Streptococcus faecium var. casselifavus, nov. var

Endophthalmitis caused by Enterococcus casseliflavus: a systematic review of literature

Introduction

Enterococcus casseliflavus is a rare pathogen in human infections, despite being widely distributed in natural environments. This systematic review aims to evaluate the evidence related to endophthalmitis caused by E. casseliflavus.

Methods

A thorough search of PubMed, PubMed Central, and Scopus databases was conducted, covering the period up to October 2022.

Results

A total of 53 records were identified, with 8 studies reporting a total of 21 cases meeting the inclusion criteria. Among these studies, 7 described isolated case reports, while 1 study described 14 cases. The overall quality of the reports was good, as all articles were determined to have low risk of bias. Vancomycin susceptibility was reported in only one case of isolated case reports, while the remaining cases were all vancomycin resistant. With regard to management, in most cases intravenous ampicillin and linezolid were administered, while only one study reported administration of vancomycin.

Conclusions

Ophthalmologists should be aware of the potential for E. casseliflavus to cause endophthalmitis infections and the challenges associated with its intrinsic resistance to vancomycin.

Successful treatment of aortic valve endocarditis caused by Enterococcus casseliflavus: a case report

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.

The Enterococcus: a Model of Adaptability to Its Environment

The genus Enterococcus comprises a ubiquitous group of Gram-positive bacteria that are of great relevance to human health for their role as major causative agents of health care-associated infections. The enterococci are resilient and versatile species able to survive under harsh conditions, making them well adapted to the health care environment. Two species cause the majority of enterococcal infections: Enterococcus faecalis and Enterococcus faecium Both species demonstrate intrinsic resistance to common antibiotics, such as virtually all cephalosporins, aminoglycosides, clindamycin, and trimethoprim-sulfamethoxazole. Additionally, a remarkably plastic genome allows these two species to readily acquire resistance to further antibiotics, such as high-level aminoglycoside resistance, high-level ampicillin resistance, and vancomycin resistance, either through mutation or by horizontal transfer of genetic elements conferring resistance determinants.

Molecular characteristics and comparative genomics analysis of a clinical Enterococcus casseliflavus with a resistance plasmid

Purpose

The aim of this work was to investigate the molecular characterization of a clinical Enterococcus casseliflavus strain with a resistance plasmid.

Materials and methods

En. casseliflavus EC369 was isolated from a patient in a hospital in southern China. The minimum inhibitory concentration was found by means of the agar dilution method to determine the antimicrobial susceptibilities of the strains. Whole-genome sequencing and comparative genomics analysis were performed to analyze the mechanism of antibiotic resistance and the horizontal gene transfer of the resistance gene-related mobile genetic elements.

Results

En. casseliflavus EC369 showed resistance to erythromycin, kanamycin, and streptomycin, but was susceptible to vancomycin, ampicillin, and streptothricin and other antimicrobials. There were six resistance genes (aph3′, ant6, bla, sat4, and two ermBs) carried by a transposon identified on the plasmid pEC369 and a complete resistance gene cluster of vancomycin and a tet (M) gene encoded on the chromosome. This is the first complete plasmid sequence reported in clinically isolated En. casseliflavus. The plasmid with the greatest sequence identity with pEC369 was the plasmid of Enterococcus sp. FDAARGOS_375, followed by the plasmids of Enterococcus faecium strains F12085 and pRE25, whereas the sequence with the greatest identity to the resistance genes carrying a transposon of pEC369 was on the chromosome of Staphylococcus aureus strain GD1677.

Conclusion

The resistance profiles of En. casseliflavus EC369 might contribute to the resistance genes encoded on the plasmid. The fact that the most similar sequence to the transposon carrying resistance genes of pEC369 was encoded in the chromosome of a S. aureus strain provides insights into the mechanism of dissemination of multidrug resistance between bacteria of different species or genera through horizontal gene transfer.

Clinical management of non-faecium non-faecalis vancomycin-resistant enterococci infection. Focus on Enterococcus gallinarum and Enterococcus casseliflavus/flavescens

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.

