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PubMed2000

[Pathogenicity of Enterococcus spp. Characteristics of 169 hospital isolates].

BACKGROUND: To know the characteristics of Enterococcus spp. strains isolated in the hospital; to analyse the importance of this microorganism and its resistance to antimicrobial agents. PATIENTS AND METHODS: Retrospective analysis of the case histories of 169 patients with Enterococcus spp. isolates, selected at random at the Infanta Cristina Hospital in Badajoz. Investigation was carried out on: age, date of admission and discharge, clinical symptoms, risk factors, previous antibiotic treatment, clinical and microbiological evolution, recommended treatment and prescribed treatment. Identification of microorganisms and antibiogram with Pos Combo 41 microScam panels, read on Baxter WalkAway-40 equipment. RESULTS: The most frequently found species was Enterococcus faecalis. In 75 cases the isolations were polymicrobial. The enterococci were isolated mainly from urinary infections (27%), skin infections (20%), intrabdominal infections (14%) and infections from surgical wounds (14%). The existence of peripheral catheter was the main risk factor. All the strains of E. faecalis were susceptible to the glycopeptides. Two strains of Enterococcus faecium were not susceptible to vancomycin and one of these was not susceptible to teicoplanin. Mortality was from 21-27.5%. CONCLUSIONS: Enterococcus spp. is frequently isolated in nosocomial infections, although in approximately half the cases it is associated with other bacteria. For this reason, it is not always possible to determine its pathogenic contribution. The isolated strains, except two strains of E. faecium, are susceptible to vancomycin. A relation exists between high resistance to aminoglucosides and resistance to fluoroquinolones.

Enterococcus↗

PubMed1992

Diarrhea caused by a slow-growing Enterococcus-like agent in neonatal rats.

An enteropathogenic Enterococcus-like agent was isolated from a spontaneous outbreak of diarrhea that occurred in a colony containing neonatal rats. Diarrhea was experimentally reproduced in virus-antibody-free neonatal rats inoculated with this purified "enterococcus." Gram-positive cocci were adhered to the small intestinal villi of affected animals from which the organism was reisolated. The isolate's classification in the genus Enterococcus was confirmed by genetic probe; however, because of its unique fermentation pattern, it could not be definitively speciated. Indirect immunofluorescence assays indicate that this strain of enterococcus and Enterococcus hirae, another strain pathogenic for neonatal rats, differ antigenically. Enterococci should be considered as potential etiologic agents in outbreaks of diarrhea involving neonatal rats and future efforts directed to increasing our understanding of the pathophysiology of this disease.

Animals↗

PubMed1993

Single-dose ampicillin prophylaxis does not eradicate enterococcus from the lower genital tract.

OBJECTIVES: To determine the carriage rate of enterococcus in the lower genital tract of women having a cesarean delivery and to determine whether a single 2-g intraoperative dose of ampicillin eradicates enterococcus from the lower genital tract. METHODS: Lower genital tract cultures were taken in 84 women who were in labor or had ruptured membranes and who were about to have an indicated cesarean delivery. The subjects were randomized to receive either a single 2-g dose of ampicillin or a cephalosporin as prophylaxis. Cultures were repeated 24 hours postpartum. RESULTS: Enterococcus was isolated preoperatively in 33 subjects (39.3%) and postoperatively in 36 (42.9%). The enterococcus was eradicated in five of 17 women (29.5%) who received ampicillin. CONCLUSION: These results suggest that a single 2-g dose of ampicillin does not eradicate enterococcus from the lower genital tract.

Adult↗

PubMed1997

[Isolation rate of Enterococcus spp. from surgical infections and their susceptibilities].

