Enterococcal

Enterococcal refers to bacteria of the genus Enterococcus, gram-positive cocci that commonly inhabit the human gut. The two species most often implicated in human disease are Enterococcus faecalis and Enterococcus faecium. Enterococci are hardy organisms that tolerate bile, salt, desiccation, and heat.

They are opportunistic pathogens, especially in hospitalized or immunocompromised patients, and can cause urinary tract infections, bacteremia, endocarditis, intra-abdominal infections, and wound infections. Transmission occurs via person-to-person contact and contaminated surfaces, making infection control and antimicrobial stewardship essential.

Laboratory identification shows gram-positive cocci in pairs or short chains, catalase negative, and bile esulin positive. They grow in 6.5% NaCl and often require biochemical tests or MALDI-TOF for species-level identification, which guides therapy.

Resistance is a major concern. Enterococci are intrinsically resistant to cephalosporins and can have high-level aminoglycoside resistance. Vancomycin-resistant Enterococcus (VRE) strains present treatment challenges. Management depends on species and susceptibility, with options including ampicillin for susceptible E. faecalis, and linezolid, daptomycin, or tigecycline for resistant infections; nitrofurantoin or fosfomycin may be used for select cystitis cases.

Prevention emphasizes hand hygiene, environmental cleaning, contact precautions for VRE, and prudent antibiotic use, along with timely source control of infections. Outcomes vary by infection site and resistance pattern, with higher morbidity and mortality associated with resistant enterococcal infections.