The epidemiology of enterococci Current Topic: Review DOI:
10.1007/BF01963631 Cite this article as: Chenoweth, C. & Schaberg, D. Eur. J. Clin. Microbiol. Infect. Dis. (1990) 9: 80. doi:10.1007/BF01963631 Abstract
The enterococci are emerging as a significant cause of nosocomial infections, accounting for approximately 10 % of hospital acquired infections. They are found as normal inhabitants of the human gastrointestinal tract, but may also colonize the oropharynx, vagina, perineal region and soft tissue wounds of asymtomatic patients. Until recently, evidence indicated that most enterococcal infections arose from patients' own endogenous flora. Recent studies, however, suggest that exogeneous acquisition may occur and that person-to-person spread, probably on the hands of medical personnel, may be a significant mode of transmission of resistant enterococci within the hospital. The use of broad-spectrum antibiotics, especially cephalosporins, is another major factor in the increasing incidence of enterococcal infections. These findings suggest that barrier precautions, as applied with other resistant nosocomial pathogens, along with more judicial use of antibiotics may be beneficial in preventing nosocomial spread of resistant enterococci.
Schlaes DM, Levy J, Wolinsky E
: Enterococcal bacteremia without endocarditis. Archives of Internal Medicine 1981, 141:578–581.
Hoffman SA, Moellering RC
: The enterococcus: “Putting the bug in our ears”. Annals of Internal Medicine 1987, 106: 757–761.
Maki DG, Agger WA
: Enterococcal bacteremia: clinical features, the risk of endocarditis and management. Medicine 1988, 67: 248–269.
Centers for Disease Control
; Nosocomial infections surveillance. CDC Surveillance Summaries 1984, 35: 17–29.
Whiteside M, Moore J, Ratzan K
: An investigation of enterococcal bacteremia. American Journal of Infection Control 1983, 11: 125–129.
Morrison AJ, Wenzel RP
: Nosocomial urinary tract infections due to enterococcus: ten years's experience at a university hospital. Archives of Internal Medicine 1986, 146: 1549–1551.
Gross PA, Harkavy LM, Barden GE, Flower MR
: The epidemiology of nosocomial enterococcal urinary tract infection. American Journal of Medical Sciences 1976, 272: 75–81.
: Enterococci: biologic and epidemiologic characteristics and in vitro susceptibility. Archives of Internal Medicine 1982, 142: 2006–2009.
: Nosocomial bacteremia: an epidemiologic overview. American Journal of Medicine 1981, 70:719–732.
Zervos MJ, Kauffman CA, Therasse PM, Bergman AG, Mikesell TS, Schaberg DR
: Nosocomial infection by gentamicin-resistant
an epidemiologic study. Annals of Internal Medicine 1987, 106: 687–691.
Zervos MJ, Dembinski S, Mikesell TS, Schaberg DR
: High level resistance to gentamicin in
risk factors and evidence for exogenous acquisition of infection. Journal of Infectious Disease 1986, 153: 1075–1083.
: The streptococci. Bacteriology Reviews 1937, 1: 3–97.
Bosley GS, Facklam RR, Grossman D
: Rapid identification of enterococci. Journal of Clinical Microbiology 1983, 18: 1275–1277.
Jawetz E, Sonne M
: Penicillin-streptomycin treatment of enterococcal endocarditis: a re-evaluation. New England Journal of Medicine 1966, 274: 710–715.
Moellering RC, Korzeniowski OM, Sande MA, Wennersten CB
: Species-specific resistance to antimicrobial synergism in
. Journal of Infectious Diseases 1979, 140: 203–8.
Moellering RC, Wennersten C, Weinberg AN
: Synergy of penicillin and gentamicin against enterococci. Journal of Infectious Diseases 1971, 124: 207–209.
Toala P, McDonald A, Wilcox C, Finland M
: Susceptibility of group D sreptococci (enterococci) to 21 antibiotics in vitro, with special reference to species difference. American Journal of Medical Sciences 1969, 258: 416–430.
Fass RJ, Wright CA
: Comparative efficacies of mezlocillin and ampicillin alone or in combination with gentamicin in the treatment of
endocarditis in rabbits. Antimicrobial Agents and Chemotherapy 1984, 25: 408–410.
Glew RH, Moellering RC
: Effect of protein binding on the activity of penicilin in combination with gentamicin against enterococci. Antimicrobial Agents and Chemotherapy 1979, 15: 87–92.