Incidence of Type II CRISPR1-Cas Systems in Enterococcus Is Species-Dependent

CRISPR-Cas systems, which obstruct both viral infection and incorporation of mobile genetic elements by horizontal transfer, are a specific immune response common to prokaryotes. Antiviral protection by CRISPR-Cas comes at a cost, as horizontally-acquired genes may increase fitness and provide rapid adaptation to habitat change. To date, investigations into the prevalence of CRISPR have primarily focused on pathogenic and clinical bacteria, while less is known about CRISPR dynamics in commensal and environmental species. We designed PCR primers and coupled these with DNA sequencing of products to detect and characterize the presence of cas1, a universal CRISPR-associated gene and proxy for the Type II CRISPR1-Cas system, in environmental and non-clinical Enterococcus isolates. CRISPR1-cas1 was detected in approximately 33% of the 275 strains examined, and differences in CRISPR1 carriage between species was significant. Incidence of cas1 in E. hirae was 73%, nearly three times that of E. faecalis (23.6%) and 10 times more frequent than in E. durans (7.1%). Also, this is the first report of CRISPR1 presence in E. durans, as well as in the plant-associated species E. casseliflavus and E. sulfureus. Significant differences in CRISPR1-cas1 incidence among Enterococcus species support the hypothesis that there is a tradeoff between protection and adaptability. The differences in the habitats of enterococcal species may exert varying selective pressure that results in a species-dependent distribution of CRISPR-Cas systems.

The combinations Lysobacter enzymogenes subsp. enzymogenes Christensen and Cook 1978, L. enzymogenes subsp. cookii Christensen 1978 and Streptococcus casseliflavus (Mundt and Graham 1968) Vaughan et al. 1979 were in accordance with the International Code of Nomenclature of Bacteria at the time of publication in the International Journal of Systematic Bacteriology, but are not to be considered to be included on the Approved Lists of Bacterial Names. Opinion 95

The Judicial Commission affirms that, according to information presented to it, the combination Lysobacter enzymogenes subsp. enzymogenes Christensen and Cook 1978, the combination Lysobacter enzymogenes subsp. cookii Christensen 1978 and the combination Streptococcus casseliflavus (Mundt and Graham 1968) Vaughan et al. 1979 were in accordance with the wording of the 1975 and 1992 revisions of the International Code of Nomenclature of Bacteria but they are not to be considered to be included on the Approved Lists of Bacterial Names.

Enterococci in the environment

Enterococci are common, commensal members of gut communities in mammals and birds, yet they are also opportunistic pathogens that cause millions of human and animal infections annually. Because they are shed in human and animal feces, are readily culturable, and predict human health risks from exposure to polluted recreational waters, they are used as surrogates for waterborne pathogens and as fecal indicator bacteria (FIB) in research and in water quality testing throughout the world. Evidence from several decades of research demonstrates, however, that enterococci may be present in high densities in the absence of obvious fecal sources and that environmental reservoirs of these FIB are important sources and sinks, with the potential to impact water quality. This review focuses on the distribution and microbial ecology of enterococci in environmental (secondary) habitats, including the effect of environmental stressors; an outline of their known and apparent sources, sinks, and fluxes; and an overview of the use of enterococci as FIB. Finally, the significance of emerging methodologies, such as microbial source tracking (MST) and empirical predictive models, as tools in water quality monitoring is addressed. The mounting evidence for widespread extraenteric sources and reservoirs of enterococci demonstrates the versatility of the genus Enterococcus and argues for the necessity of a better understanding of their ecology in natural environments, as well as their roles as opportunistic pathogens and indicators of human pathogens.

Comparative genomics of enterococci: variation in Enterococcus faecalis, clade structure in E. faecium, and defining characteristics of E. gallinarum and E. casseliflavus

The enterococci are Gram-positive lactic acid bacteria that inhabit the gastrointestinal tracts of diverse hosts. However, Enterococcus faecium and E. faecalis have emerged as leading causes of multidrug-resistant hospital-acquired infections. The mechanism by which a well-adapted commensal evolved into a hospital pathogen is poorly understood. In this study, we examined high-quality draft genome data for evidence of key events in the evolution of the leading causes of enterococcal infections, including E. faecalis, E. faecium, E. casseliflavus, and E. gallinarum. We characterized two clades within what is currently classified as E. faecium and identified traits characteristic of each, including variation in operons for cell wall carbohydrate and putative capsule biosynthesis. We examined the extent of recombination between the two E. faecium clades and identified two strains with mosaic genomes. We determined the underlying genetics for the defining characteristics of the motile enterococci E. casseliflavus and E. gallinarum. Further, we identified species-specific traits that could be used to advance the detection of medically relevant enterococci and their identification to the species level.

