isolates). No one was beta-lactamase producer by Cefinase disk method. We use disk diffusion as reference technique to detect high-level streptomycin resistance. The susceptibility to the remainder antibiotics was studied by agar dilution method, according to NCCLS. We studied the accuracy of GPS-TA cards and Uniscept MIC-3 in relation to the degree of agreement with conventional means, following FDA criteria. RESULTS: Essential agreement for MIC was less than 90 with MIC-3 for ampicillin (81.5%) and ciprofloxacin (71.3%). Categorical agreement rate was less than 90% (76.4%) and major error rate was higher than 3% (10.9%) with the use of MIC-3 for ciprofloxacin. Very major errors for ampicillin, vancomycin and ciprofloxacin were not produced by any system. The very major error rates for high level resistance to gentamicin and streptomycin with GPS-TA card were 5 and 15.7%, respectively. CONCLUSIONS: We do not recommend the use of the Uniscept MIC-3 panel with visual reading to detect susceptibility to ciprofloxacin. Detection of high levels of aminoglucoside resistance by GPS-TA card should be supplemented with conventional techniques because of the high rate of major error. Due to the low number of strains that have been studied, we can not assure the suitability of these systems to detect ampicillin or vancomycin resistance.

Ampicillin↗
PubMed1995

[Spondylodiscitis caused by Enterococcus: an unusual entity].

BACKGROUND: Spondylodiscitis by enterococcus is a very infrequent disease with only 2 cases caused exclusively by this microorganism having been reported in the literature. METHODS: Two clinical cases of spondylodiscitis by enterococcus diagnosed in the authors' department are presented with the clinical, radiologic and evolutive features of both. RESULTS: In the first case the spondylodiscitis was secondary to endocarditis with lumbosacral involvement and formation of an anterior epidural inflammatory mass. The second case was the consequence of an infection of urinary origin with lumbosacral involvement. Both patients responded favorably with only antibiotic treatment. CONCLUSIONS: Spondylodiscitis by enterococci is an unusual disease with no therapeutic experience. The authors report 2 cases which were treated exclusively with antibiotics.

Aged↗
PubMed1996

Clinical isolation of vancomycin-resistant Enterococcus faecalis in Taiwan.

We report the isolation of a vancomycin-resistant strain of Enterococcus faecalis, designated AH803, from a 76-year-old Taiwanese woman with pneumonia and bacteremia. This is the first documented clinical isolation of a vancomycin-resistant enterococcus in Taiwan. AH803 was repeatedly isolated from sputum specimens of the patient. AH803 had a high level of vancomycin (minimal inhibitory concentration, MIC = 512 micrograms/mL) and gentamicin (MIC > 2,000 micrograms/mL) resistance, but was susceptible to teicoplanin (MIC = 8 micrograms/mL) and ampicillin (MIC = 2 micrograms/mL). AH803 was shown by polymerase chain reaction to have the vanA gene, but not the vanB gene. Despite treatment efforts, the patient's condition continued to deteriorate. She requested to be discharged, against medical advice. The patient died at home the following day after discharge.

Aged↗