From the Guidelines
Enterococcus faecalis is a gram-positive, facultatively anaerobic bacterium that belongs to the genus Enterococcus. It is a commensal organism commonly found in the gastrointestinal tract of humans and animals. E. faecalis is characterized by its ability to grow in harsh environments, including high salt concentrations, extreme pH levels, and a wide range of temperatures. This bacterium is naturally resistant to many antibiotics and can acquire additional resistance mechanisms, making infections difficult to treat. E. faecalis can cause various infections including urinary tract infections, bacteremia, endocarditis, and wound infections, particularly in healthcare settings and immunocompromised patients. It often forms biofilms on medical devices and surfaces, contributing to its persistence and virulence. Treatment typically involves antibiotics like ampicillin or vancomycin, though vancomycin-resistant strains (VRE) require alternative approaches such as linezolid or daptomycin 1.
Some key points to consider when dealing with E. faecalis infections include:
- The importance of differentiating colonization from true infection prior to empiric prescription of anti-VRE antimicrobial agents 1
- The use of high-dose daptomycin (8-12 mg/kg daily) for the treatment of serious VRE infections 1
- The potential for combination antimicrobial therapy, such as daptomycin plus ampicillin or ceftaroline, for the treatment of multidrug-resistant enterococcal infections 1
- The need for infectious disease consultation and individualized treatment plans for patients with enterococcal infections, particularly those with complicated or resistant infections 1
Overall, the management of E. faecalis infections requires a comprehensive approach that takes into account the specific characteristics of the infecting organism, the severity of the infection, and the individual patient's needs and circumstances.
From the Research
Characteristics of E. Faecalis
- E. faecalis is a Gram-positive, catalase-negative, non-spore-forming, facultative anaerobic bacteria 2
- It is a commensal member of the gut microbiota of a wide range of organisms 3
- E. faecalis can survive a range of stresses and hostile environments, including extreme temperature, pH, and high NaCl concentration 2
- It is able to colonize a wide range of niches and is found in the intestinal flora, as well as less frequently in the vagina or mouth 4
Virulence Factors
- E. faecalis has several virulence factors, including the extracellular protein Esp and aggregation substances (Agg), which aid in colonization of the host 2
- It also produces a pore-forming exotoxin called cytolysin, which lyses both bacterial and eukaryotic cells in response to quorum signals 3
- The presence of virulence genes, such as esp, gelE, and cylA, has been investigated in E. faecalis strains 5
Clinical Significance
- E. faecalis is a frequent etiologic agent of invasive infections in hospitalized patients, including bacteremia, urinary tract infections, and endocarditis 5, 2
- It is also a common cause of hospital-acquired infections, particularly in patients with underlying comorbidities 6
- The management of infections caused by E. faecalis can be challenging due to its ability to develop resistance to multiple antibiotics, including vancomycin 6