The enterococci, in particular, vancomycin-resistant enterococci, have emerged as leading causes of multidrug-resistant hospital-acquired infections. In this study, we examined genome sequence data to define traits with the potential to influence host-microbe interactions and to identify sequences and biochemical functions that could form the basis for the rapid identification of enterococcal species or lineages of importance in clinical and environmental samples.

Enterococcus species composition determined by capillary electrophoresis of the groESL gene spacer region DNA

Marine recreational beaches are monitored for fecal contamination by Enterococcus spp. (ENT) counts. Although different ENT species in the environment tend to thrive in and originate from distinct hosts, the current monitoring method does not differentiate among species. Time-consuming isolation-based species identification precludes routine analysis of environmental ENT communities. Therefore, an isolation-independent DNA fingerprinting method was developed to characterize environmental ENT communities using DNA length polymorphism of the spacer region between the groES and groEL genes common to most ENT species. Capillary electrophoresis resulted in distinct peak sizes of PCR products that carried polymorphic groESL spacers (300-335 bp in length) among 8 different ENT species (Enterococcus avium, Enterococcus gallinarum, Enterococcus casseliflavus, Enterococcus mundtii, Enterococcus hirae, Enterococcus faecium, Enterococcus durans, and Enterococcus faecalis). Distortions in true species ratios observed in electropherograms were caused by PCR biases arising in a mixed ENT community DNA template. E. faecalis was overestimated and E. avium and E. faecium were underestimated compared to the original species ratios in the mixed community. The PCR product bias was constant between species, so good approximation of the species ratio in ENT communities is possible. In environmental samples, a high percentage of E. faecalis (96%) together with high total ENT counts were observed in samples collected from a sewer line and from several sites in a storm drain system where sewage leaks were suspected. In contrast, samples with <400 CFU 100 ml-1 ENT were either dominated by E. mundtii or had 4 or more ENT species. The latter ENT community profiles are considered to be signatures of enterococci rarely associated with animals with low or of non-fecal origin.

Enterococcus species distribution among human and animal hosts using multiplex PCR

AIMS

This study evaluated the use of Enterococcus species differentiation as a tool for microbial source tracking (MST) in recreational waters.

METHODS AND RESULTS

Avian, mammalian and human faecal samples were screened for the occurrence of Enterococcus avium, Enterococcus casseliflavus, Enterococcus durans, Enterococcus gallinarum, Enterococcus faecium, Enterococcus faecalis, Enterococcus hirae and Enterococcus saccharolyticus using multiplex PCR. Host-specific patterns of Enterococcus species presence were observed only when data for multiple Enterococcus species were considered in aggregate.

CONCLUSIONS

The results suggest that no single Enterococcus species is a reliable indicator of the host faecal source. However, Enterococcus species composite 'fingerprints' may offer auxiliary evidence for bacterial source identification.

SIGNIFICANCE AND IMPACT OF STUDY

This study presents novel information on the enterococci species assemblages present in avian and mammalian hosts proximate to the nearshore ocean. These data will aid the development of appropriate MST strategies, and the approach used in this study could potentially assist in the identification of faecal pollution sources.

Species distribution and antimicrobial resistance of enterococci isolated from surface and ocean water

AIMS

The species identification and antimicrobial resistance profiles were determined for enterococci isolated from Southern California surface and ocean waters.