Enterococcus spp. isolated from surgical infections during the period from July 1982 to June 1995 were investigated in a multicenter study involving 19 hospitals in Japan, and the following results were obtained. 1. Though the isolation rate of Enterococcus faecalis and other Enterococcus spp. were not high from primary infections, and from postoperative infections the isolation rate of other Enterococcus spp. was also low, the isolation rate of E. faecalis was highest from postoperative infections after 1993. 2. Vancomycin (VCM) showed strongest activity against E. faecalis, and followed by those of ampicillin (ABPC), imipenem. levofloxacin (LVFX) and meropenem in this order. Against other Enterococcus spp., VCM showed strongest activity, and followed by those of ABPC and LVFX. There were no resistant strains against VCM.

Ampicillin↗

PubMed1998

Effect of quinupristin/dalfopristin alone or in combination with vancomycin on the structure of Enterococcus faecium.

Twenty strains of Enterococcus faecium susceptible to quinupristin/dalfopristin (< 2 mg/l) were DNA fingerprinted to exclude strain duplication. Ten strains were susceptible to vancomycin (minimal inhibitory concentration [MIC] < 2 mg/l) and 10 were resistant to vancomycin (MIC > 400 mg/l). Vancomycin at 1/2 MIC, quinupristin/dalfopristin at 1/4 MIC and their combination, except for a tube control, was added to 10 ml trypticase soy broth tubes which were planted with the respective 24-h trypticase soy broth cultures. The products of incubation were sampled periodically throughout 24 h for gram stain and electron microscopy. Cell size was measured on photographs at 20,000x final magnification and results were statistically analyzed. The cells of all strains of Enterococcus faecium exposed for 12 h to quinupristin/dalfopristin were comparable in size to the control, Most cells, however, showed areas of low density of ribosome in the center of the cells. The cells of Enterococcus faecium resistant to vancomycin exposed to vancomycin were larger than the controls with means of 1.96 micron -2.07 micron versus 1.16 micron (p < 0.001); these cells consisted of individual organisms connected by wide cross walls of abnormal fibrous structure. Enterococcus faecium sensitive to vancomycin exposed to vancomycin remained comparable to the control. The combination of quinupristin/dalfopristin plus vancomycin produced large cells with multiple abnormal cross walls in both vancomycin-resistant and vancomycin-sensitive Enterococcus faecium. The addition of quinupristin/dalfopristin to vancomycin appears to modify the vancomycin-susceptible strains to respond to vancomycin in the same manner as do the vancomycin-resistant organisms.

Anti-Bacterial Agents↗

PubMed1989

Identification of Enterococcus species isolated from human infections by a conventional test scheme.

Streptococci (206 cultures) previously identified as enterococci were retrieved from storage and reidentified by using tests designed to identify species of the genus Enterococcus. Of these 188, 91% were correctly identified as Enterococcus species. Of the remaining strains, nine (4%) were unidentified and six (3%) and 3 (1.5%) were identified as Leuconostoc sp. and Lactococcus sp., respectively. Two new Enterococcus species were discovered: E. raffinosus and E. solitarius. DNA-DNA hybridizations were performed on selected strains to assure correct identification. Cultures representing 10 of the 12 Enterococcus species were among the 188 strains identified. An identification system based on the grouping of key reactions of 20 phenotypic characteristics of Enterococcus species is described.

Bacteriological Techniques↗

PubMed1997

Enterococcus faecium in hospitals.

Most of the characteristics that have ensured the success of enterococci as nosocomial pathogens were described early in this century. Enterococcus faecium and Enterococcus faecalis, the enterococci most frequently isolated from clinical material, differ fundamentally. The intrinsic antimicrobial resistance of Enterococcus faecium, supplemented by acquired resistance mechanisms, can generate a glycopeptide-multiply-resistant nosocomial pathogen that survives on hands and in the environment, and has the potential for intra-hospital and inter-hospital spread. The use of terms such as 'an enterococcus', 'faecal streptococci' and 'group D streptococci' have hindered, and still hinder, our understanding of a species rapidly emerging as the most problematic of nosocomial pathogens.

Anti-Bacterial Agents↗

PubMed2001

Determination of Enterococcus faecalis groESL full-length sequence and application for species identification.