: In vitro activities of β-lactam and aminoglycosides antibiotics: a comparative study of 20 parenterally administered drugs. Archives of Internal Medicine 1980, 140: 766–767.
Watanakunakorn C, Glotzbecker C
: Comparative in vitro activity of nafcillin, oxacillin and methicillin in combination with gentamicin and tobramycin against enterococci. Antimicrobial Agents and Chemotherapy 1977, 11: 88–91.
Weinstein AJ, Moellering RC
: Studies of cephalothin: aminoglycoside synergism against enterococci. Antimicrobial Agents and Chemotherapy 1975, 7: 522–529.
: Antimicrobial susceptibility of group D hemolytic streptococci (enterococci). American Journal of Medical Sciences 1967, 253: 14–18.
Crider SR, Colby SD
: Susceptibility of enterococci to trimethoprim and trimethoprim-sulfamethoxazole. Antimicrobial Agents and Chemotherapy 1985, 27: 71–75.
Zervos MJ, Schaberg DR
: Reversal of in vitro susceptibility of enterococci to trimethoprim-sulfamethoxazole by folinic acid. Antimicrobial Agents and Chemotherapy 1985, 28: 446–448
: In vivo versus in vitro susceptibility of enterococcus to trimetropim-sulfamethoxazole: a pitfall. Journal of the American Medical Association 1984, 252: 2748–2749.
Mandell GL, Lindsey E, Hook EW
: Synergism of vancomycin and streptomycin for enterococci. American Journal of Medical Sciences 1970, 259: 346–349.
Sullam PM, Tauber MG, Hackbarth CJ, Sande MA
: Therapeutic efficacy of teicoplanin in experimental enterococcal endocarditis. Antimicrobial Agents and Chemotherapy 1985, 27: 135–136.
Mederski-Samoraj BD, Murray BE
: High-level resistance to gentamicin in clinical isolates of enterococci. Journal of Infectious Diseases 1983, 147: 751–757.
Horodniceanu T, Bouguerleret L, El-Solh N, Bieth G, Debos F
: High-level plasmid-born resistance to gentamicin in
. Antimicrobial Agents and Chemotherapy 1979, 16: 686–688.
Zervos MJ, Terpenning MS, Schaberg DR, Therasse PM, Medendorp SV, Kauffman CA
: High-levelaminoglycoside-resistant enterococci: colonization of nursing home and acute care hospital patients. Archives of Internal Medicine 1987, 147: 1591–1594.
Murray BE, Tsao J, Panida J
: Enterococci from Bangkok, Thailand, with high level resistance to currently available aminoglycosides. Antimicrobial Agents and Chemotherapy 1983, 23: 799–802.
: Enterococci. In: Sneath PH, Mair NS Sharpe ME, Holt JG (ed): Bergey's manual of systematic bacteriology. Williams and Wilkins, Baltimore, 1984, p. 1063–1065.
Schleifer KH, Kilpper-Balz R
: Transfer of
to the genus
non rev as
comb nov and
comb nov. International Journal of Systematic Bacteriology 1984, 34: 31–34.
Collins MD, Jones D, Farrow JAE, Killper-Balz R, Schleiffer KH
nom rev comb nov;
nom rev comb nov;
nom rev comb nov;
comb nov; and
sp. nov. International Journal of Systematic Bacteriology 1984, 34: 220–223.
Farrow JAE, Collins MD
a new species that includes amino acid assay strain NCDO 1258 and strains causing growth depression in young chickens. International Journal of Systematic Bacteriology 1985, 35: 73–75.
Collins MD, Farrow AE, Jones D
sp nov. International Journal of Systematic Bacteriology 1986, 36: 8–12.
Facklam RR, Collins MD
: Identification of
species from human Infectious by a conventional test scheme. Journal of Clinical Microbiology 1989, 27: 731–734.
Andrews FW, Harder TJ
: A study of the streptococci pathogenic for man. Lancet 1906, ii: 708–713, 775–782.
Rantz LA, Kirby WM
: Enterococcic infections: an evaluation of the importance of fecal streptococci and related organisms in the causation of human disease. Archives of Internal Medicine 1943, 71: 516–528.
: Carriage of group D streptococci in the human bowel. Journal of Clinical Pathology 1978, 31: 1182–1186.
Hill MJ, Drasar BS, Aries V, Crowther JS, Hawksworth G, Williams RW
: Bacteria and aetiology of cancer of large bowel. Lancet 1971, i: 95–100.
Finegold SM, Attebery HR, Sutter VL
: Effect of diet on human fectal flora: comparison of Japanese and American diets. American Journal of Clinical Nutrition 1974, 27: 1456–1469.