METHODS AND RESULTS

Species identification was determined for 1413 presumptive Enterococcus isolates from urban runoff, bay, ocean and sewage water samples. The most frequently isolated species were Enterococcus faecalis, Enterococcus faecium, Enterococcus hirae, Enterococcus casseliflavus and Enterococcus mundtii. All five of these species were isolated from ocean and bay water with a frequency ranging from 7% to 36%. Enterococcus casseliflavus was the most frequently isolated species in urban runoff making up 36-65% of isolates while E. faecium was the most frequently isolated species in sewage making up 53-78% of isolates. The similar distribution of species in urban runoff and receiving water suggests that urban runoff may be the source of Enterococcus. No vancomycin or high level gentamycin resistance was detected in E. faecalis and E. faecium isolates.

CONCLUSIONS

Enterococcus faecalis, E. faecium, E. casseliflavus and E. mundtii are the most commonly isolated Enterococcus species from urban runoff and receiving waters in Southern California.

SIGNIFICANCE AND IMPACT OF THE STUDY

Determination of the Enterococcus species isolated from receiving waters and potential pollution sources may assist in determining the sources of pollution.

Lysobacter enzymogenes subsp. enzymogenes Christensen and Cook 1978, L. enzymogenes subsp. cookii Christensen 1978 and Streptococcus casseliflavus (Mundt and Graham 1968) Vaughan et al. 1978 should have been cited in the Approved Lists of Bacterial Names. Request for an opinion

Lysobacter enzymogenes subsp. enzymogenes Christensen and Cook 1978, L. enzymogenes subsp. cookii Christensen 1978 and Streptococcus casseliflavus (Mundt and Graham 1968) Vaughan et al. 1978 were inadvertently omitted from the Approved Lists of Bacterial Names. According to Rule 24a, Note 1, the authors request that these names be considered as included in these Lists.

Reclassification of Enterococcus flavescens Pompei et al. 1992 as a later synonym of Enterococcus casseliflavus (ex Vaughan et al. 1979) Collins et al. 1984 and Enterococcus saccharominimus Vancanneyt et al. 2004 as a later synonym of Enterococcus italicus Fortina et al. 2004

The taxonomic relatedness between the speciesEnterococcus casseliflavusandEnterococcus flavescensand betweenEnterococcus italicusandEnterococcus saccharominimuswas investigated. Literature data had already indicated the synonymy betweenE. casseliflavusandE. flavescens, but this observation had not been formally published. Additional evidence that the two taxa represent a single species was provided by comparison of the partial sequences for three housekeeping genes, phenylalanyl-tRNA synthase alpha subunit (pheS), RNA polymerase alpha subunit (rpoA) and the alpha subunit of ATP synthase (atpA). Additional genomic data derived from DNA–DNA hybridization demonstrated that the two species are synonymous. ForE. italicusandE. saccharominimus, two recently described taxa, a high 16S rRNA gene sequence similarity of >99 % and analogous phenotypic features indicated a close taxonomic relatedness. The same multilocus sequence analysis scheme for the three housekeeping genes was also applied forE. italicusandE. saccharominimusand indicated possible conspecificity, an observation that was also confirmed by a high DNA–DNA hybridization value (⩾78 %). Data from the present study led to the proposal thatE. flavescensshould be reclassified as a later synonym ofE. casseliflavusand thatE. saccharominimusshould be reclassified as a later synonym ofE. italicus.

Clinical and epidemiological features of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum bacteremia: a report of 20 cases

The clinical significance of intrinsically vancomycin-resistant enterococci is not yet fully established, as these organisms are infrequently recovered from clinical specimens. We report our experience with 20 cases of Enterococcus gallinarum and Enterococcus casseliflavus/flavescens bacteremia in humans from 1992 through 1998. Sixteen cases of bacteremia were caused by E. gallinarum. Underlying conditions were present in 19 (95%) of the patients and included malignancy, receipt of transplant, and Caroli's disease. Polymicrobial bacteremia was present in 9 patients (45%). E. gallinarum and E. casseliflavus/flavescens, although they are infrequently isolated from clinical specimens, may cause serious invasive infections.

Identification of Enterococcus spp. with a biochemical key

A six-step biochemical key is presented for the identification of all recognized Enterococcus spp. The key consists of 12 tests, but no more than 6 are needed for the most complicated identification. The reliability of the key has been evaluated with collection type strains and clinical and environmental isolates. This key has fewer tests than those reported in previous studies. There is no commercial kit that includes the whole set of tests. However, some of the tests are included in enzyme activity-based kits that could be used with the proposed key. The key is designed for use in routine applications, especially in environmental and clinical studies with a high number of isolates.

