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Mullally CA, Fahriani M, Mowlaboccus S, Coombs GW. Non- faecium non- faecalis enterococci: a review of clinical manifestations, virulence factors, and antimicrobial resistance. Clin Microbiol Rev 2024; 37:e0012123. [PMID: 38466110 PMCID: PMC11237509 DOI: 10.1128/cmr.00121-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
SUMMARYEnterococci are a diverse group of Gram-positive bacteria that are typically found as commensals in humans, animals, and the environment. Occasionally, they may cause clinically relevant diseases such as endocarditis, septicemia, urinary tract infections, and wound infections. The majority of clinical infections in humans are caused by two species: Enterococcus faecium and Enterococcus faecalis. However, there is an increasing number of clinical infections caused by non-faecium non-faecalis (NFF) enterococci. Although NFF enterococcal species are often overlooked, studies have shown that they may harbor antimicrobial resistance (AMR) genes and virulence factors that are found in E. faecium and E. faecalis. In this review, we present an overview of the NFF enterococci with a particular focus on human clinical manifestations, epidemiology, virulence genes, and AMR genes.
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Affiliation(s)
- Christopher A Mullally
- Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Marhami Fahriani
- Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine-WA, Department of Microbiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine-WA, Department of Microbiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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2
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Okumura N, Watanabe T, Teranishi S, Suzuki D, Hashimoto T, Takahashi K, Hara T. Successful treatment of aortic valve endocarditis caused by Enterococcus casseliflavus: a case report. BMC Infect Dis 2021; 21:447. [PMID: 34006246 PMCID: PMC8130351 DOI: 10.1186/s12879-021-06160-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Enterococcus casseliflavus is rarely isolated from human specimens. To the best of our knowledge, there are no reports on its detailed treatment course and prognosis. Here, we present the first known case of E. casseliflavus endocarditis with a detailed treatment course. Case presentation An 86-year-old Japanese woman was transferred to the emergency department with dyspnoea, wheezing, and lumbago. Her medical history included hypertension, chronic kidney disease, idiopathic interstitial pneumonia, and rectal carcinoma. Physical examination revealed expiratory wheezes and a diastolic murmur (Levine 2/6) at the 4th right sternal border. Chest radiography revealed bilateral interstitial opacities and slight cardiac dilatation. Transthoracic echocardiography demonstrated the presence of mobile vegetation with perforation, prolapse, and regurgitation of the aortic valve. With a suspicion of infective endocarditis, we started administering intravenous ampicillin/sulbactam. Thereafter, blood cultures identified E. casseliflavus through matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The antimicrobial treatment was then switched to ampicillin plus gentamicin. The patient underwent aortic valve replacement on the thirteenth hospital day. She was administered intravenous ampicillin and gentamicin for 6 weeks. The patient was discharged 8 weeks after admission. Conclusions Our case demonstrated that E. casseliflavus could cause infective endocarditis, which can be successfully treated with a 6-week regimen of ampicillin and gentamicin in combination with proper surgical treatment.
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Affiliation(s)
- Nobumasa Okumura
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan.
| | - Takashi Watanabe
- Department of Cardiology, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan
| | - Satoshi Teranishi
- Emergency Department, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan
| | - Daisuke Suzuki
- Department of Infectious Diseases, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan
| | - Takahiko Hashimoto
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan
| | - Kosuke Takahashi
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan
| | - Toru Hara
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan.,Department of Infectious Diseases, Anjo Kosei Hospital, Anjo-cho Higashi-Hirokute 28, Anjo City, Aichi Prefecture, Japan
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Dias T, de Almeida J, Santos A, Santos RM, Carvalho A. Enterococcus gallinarum Causing Native Valve Endocarditis. Eur J Case Rep Intern Med 2019; 6:001054. [PMID: 30931277 PMCID: PMC6438118 DOI: 10.12890/2019_001054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 11/14/2022] Open
Abstract
Endocarditis due to Enterococcus gallinarum is a rare condition, usually affecting older patients. The most frequent source of infection is the gastrointestinal or genitourinary tracts; it frequently involves the aortic valve and tends to produce heart failure. We present a case of Enterococcus gallinarum endocarditis developing on a normal native heart valve. Enterococcus gallinarum is intrinsically resistant to vancomycin. Antibiotic susceptibility patterns indicate that most isolates are penicillin and ampicillin-susceptible.
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Affiliation(s)
- Teresa Dias
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José de Almeida
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Arsénio Santos
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui M Santos
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Armando Carvalho
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Han H, Mo F, Zhang W, Luo Q. Meningitis Caused by Enterococcus gallinarum in an Immunocompetent Host. Jundishapur J Microbiol 2018; 11. [DOI: 10.5812/jjm.67164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
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Monticelli J, Knezevich A, Luzzati R, Di Bella S. Clinical management of non-faecium non-faecalis vancomycin-resistant enterococci infection. Focus on Enterococcus gallinarum and Enterococcus casseliflavus/flavescens. J Infect Chemother 2018; 24:237-246. [PMID: 29396199 DOI: 10.1016/j.jiac.2018.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023]
Abstract
Enterococcus gallinarum and Enterococcus casseliflavus/flavescens are enterococci intrinsically resistant to vancomycin belonging to the E. gallinarum group. They are responsible mainly for healthcare-associated infections, in particular bloodstream, urinary tract and surgical wound infections. Diseases due to these bacteria are significantly increasing worldwide, as they are prone to cause infection in patients with concurrent hepatobiliary or oncohematological disorders. Along with their distinguishing vancomycin resistance, due to a chromosomally-encoded VanC operon, their additional intrinsic resistance to many antibiotics other than glycopeptides limits the therapeutic choices. In addition, their intrinsic vancomycin resistance, unlike the vancomycin resistance of Enterococcus faecalis and Enterococcus faecium caused by transmissible plasmids, poses different infection control issues. We focused on the therapeutic and infection control issues of clinical syndromes caused by E. gallinarum and E. casseliflavus/flavescens. We propose therapeutic algorithms on bloodstream infections, endocarditis, central nervous system infections, endophthalmitis and urinary tract infections. The implementation of infection control measures in cases of E. gallinarum and E. casseliflavus/flavescens infection or colonization should be evaluated on a case-by-case basis, especially for epidemic outbreaks or for isolates supposed to harbor a potential transmissible vancomycin-resistance phenotype.