Amplification of the partial Cpn60 (or GroEL) gene segment has been used for identification of many bacteria, including Enterococcus species. To obtain more sequence data from groESL genes of Enterococcus faecalis, the full-length sequence of the E. faecalis groESL genes containing groES (285 bp), spacer (57 bp), and groEL (1,626 bp) was determined. A database search of GenBank revealed that the deduced E. faecalis GroES and GroEL proteins show significant homology to the GroES and GroEL proteins of other bacteria. The GroEL (groEL) of E. faecalis had the highest identity with Streptococcus pneumoniae (81.8% amino acid sequence identity and 73.0% nucleotide sequence identity), followed by Lactococcus zeae, while GroES (groES) had 60.2% (64.6%) identity with Lactobacillus zeae and 58.5% (66.2%) identity with Lactococcus lactis, followed by 57.0% (65.5%) identity with Bacillus subtilis. Based on the groES sequence, an E. faecalis-specific PCR assay was developed, and this PCR assay was positive for all the E. faecalis strains tested. Dot blot hybridization using either groES or groEL as the probe distinguished E. faecalis clearly from other species, indicating that both genes can be used as suitable targets for E. faecalis identification. Moreover, broad-range PCR-restriction fragment length polymorphism of groESL was designed to differentiate eight commonly encountered Enterococcus species. The Enterococcus species of reference strains could be easily differentiated on the basis of restriction patterns produced by HaeIII and RsaI. The DNA-based assays developed in this study provide an alternative to currently used methods of identification for clinically important enterococcal species.

Bacterial Proteins↗

PubMed1998

Time-kill profiles of Enterococcus to antibiotics used for intravitreal therapy.

BACKGROUND AND OBJECTIVE: To determine and then compare the time-kill profiles of Enterococcus to antibiotics used for intravitreal therapy. PATIENTS AND METHODS: The time-kill profiles of four endophthalmitis isolates of Enterococcus faecalis, one vancomycin-resistant E. faecalis isolate, and three vancomycin-resistant isolates of E. faecium were determined against vancomycin, amikacin, cefazolin, gentamicin, ampicillin, ciprofloxacin, ceftazidime, clindamycin, and the combinations of vancomycin and amikacin, vancomycin and ceftazidime, vancomycin and gentamicin, vancomycin and ampicillin, cefazolin and gentamicin, and ampicillin and gentamicin. RESULTS: No single antibiotic or combination was bactericidal (defined as 99.9% kill) to all isolates of Enterococcus. Gentamicin was bactericidal to all E. faecalis isolates. None of the tested antibiotics were bactericidal to vancomycin-resistant E. faecium. CONCLUSIONS: The time-kill profiles demonstrated that vancomycin and ceftazidime did not produce a 99.9% kill for E. faecalis in this small study. Gentamicin combined with either cefazolin or ampicillin had somewhat better bactericidal activity and should be considered as an alternative therapy. Novel therapy may be necessary to treat endophthalmitis because of vancomycin-resistant Enterococcus, depending on the susceptibility patterns of the individual isolate and the response to initial therapy.

Anti-Bacterial Agents↗

PubMed2002

The virulence of Enterococcus to freshwater prawn Macrobrachium rosenbergii and its immune resistance under ammonia stress.

