NOTES
NOTES
ENTEROCOCCUS
ENTEROCOCCUS
[Link]/enterococcus
▪ Prolonged hospitalization, mechanical
PATHOLOGY & CAUSES ventilation
▪ Prior antibiotic use, immunodeficiency
▪ Gram-positive spherical-shaped bacteria
(cocci)
▪ Grow in pairs (diplococci)/short chains COMPLICATIONS
▪ Non-spore forming ▪ Bacteremia
▪ Optimal growing conditions: 45ºC/113°F, ▫ Immunocompromised individuals
can withstand up to 60ºC/140°F
▫ Facultatively anaerobic bacteria
SIGNS & SYMPTOMS
▫ 6.5% NaCl, bile-containing media
▪ Characteristics ▪ UTIs
▫ Catalase negative, pyrrolidonyl ▫ Cystitis, pyelonephritis; dysuria,
arylamidase (PYR) positive frequency, urgency, suprapubic/flank
▫ Variable hemolytic activity on blood tenderness
agar plates; most commonly gamma ▪ Infective endocarditis
hemolytic
▫ Subacute onset of fever, malaise,
▪ Common human pathogens: E. faecalis, E. peripheral signs (e.g. Janeway lesions,
faecium Osler’s nodes), cardiac murmurs (usually
▪ Important cause of hospital-acquired left-sided), splenomegaly
infections, esp. infective endocarditis, ▪ Infection of prosthetic devices, wounds
urinary tract infections (UTIs), infections
▫ Erythema, swelling, tenderness, warmth
of prosthetic devices (e.g. venus/urinary
catheters)
▫ Surface carbohydrates → adherence to DIAGNOSIS
cardiac valves → fibrinogen synthesis
→ valve vegetations → infective DIAGNOSTIC IMAGING
endocarditis
▫ Adherence to renal epithelial cells → UTI Transthoracic echocardiography; abdomi-
▪ Less common associations nal CT scan; ultrasound
▫ Wound, bloodstream, biliary tract, pelvic ▪ Identify organ involvement
infections; intraabdominal abscesses
LAB RESULTS
RISK FACTORS ▪ Cultures from infected sites (e.g. blood,
▪ Indwelling medical devices (e.g. central urine)
venous, urinary catheterization) ▪ Susceptibility testing
▪ Cardiovascular abnormalities ▫ Detect antibiotic resistance
380 [Link]
Chapter 70 Enterococcus
▪ Complete blood count (CBC)
▫ ↑ polymorphonuclear cells
▪ Urinalysis
▫ UTI → pyuria, proteinuria, hematuria
TREATMENT
MEDICATIONS
Antimicrobial therapy
▪ Localized infections
▫ Ampicillin/beta lactamase inhibitors
(clavulanate/sulbactam)
▫ Alternative: nitrofurantoin
▪ Serious infections with bacteremia,
meningitis, endocarditis
▫ Penicillin/ampicillin + aminoglycoside
▫ Alternative: vancomycin,
aminoglycoside
▪ Vancomycin-resistant enterococcal (VRE)
infection
▫ Linezolid/daptomycin
SURGERY
▪ Drain abscess
▪ Valve replacement
OTHER INTERVENTIONS
▪ Remove venous/urinary catheters
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