Enterococcus faecium

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Enterococcus faecium
Systematics
Department : Firmicutes
Class : Bacilli
Order : Lactic acid bacteria (Lactobacillales)
Family : Enterococcaceae
Genre : Enterococcus
Type : Enterococcus faecium
Scientific name
Enterococcus faecium
( Orla-Jensen 1919)
Schleifer & Kilpper-Bälz 1984

Enterococcus faecium (formerly known as Streptococcus faecium ) is a type of bacteria from the Enterococcus genus ( German : Enterococci). Enterococcus faecium occurs in the intestines of humans and animals. The relationship with Enterococcus faecalis is very close, but E. faecium has some clinically relevant properties that distinguish it from E. faecalis .

features

The cells of Enterococcus faecium behave gram positive . They are cocci-shaped and are arranged in pairs or in chains. Enterococcus faecium is negative in the catalase and oxidase test . It can multiply in the presence and absence of oxygen , so the metabolism is facultatively anaerobic .

Usually no hemolysis or γ-hemolysis can be observed on blood agar . Enterococcus faecium , like its close relative Enterococcus faecalis, is largely resistant to bile salts and optochin . It is thermotolerant (growth still at 45 ° C) and salt tolerant (growth in 6.5% NaCl solution). It is also capable of aesculin hydrolysis . It carries the Lancefield group D- antigen , but the extraction of the antigen is more difficult than with the streptococci , since this antigen of the enterococci is based on a cell wall - bound teichonic acid , which functions as a C substance.

Clinical significance

The presence in the intestine alone has no disease value. When antibiotics are given, E. faecium can become the main component of the intestinal flora through the development of resistance .

So far, no toxins and only a few other virulent factors have been detected, for example an aggregation substance.

The pathogenic strains cause nosocomial infections in people with compromised immune systems. Furthermore, one endocarditis , and cholecystitis with, cystitis and decubitus ulcers E. faecium arise. Complications such as urosepsis or peritonitis are often difficult to treat because of the resistance of the pathogen. Overall, E. faecium is found less often in infections than E. faecalis , but the vancomycin-resistant Enterococcus (faecium) (VRE), which was increasingly observed in the years before 2020, is one of the most difficult germs to control.

Live germs of the strain Cernelle 68 (SF 68) from Enterococcus faecium are offered in the form of capsules for the treatment of diarrheal diseases and for the reconstruction of the intestinal flora .

Resistances

Natural resistance exists to all cephalosporins , macrolides , fusidic acid and sulfonamides . Furthermore, the vast majority of isolates (approx. 90%) are also resistant to ampicillin and amoxicillin . This resistance is typically not mediated enzymatically by β-lactamases , but rather by mutations or overexpression of the penicillin binding protein 5. Therefore, it can usually not be overcome by adding a β-lactamase inhibitor .

treatment

Infections caused by Enterococcus faecium are relatively difficult to treat with antibiotics as few antibiotics are considered. Therapy with vancomycin can be regarded as the standard treatment , although this is fundamentally ineffective for VRE (see above), but teicoplanin and daptomycin can also be considered. As alternatives (for VRE) linezolid and tigecycline come into question, in the case of uncomplicated urinary tract infections (which are only rarely caused by E. faecium ) possibly also fosfomycin or nitrofurantoin .

In a study with mice, colonization with vancomycin-resistant E. faecium could be prevented and reversed by implantation with bacteria of the genus Barnesiella .

Individual evidence

  1. ↑ Michael T. Madigan, John M. Martinko, Jack Parker: Brock Microbiology. German translation edited by Werner Goebel, 1st edition. Spektrum Akademischer Verlag GmbH, Heidelberg / Berlin 2000, ISBN 978-3-8274-0566-1 , pp. 559-563.
  2. ↑ a b c Uwe Groß: Short textbook on medical microbiology and infectious diseases: 129 tables , 2nd edition. Edition, Thieme, Stuttgart 2009, ISBN 978-3-13-141652-0 .
  3. ↑ a b Helen W Boucher, George H Talbot, John S Bradley, John E Edwards, David Gilbert, Louis B Rice, Michael Scheld, Brad Spellberg, John Bartlett: Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America . In: Clinical Infectious Diseases . 48, No. 1, January 1, 2009, ISSN  1058-4838 , pp. 1-12. doi : 10.1086 / 595011 . Retrieved February 12, 2012.
  4. ↑ "Hospital & Practice Hygiene" working group of the AWMF: Guideline 029-019 - Measures in the event of the occurrence of multi-resistant pathogens (MRE) . Retrieved February 12, 2012.
  5. ↑ Ines Noll, Tim Eckermanns, Muna Abu Sin: Antibiotic Resistance: A Heterogeneous Picture. In: Deutsches Ärzteblatt. Volume 117, issue, 1–2, January 6, 2020, p. B 26 f.
  6. ↑ Henrik Holtmann: Basics of medical microbiology, virology and hygiene / Henrik Holtmann; Monika Bobkowski , 1st ed., Elsevier, Urban & Fischer, Munich 2008, ISBN 978-3-437-42416-8 .
  7. ↑ Gerd Herold: Internal medicine: a lecture-oriented presentation , 2012. Edition, Herold, Cologne 2012, ISBN 9783981466010 .
  8. ↑ Description of Bioflorin capsules , a preparation with germs of Enterococcus faecium ( Memento of the original from August 2, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / aposhop.aponet.at
  9. ^ R. Leclercq et al .: EUCAST expert rules in antimicrobial susceptibility testing . In: Clinical Microbiology and Infection . tape 19 , no. 2 . Wiley-Blackwell, 2013, ISSN  1469-0691 , pp. 141-160 , doi : 10.1111 / j.1469-0691.2011.03703.x , PMID 22117544 ( wiley.com [accessed February 17, 2013]).
  10. ^ A b Cesar A. Arias and Barbara E. Murray: Enterococcus Species, Streptococcus bovis Group, and Leuconostoc Species . In: Gerald L Mandell, John E. Bennett and Raphael Dolin (Eds.): Principles and Practice of Infectious Diseases . 7th edition. Churchill Livingstone Elsevier, Philadelphia 2010, ISBN 978-0-443-06839-3 , pp. 2643-2653 .
  11. ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 263.
  12. ↑ C. Ubeda, V. Bucci et al. a .: Intestinal Microbiota Containing Barnesiella Species Cures Vancomycin-Resistant Enterococcus faecium Colonization. In: Infection and Immunity . 81, 2013, pp. 965-973, doi : 10.1128 / IAI.01197-12 .

literature

  • Rolle / Mayr: Medical microbiology, infection and disease theory. Enke Verlag, Stuttgart 2007