Growth of pathogen bacterium. Enterococcus was not affected in tryptic soy broth (TSB) medium containing ammonia-N concentration in the range of 0-5.14 mg l(-1). Giant freshwater prawn Macrobrachium rosenbergii (8-12 g) were challenged with Enterococcus which had been incubated for 24 h in TSB medium containing different concentrations of ammonia-N at 0-5.14 mg l(-1) Cumulative mortality of M. rosenbergii was higher for the bacteria incubated in TSB medium having ammonia-N at 0 and 0.26 mg l(-1), than those incubated in TSB medium having 1.28, 2.57 and 5.14 mg l(-1) ammonia-N after 24 h of challenge. However, cumulative mortality of prawn was significantly higher for the bacteria incubated in TSB medium with no ammonia added after 120 h of challenge. The prawns (8-12 g) were challenged with Enterococcus previously incubated in TSB medium for 24 h, then placed in water having concentrations of ammonia-N at control (0.06 mg l(-1)), 0.55, 1.01, 1.68 and 3.18 mg l(-1). Mortality of prawns increased directly with ammonia-N concentrations after 72 h challenge. The pranws (20-30 g) which had been exposed to control, 0.55, 1.68 and 3.18 mg (-1) ammonia-N for 7 days were examined for the total haemocyte count (THC), differential haemocyte count (DHC), phenoloxidase activity and respiratory burst of haemocytes. Phenoloxidase activity decreased when the prawns were exposed to ammonia-N greater than 0.55 mg l(-1). The respiratory burst increased significantly at 0.55 mg l(-1) but decreased significantly at 1.68 and 3.18mg (-1) ammonia-N. No significant difference in haemocyte count was observed among the prawns at different ammonia-N concentrations. It is suggested that ammonia in water decreases the virulence of Enterococcus, and reduces the immune resistance of M. rosenbergii.

Ammonia↗

PubMed1995

Epidemiologic analysis of glycopeptide-resistant Enterococcus strains in neutropenic patients receiving prolonged vancomycin administration.

Vancomycin-resistant enterococci have been isolated with increasing frequency since 1988. Thus far, most of these resistant enterococci have belonged to the Enterococcus faecium species, and epidemiological studies have shown a wide diversity among interhospital and intrahospital isolates. This report presents an epidemiologic investigation of 25 vancomycin-resistant Enterococcus strains--24 Enterococcus faecium and one Enterococcus gallinarum--isolated from the stools or blood of adult patients receiving intravenous vancomycin prophylaxis during neutropenia and hospitalized in a single hematologic unit. Macrorestriction patterns of total DNA and of ribosomal DNA regions were used to analyze the strains. Strains produced different total DNA restriction fragment length polymorphism patterns after SmaI digestion. Ribotyping was less discriminative than pulsed-field gel electrophoresis. The results confirmed the genetic unrelatedness of the strains. Prolonged vancomycin administration, commonly used in hematologic units, could be involved in the selection of endogenous resistant enterococcal strains.

Anti-Bacterial Agents↗

PubMed1984

Role of enterococcus in intraabdominal sepsis.

Although enterococcus is well recognized as a pathogen in endocarditis, urinary tract infections, and biliary sepsis, its role in other forms of intraabdominal sepsis remains controversial. Antibiotics that lack activity against enterococcus can often be employed successfully in intraabdominal infections, even when enterococci are present as part of the polymicrobial flora. Furthermore, the enterococcus rarely emerges as a blood borne pathogen in such a setting. Breakthrough enterococcal septicemia may occur, however, in the immunodepressed host, particularly in the face of broad-spectrum antibiotic therapy not specific for enterococcus. Like infections with other opportunistic pathogens, enterococcal sepsis under these circumstances carries a high mortality. Specific antienterococcal drug therapy may be indicated as an adjunct to surgical management in selected patients with intraabdominal sepsis.

Abdomen↗

PubMed1997

Identification and characterization of proteolytic activity of Enterococcus spp. isolated from milk and Roncal and Idiazábal cheese.

Roncal and Idiazábal cheeses are manufactured from ewe's milk in the Autonomous Region of Navarre in Spain. Levels of enterococci are high in these cheeses and in other types of ewe's-milk cheeses. The present study has identified enterococci present in the milk used and in the Roncal and Idiazábal cheeses after 120 days of ripening. A total of 282 strains were isolated and identified, and the cytoplasmic and extracellular enzymatic activities of some of the strains were assessed. The dominating species were Enterococcus faecalis, which accounted for 85% of the total both in the milk as well as in the two types of cheese, and Enterococcus faecium, Enterococcus durans, and Enterococcus avium which were present in lower proportions. Aminopeptidase and proteinase activity levels in enterococci were low, and considerable variation between strains of the same species was recorded, highlighting the need to study individual strains when selecting the most suitable bacteria as a starter culture. Aminopeptidase activity levels for the enterococci were appreciably higher at pH 7 than at pH 5.5, hence aminopeptidase activity by enterococci would appear to be less significant in the normal manufacturing conditions of the two cheeses.