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Affiliation(s)
- Jacopo Monticelli
- Infectious Diseases Division, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Piazza dell'Ospitale 1, 34129, Trieste, Italy.
| | - Anna Knezevich
- Microbiology Division, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Strada di Fiume 447, 34149, Trieste, Italy.
| | - Roberto Luzzati
- Infectious Diseases Division, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Piazza dell'Ospitale 1, 34129, Trieste, Italy.
| | - Stefano Di Bella
- Infectious Diseases Division, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Piazza dell'Ospitale 1, 34129, Trieste, Italy.
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Soares FS, Amaral FC, Silva NLC, Valente MR, Santos LKR, Yamashiro LH, Scheffer MC, Castanheira FVES, Ferreira RG, Gehrke L, Alves-Filho JC, Silva LP, Báfica A, Spiller F. Antibiotic-Induced Pathobiont Dissemination Accelerates Mortality in Severe Experimental Pancreatitis. Front Immunol 2017; 8:1890. [PMID: 29375557 PMCID: PMC5770733 DOI: 10.3389/fimmu.2017.01890] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/11/2017] [Indexed: 12/23/2022] Open
Abstract
Although antibiotic-induced dysbiosis has been demonstrated to exacerbate intestinal inflammation, it has been suggested that antibiotic prophylaxis may be beneficial in certain clinical conditions such as acute pancreatitis (AP). However, whether broad-spectrum antibiotics, such as meropenem, influence the dissemination of multidrug-resistant (MDR) bacteria during severe AP has not been addressed. In the currently study, a mouse model of obstructive severe AP was employed to investigate the effects of pretreatment with meropenem on bacteria spreading and disease outcome. As expected, animals subjected to biliopancreatic duct obstruction developed severe AP. Surprisingly, pretreatment with meropenem accelerated the mortality of AP mice (survival median of 2 days) when compared to saline-pretreated AP mice (survival median of 7 days). Early mortality was associated with the translocation of MDR strains, mainly Enterococcus gallinarum into the blood stream. Induction of AP in mice with guts that were enriched with E. gallinarum recapitulated the increased mortality rate observed in the meropenem-pretreated AP mice. Furthermore, naïve mice challenged with a mouse or a clinical strain of E. gallinarum succumbed to infection through a mechanism involving toll-like receptor-2. These results confirm that broad-spectrum antibiotics may lead to indirect detrimental effects during inflammatory disease and reveal an intestinal pathobiont that is associated with the meropenem pretreatment during obstructive AP in mice.
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Affiliation(s)
- Fernanda S Soares
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Flávia C Amaral
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Natália L C Silva
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Matheus R Valente
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Lorena K R Santos
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Lívia H Yamashiro
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Mara C Scheffer
- Microbiology Laboratory, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Fernanda V E S Castanheira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Raphael G Ferreira
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Laura Gehrke
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - José C Alves-Filho
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Luciano P Silva
- Embrapa Genetic Resources and Biotechnology, Brasilia, Brazil.,Institute of Biological Sciences, University of Brasilia, Brasilia, Brazil
| | - André Báfica
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Fernando Spiller
- Laboratory of Immunobiology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Pharmacology, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
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Pericás JM, Zboromyrska Y, Cervera C, Castañeda X, Almela M, Garcia-de-la-Maria C, Mestres C, Falces C, Quintana E, Ninot S, Llopis J, Marco F, Moreno A, Miró JM. Enterococcal endocarditis revisited. Future Microbiol 2015; 10:1215-40. [PMID: 26118390 DOI: 10.2217/fmb.15.46] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.
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Affiliation(s)
- J M Pericás
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Y Zboromyrska
- Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Cervera
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - X Castañeda
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - M Almela
- Clinical Microbiology Service, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - C Garcia-de-la-Maria
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - C Mestres
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Falces
- Cardiology Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Quintana
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - S Ninot
- Cardiovascular Surgery Service, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Llopis
- Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - F Marco
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Microbiology Service, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS (Institut d'Investigacions Biomèdiques Pi i Sunyer), University of Barcelona, Barcelona, Spain
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Lozano C, González-Barrio D, García JT, Ceballos S, Olea PP, Ruiz-Fons F, Torres C. Detection of vancomycin-resistant Enterococcus faecalis ST6-vanB2 and E. faecium ST915-vanA in faecal samples of wild Rattus rattus in Spain. Vet Microbiol 2015; 177:168-74. [DOI: 10.1016/j.vetmic.2015.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/19/2015] [Accepted: 02/21/2015] [Indexed: 11/25/2022]
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