Enterococcus faecium
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| Enterococcus faecium (Orla-Jensen 1919) Schleifer & Kilpper-Bälz 1984 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Enterococcus faecium is a Gram-positive, alpha-hemolytic or nonhemolytic bacterium in the genus Enterococcus.[1] It can be commensal (innocuous, coexisting organism) in the human intestine, but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.
Vancomycin-resistant E. faecium is often referred to as VRE.[2]
Some strains of E. faecium are used as probiotics in both animals,[3] and humans.[4]
Genome sequences
Genomes listed below are from the Integrated Microbial Genomes website.
The 22 sequenced Enterococcus faecium genomes
| Strain | ST | CC17 | Country | Year |
|---|---|---|---|---|
| 1,231,408 | 582 | Yes | NA | NA |
| 1,231,501 | 52 | No | NA | NA |
| Com15 | 583 | No | USA (MA) | 2006 |
| 1,141,733 | 327 | No | NA | NA |
| 1,230,933 | 18 | Yes | NA | NA |
| 1,231,410 | 17 | Yes | NA | NA |
| 1,231,502 | 203 | Yes | NA | NA |
| Com12 | 107 | No | USA (MA) | 2006 |
Treatment
Antimicrobial Regimen
- 1. Bacteremia[5]
- 1.1 Ampicillin or penicillin susceptible
- Preferred regimen (1): Ampicillin 2 g IV q4-6h
- Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h
- 1.2 Ampicillin resistant and vancomycin susceptible or penicillin allergy
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
- Preferred regimen (2): Linezolid 600 mg IV q12h
- Preferred regimen (3): Daptomycin 6 mg/kg IV q24h.
- 1.3 Ampicillin and vancomycin resistant
- Preferred regimen (1): Linezolid 600 mg IV q12h
- Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
- 2.1 Endocarditis in adults
- 2.1.1 Strains susceptible to penicillin, gentamicin, and vancomycin
- Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
- Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- 2.1.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
- Preferred regimen (1): (Ampicillin 12 g IV q24h for 4–6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
- Preferred regimen (2): Aqueous crystalline penicillin G sodium 24 MU/day IV q24h for 4–6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
- Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.1.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin
- 2.1.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- 2.1.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- 2.1.4 Strains resistant to penicillin, aminoglycoside, and vancomycin
- Preferred regimen (1): Linezolid 1200 mg IV/PO q24h ≥ 8 weeks
- Preferred regimen (2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks
- 2.2 Endocarditis in pediatrics
- 2.2.1 Strains susceptible to penicillin, gentamicin, and vancomycin
- Preferred regimen (1): Ampicillin 300 mg/kg IV q24h for 4–6 weeks AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
- Preferred regimen (2): Penicillin 0.3 MU/kg IV q24h for 4–6 weeks AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
- Alternative regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- 2.2.2 Strains Susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin
- Preferred regimen (1): Ampicillin 300 mg/kg IV q24h for 4–6 weeks AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
- Preferred regimen (2): Penicillin 0.3 MU/kg IV q24h for 4–6 weeks AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
- Alternative regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.2.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin
- 2.2.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- Alternative regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.4 Strains resistant to penicillin, aminoglycoside, and vancomycin
- Preferred regimen (1): Linezolid 30 mg/kg IV/PO q24h ≥ 8 weeks
- Preferred regimen (2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks
- 3. Meningitis[8]
- 3.1 Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h
- 3.2 Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h
- 3.3 Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- 4. Urinary tract infections[9]
- Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
- Preferred regimen (2): Fosfomycin 3 g PO single dose
- Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days
- 5. Intra abdominal or wound infections [10]
- Preferred regimen (1): Penicillin
- Preferred regimen (2): Ampicillin
- Alternative regimen (penicillin allergy or high-level penicillin resistance): Vancomycin
- Alternative regimen (for complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h
References
- ↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 294–5. ISBN 0-8385-8529-9.
- ↑ Mascini EM, Troelstra A, Beitsma M; et al. (March 2006). "Genotyping and preemptive isolation to control an outbreak of vancomycin-resistant Enterococcus faecium". Clin. Infect. Dis. 42 (6): 739–46. doi:10.1086/500322?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov. PMID 16477546.
- ↑ http://www.purinaveterinarydiets.com/Product/FortiFloraCatNutritionalSupplements.aspx
- ↑ Sisson, G.; Ayis, S.; Sherwood, RA.; Bjarnason, I. (Jul 2014). "Randomised clinical trial: A liquid multi-strain probiotic vs. placebo in the irritable bowel syndrome--a 12 week double-blind study". Aliment Pharmacol Ther. 40 (1): 51–62. doi:10.1111/apt.12787. PMID 24815298.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
|month=ignored (help) - ↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
- ↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
Further reading
Sadowy, E; Luczkiewicz, A (14 March 2014). "Drug-resistant and hospital-associated Enterococcus faecium from wastewater, riverine estuary and anthropogenically impacted marine catchment basin". BMC microbiology. 14: 66. doi:10.1186/1471-2180-14-66. PMID 24629030. Retrieved 12 November 2014.