Aminopeptidases↗

PubMed2003

Low prevalence of colonization with vancomycin-resistant Enterococcus in patients awaiting liver transplantation.

The orthotopic liver transplant (OLT) population has been particularly affected by the increase in vancomycin-resistant enterococcus (VRE) infections in recent years. Pre-transplant colonization prevalence, the role of spontaneous bacterial peritonitis (SBP) antimicrobial prophylaxis as a risk factor, and the risk of post-OLT infection in colonized patients are all unknowns. We prospectively evaluated OLT candidates at our center with the aim of answering these questions. Vancomycin-resistant enterococcus colonization status was determined by rectal culture. Data collected included illness severity, antibiotic use (including SBP prophylaxis), waiting time, previous hospitalizations, and invasive procedures. Eighty-eight patients (31 female, 57 male, median age 52 years) were enrolled. The most common diagnoses were hepatitis C (49%), primary sclerosing cholangitis (13.6%), and alcoholic liver disease. Median MELD score was 11.5 (range 7-24), and median waiting time was 551 days (range 1-2224). Vancomycin-resistant enterococcus risk factors were common in our patients: recent hospitalization in 16%, recent antibiotic exposure in 39%, and renal insufficiency in 7%. Seventeen percent were receiving SBP prophylaxis. Despite the presence of established risk factors, VRE colonization prevalence was 3.4%. Preliminary limited data showed poor correlation between screening rectal cultures and operative/peri-operative cultures. Vancomycin-resistant enterococcus colonization prevalence in an OLT candidate population with mid-level MELD scores was low, and SBP prophylaxis was not a significant risk factor.

Adult↗

PubMed2003

Partial characterization of bacteriocins produced by environmental strain Enterococcus faecium EK13.

AIMS: The partial characterization of bacteriocins produced by an environmental strain Enterococcus faecium EK13, isolated from cattle dung water. METHODS AND RESULTS: A bacteriocin was partially purified by ammonium sulphate precipitation, followed by a SP-Sepharose column, reverse-phase chromatography and N-terminal region sequenced. The anti-microbial substance produced was found to be a heat-stable polypeptide with molecular mass 4.83 kDa, which was determined by N-terminal amino acid sequencing to be enterocin A. A second substance was specified by PCR as enterocin P. Bacteriocins were stable at 4 and -20 degrees C for long storage periods. The optimum of bacteriocin production was observed in the range of pH 5.0-6.5 at 30 and 37 degrees C. The most active substances are produced by strain EK13 in logarithmic growth phase and bacteriocins are produced after 1 h of fermentation. The highest activity detected in fermentation experiments was 51 200 AU ml(-1) and the most sensitive indicator strain was found to be Listeria innocua LMG 13568. Differences in bacteriocin activity against two indicators could be explained by more than one type of enterocin production by strain EK13, or with different mode of action or in different sensitivity of strains. CONCLUSION: Enterococcus faecium strain EK13 isolated from cattle dung water produces two bacteriocins, enterocin A and P, with an inhibitory effect against the strain of the genera Enterococcus, Leuconostoc, Lactobacillus, Streptococcus, Staphylococcus, Bacillus and Listeria (in different origin). SIGNIFICANCE AND IMPACT OF THE STUDY: Enterococcus faecium EK13 environmental strain is a new producer of enterocin A and P. The E. faecium EK13, isolated from cattle dung water, is presented with the further aim to utilize it for waste treatment by biotechnological processes.

Animals↗

PubMed2003

Characteristics and identification of enterocins produced by Enterococcus faecium JCM 5804T.