Characterization of yellow-pigmented enterococci from severe human infections

Four strains of yellow-pigmented enterococci that resembled the species Enterococcus casseliflavus were isolated from patients who had undergone surgical treatment. They were substantially homologous in terms of biochemical properties, antibiotic susceptibilities, and plasmid DNA profiles. Yellow-pigmented enterococci could be another potentially important cause of nosocomial infection in surgical units.

Recent taxonomic changes in the genus Enterococcus

Recent taxonomic changes among the catalase-negative gram-positive cocci have led to the recognition of a separate genus for bacteria previously considered to be members of the genus Streptococcus. Presently, a total of 12 species of the genus Enterococcus have been described. The characteristics, taxonomy and nomenclature of these species, along with the possible clinical implications of revised enterococcal taxonomy, are discussed.

The life and times of the Enterococcus

Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.

Enumeration and speciation of group D streptococci from above and below a sewer outfall, their susceptibilities to six antibiotics and a comparison with clinical isolates

Isolates of group D streptococci from above and below a sewer outfall and a series of clinical isolates have been speciated to sub-species level. From below the sewer outfall, Streptococcus faecalis var. faecalis predominates whereas above the outfall, S. faecium var. casseliflavus predominates. S. faecalis var. faecalis, S. faecalis var. liquefaciens and S. faecalis var. zymogenes were the predominant sub-species in the clinical isolates where S. faecium var. casseliflavus was virtually absent. S. faecalis var. liquefaciens and S. faecalis var. zymogenes were uncommon in the environmental isolates. S. faecium and S. durans were more abundant in the environmental than in the clinical isolates. The use of group D streptococci as indicators of faecal pollution would seem more suited to higher, rather than lower, levels of pollution. A statistically significant increase in resistance to antibiotics (ampicillin, penicillin, streptomycin, gentamicin, erythromycin and tetracycline) was seen in isolates from below the outfall compared with those from above and a further significant increase was seen in the clinical isolates compared with the former. Resistance to tetracycline was most common and ampicillin was the only antibiotic tested to which no resistance was detected. Multiple antibiotic resistance was rare in the environmental isolates. Even in moderately polluted water, there is not a large pool of antibiotic resistance.

The ecology of the streptococci

All species of streptococci are divided into several groups according to the ecological niches they occupy. Members of the lactic acid group are found only in the plant environment and the dairy. Members of the pyogenic group and the buccal and intestinal residents of the subthermophilic group are found in intimate association only with homeothermic hosts. Members of the virulent pyogenic group, such asStreptococcus pyogenes, S. equi, andS. infrequens, are restricted to single hosts-the human, the horse, and the pig-whereas others, such asS. agalactiae can be found in several hosts. The intestinal dwellers of the subthermophilic group,S. bovis andS. equinus, occur in several animal species and are not isolated from other sources. The superficially homogeneousS. faecalis of the "enteric" group may actually consist of a group specifically restricted to the human host, and of a second group distributed among wild animals, insects, and plants. The latter group differs from the human type by the ability to hydrolyze starch and to produce a rennin-proteolytic type of curd in milk.Streptococcus faecium is widely distributed in both the homeothermic and poikilothermic environments, but no properties which differentiate the sources are known.Streptococcus faecium biot.casseliflavus has been isolated only from insects and plants.Streptococcus uberis occurs on the bovine lips and skin. Unidentified streptococci from all environments vary widely in properties. Many resembleS. lactis, S. faecalis, andS. faecium.

Presumptive identification of enterococci from other D streptococci by a rapid sodium chloride tolerance test

Ability of enterococci to cause severe disease in humans and their relative resistance to chemotherapeutic agents necessitate their differentiation from other group D streptococci. We developed and evaluated a medium that differentiates enterococci from other group D streptococci within 4 to 24 hours. The 410 clinical isolates used in this study consisted of 328 strains of enterococci and 82 strains of other group D streptococci. The method showed 100 percent sensitivity and specificity with the conventional sodium chloride test. It is simple, reliable, and rapid.

