Enterococcal Infections Flashcards
1
Q
Enterococcal Infections
A
etiology:
- Enterococcus faecalis and Enterococcus faecium, are responsible for most human enterococcal infections
- cause wound infections, UTIs, bacteremia, and endocarditis
P/TX:
- resistance to vancomycin, PCN, and gentamicin is common (esp with E faecium)
- essential to determine suscpetibility isolates
- PCN-susceptible strains
- PCN
- ampicillin
- if pt is PCN allergic = vancomycin
- if pt has endocarditis or meningitis
- gentamicin IV should be added
- infectious control measures to limit spread = isolation, barrier precautions, avoidance of overuse of vancomycin and gentamicin
- consultation with an ID specialist is strongly advised when treating infections caused by resistant strains
- vancomycin-resistant strains=
- Quinupristin/dalfopristin and linezolid are FDA approved
- Quinupristin/dalfopristin is not active against strains of *E faecalis *and should only be used against *E faecium *
- phlebitis and irritation at infusion site and arthralgia-myalgia syndrome are common side effects
- Linezolid is active against both strains
- side effects: thrombocytopenia and bone marrow suppression
- also peripheral neuropathy, optic neuritis, and lactic acidosis have been observed with prolonged use
- emergence of resistance has occured during therapy with both
2
Q
Enterococcus spp
A
E. faecalis and E. faecium
How to identify:
- alpha, beta, or gamma hemolysis on blood agar
- Esculin hydrolysis in presence of bile salts (agar turns brownish black)
- salt tolerant so grow in 6.5% NaCl broth (turbidity due to growth)
- PYRase test positive
Epidemiology:
- lives on mucous membranes and skin
- preferentially colonizes the GI tract
Infections:
- endocarditis
- catheter-related sepsis
- seen in ppl hospitalized for long periods of time
- UTI
Worrisome Antimicrobial Resistance
- Ampicillin resistance in E. faecium
- Vancomycin resistance
- Inducible clindamycin resistance in beta-hemolytic strep