AIMS: To screen bacteriocin-producing lactic acid bacteria (LAB) in 52 type and reference strains, which have not previously been studied, with respect to bacteriocins, and to characterize the presence of bacteriocins. METHODS AND RESULTS: Only Enterococcus faecium JCM 5804T showed bacteriocin-like activity. It inhibited the growth of Lactobacillus spp., Enterococcus spp., Clostridium spp., Listeria monocytogenes, and vancomycin resistant Enterococcus (VRE). However, it was not effective against Gram-negative strains, Weisella spp., Leuconostoc spp., Lactococcus spp., or methicillin resistant Staphylococcus aureus (MRSA). The inhibitory activity of Ent. faecium JCM 5804T was inactivated by proteinase K, trypsin, alpha-chymotrypsin, and papain, but not by lysozyme, lipase, catalase, or beta-glucosidase. The inhibitory activity was stable at 100 degrees C for 30 min, and had a pH range from 2 to 10. The molecular weight of the partially purified bacteriocin(s) was approx. 4.5 kDa, according to tricine-sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Polymerase chain reaction and direct sequencing methods identified three different types of bacteriocins produced by Ent. faecium JCM 5804T, enterocin A, enterocin B, and enterocin P-like bacteriocin. CONCLUSION: Enterococcus faecium JCM 5804T produced three different types of bacteriocins, and they inhibited LAB and pathogens. SIGNIFICANCE AND IMPACT OF STUDY: This is the first report of enterocin A, enterocin B, and enterocin P-like bacteriocin, detected in Ent. faecium JCM 5804T among LAB type and reference strains.

Amino Acid Sequence↗

PubMed1994

Investigation of the potential role of Enterococcus faecalis in the pathophysiology of experimental peritonitis.

Two nonfatal models of peritonitis differing by the duration and the severity of the disease were studied in rats by implantation of Escherichia coli and Bacteroides fragilis with or without increasing concentrations of Enterococcus faecalis. Results were evaluated at 3 or 6 days after inoculation. The highest enterococcal concentrations (10(9) cfu/mL) enhanced the severity of the infection, evident by increased emaciation, increased peritoneal counts of E. coli and B. fragilis, and increased frequency of E. coli and B. fragilis bacteremia compared with enterococcus-free animals. Six therapeutic regimens (low-dose amoxicillin + low-dose gentamicin, high-dose amoxicillin + high-dose gentamicin, pefloxacin, ornidazole, pefloxacin + ornidazole, imipenem + gentamicin) were tested. All treatments failed to eradicate E. faecalis except the combination pefloxacin + ornidazole, which achieved a significant reduction of local bacterial counts and suppressed bacteremia. Enterococcus played an important role in the mechanisms of bacterial synergy in experimental peritonitis. However, eradication of enterococcus did not seem possible by conventional antienterococcal therapy.

Abscess↗

PubMed1996

Augmented production of extracellular superoxide by blood isolates of Enterococcus faecalis.

To assess the frequency of extracellular superoxide (O-2) production by enterococci, multiple species were surveyed in a whole organism assay for their ability to reduce ferricytochrome c in a superoxide dismutase-inhibitable fashion. For stool and clinical enterococcal isolates and 12 type strains, only Enterococcus faecalis (87/91 isolates and ATCC 19433), Enterococcus faecium (5/13 isolates), Enterococcus casseliflavus (ATCC 25778), and Enterococcus gallinarum (ATCC 35038) produced extracellular O-2. Among 106 strains comprising 13 species of enteric gram-negative bacilli and gram-positive cocci, only Lactococcus lactis subspecies lactis produced extracellular O-2. Mean (+/-SE) rates of extracellular O-2 production in vitro by E . faecalis for isolates associated with bacteremia and endocarditis and for isolates from stool were 2.4+/-0.2, 1.9+/-0.2, 1.5+/-0.3 nmol of O-2 min(-1) 10(9) cfu(-1), respectively (P=.025, analysis of variance), suggesting an association between invasiveness and extracellular O-2 production.

Bacteremia↗