Isolation of Streptococcus equinus from non-respiratory sources in children

Streptococcus equinus, a non-enterococcal streptococcus, was isolated with increased frequency in a pediatric population.

Evaluation of a new presumptive medium for group D streptococci

A new medium designated as D streptococcus-enterococcus broth was formulated and evaluated for the enrichment and isolation of strains of serological group D streptococci. This medium was made by modifying Todd-Hewitt broth. Most-probable-number multiple-tube and membrane filter techniques were employed to estimate the numbers of enterococci in known cultures, wastewater, and other samples. Preliminary most-probable-number counts with this medium were as much as 3 logs higher than those counts obtained from four other media with which it was compared. The methodology for using this medium to estimate the numbers of group D streptococci in water is discussed.

Differentiation of some enterococci by gas chromatography

Relative fatty acid compositions of 37 enterococci were examined by gas chromatography. Streptococcus faecalis, S. faecium, and S. faecium var. durans yielded similar fatty acid patterns. Strains of S. faecium var. casseliflavus, and a motile yellow-pigmented streptococcus, contained very low levels of C(19:0) cyclopropane fatty acid and four unidentified components, compared to the other strains of enterococci examined. There were no significant differences in the fatty acid patterns of enterococci grouped according to plant, animal, or human source.

Recognition of group D streptococcal species of human origin by biochemical and physiological tests

The speciation of 262 strains of group D streptococci isolated from human sources is described. One hundred forty-two isolates from blood cultures were included; 96 of these were submitted as isolates from clinical cases of subacute bacterial endocarditis. The results show that 98 Streptococcus faecalis, 29 S. faecalis var. zymogenes, 44 S. faecalis var. liquefaciens, 27 S. faecium, 13 S. durans, 44 S. bovis, and 7 unspeciated S. bovis-like group D isolates were identified. No S. faecium var. casseliflavus, S. equinus, or S. avium (group Q streptococci) were identified among the human isolates. The speciation procedures and techniques are detailed. The procedures and limitations of the tests used are discussed. Ninety-eight percent of the 262 strains were speciated by a spectrum of tests that allowed us to recognize atypical as well as typical strains within species.

Carotenoids in yellow-pigmented enterococci

Pigments extracted from three strains of yellow enterococci showed the spectral and solvent partition characteristics of carotenoids. An unusual C(32) carotenoid aldehyde appears to predominate.

Laboratory studies with a selective Enterococcus medium

Lancefield group D streptococci are involved with appreciable frequency in a variety of infectious processes. The presumptive recognition of these bacteria on initial culturing of clinical specimens is an objective not attained readily by selective media available in the clinical laboratory. Selective Enterococcus agar was evaluated with emphasis on its ability to sequester enterococci from specimens with many microbial components. In addition, the sensitivity of this new agar was compared with Trypticase Soy agar containing sheep blood and Mitis Salivarius agar. All enterococci isolated from clinical material were classified in accordance with accepted biochemical and immunochemical criteria. The enterococci grew on the new medium as distinctive colonies surrounded by a black zone. Only Listeria monocytogenes presented similar colonial morphology after 48 hr. Most other bacteria did not grow at all or appeared markedly different. The sensitivity of the new agar was of the same order of magnitude as on blood or Mitis-Salivarius agars, but its selectivity was superior.

Presumptive identification of group D streptococci: the bile-esculin test

Six tests commonly used for the presumptive identification of group D streptococci were evaluated. Strains tested included 282 group D streptococci and 366 non-group D. Ratios of percentages of group D to non-group D strains which gave positive reactions for each test are as follows: bile-esculin, 100:2; salt tolerance, 88:24; heat tolerance, 100:80; SF broth, 86:1; KF broth, 99:40; and methylene blue milk reduction, 90:17. These data indicate that the bile-esculin test provided a reliable means of identifying group D streptococci and differentiating them from non-group D streptococci. Methodology for reading and interpreting positive reactions and time of incubation of the bile-esculin medium was defined. Evidence of the need for standardization of salt and heat-tolerance tests was obtained.