: Streptococci in the intestinal flora of man and other nonruminants. In: Skinner FA, Quesnel LB (ed): Streptococci. Academic Press, London, 1978, p. 245–261.
Benno Y, Suzuzki K, Narisawa K, Bruce WR, Mitsuoka T
: Comparison of fecal microflora in rural Japanese and urban Canadians. Microbiology and Immunology 1986, 30: 521–532.
Enzenberger R, Shah PM, Knothe H
: Impact of oral ciprofloxacin on the faecal flora of healthy volunteers. Infection 1985, 13: 273–275.
Shah PM, Enzenberger R, Glogau O, Knothe H
: Influenceof oral ciprofloxacin or ofloxacin on the faecal flora of healthy volunteers. American Journal of Medicine 1987, 82: 333–338.
Hardie JM, Marsh PD
: Streptococci and the human oral flora. In: Skinner FA, Quesnel LD (ed): Streptococci. Academic press, London, 1978, p. 157–206.
Kurrie E, Bhaduri S, Krieger D, Gaus W, Heimpel A, Pfleiger H, Arnold R, Vanek E
: Risk factors for infections of the oropharynx and the respiratory tract in patients with acute leukemia. Journal of Infectious Diseases 1981, 144: 128–136.
Smyth CJ, Docent MA, Halpenny MK, Ballach SJ
: Carriage rates of enterococci in the dental plaque of hemodialysis patients in Dublin. British Journal of Oral and Maxillofacial Surgery 1987, 25: 21–33.
Barlett JG, Onderdonk AB, Drude E, Goldstein C, Anderka M, Alpert S, McComack WM
: Quantitative bacteriology of the vaginal flora. Journal of Infectious Diseases 1977, 136: 271–277.
Tashjian JH, Coulam CB, Washington JA
: Vaginal flora in asymptomatic women. Mayo Clinic Proceedings 1976, 51: 557–561.
: Gallbladder bacteriology, histology and gallstones: study of unselected cholecystectomy specimens in Honolulu. The Archives of Surgery 1973, 106: 169–171.
Horvitz RA, von Graevenitz A
: A clinical study of the role of enterococci as sole agents of wound and tissue infection. Yale Journal of Biology and Medicine 1977, 50: 391–395.
Evans AC, Chinn AL
: The enterococci: with special reference to their association with human disease. Journal of Bacteriology 1976, 54: 495–512.
Duma RJ, Weinberg AN, Medrek TF, Kunz LJ
: Streptococcal infections: a bacteriologic and clinical study of streptococcal bacteremia. Medicine 1969, 48: 87–127.
Stamm WE, Weinstein RA, Dixon RE
: Comparison of endemic and epidemic nosocomial infection. American Journal of Medicine 1981, 70: 393–397.
Hall RW, Bayer AS, Mayer WP, Pitchon HE, Yoslukawa TT, Guze LB
: Infective endocarditis following human to human enterococcal transmission: a complication of intravenous narcotic abuse. Archives of Internal Medicine 1976, 136: 1173–1174.
Smith RF, Dayton SL
: Colonization of burns by
related to contaminated porcine xenografts. Texas Reports on Biology and Medicine 1973, 31: 47–54.
Schaberg DR, Zervos M
: Plasmid analysis in the study of the epidemiology of nosocomial grampositive cocci. Reviews of Infectious Diseases 1986, 8: 705–711.
Zervos MJ, Mikesell TS, Schaberg DR
: Heterogeneity of plasmids determining high-level resistance to gentamicin in clinical isolates of
. Antimicrobial Agents and Chemotherapy 1986, 39: 78–81.
: Molecular analysis of plasmids in epidemiologic investigation. Journal of Infectious Disease 1983, 148: 1–6.
McGowan JE, Terry PM, Huang T, Hawk CL, Davies J
: Nosocomial infections with gentamicin-resistant
plasmid analysis as an epidemiologic tool. Journal of Infectious Diseases 1979, 140: 864–872.
Peacock JE, Marsik FJ, Wenzel RP
: Methicillin resistant
introduction and spread within a hospital. Annals of Internal Medicine 1980, 93: 526–532.
Thompson RL, Cabezudo I, Wenzel RP
: Epidemiology of nosocomial infections caused by methicillin-resistant
. Annals of Internal Medicine 1982, 97: 309–317.
Haley RM, Hightower AW, Khabbaz RF, Thomsberry C, Martone WJ, Allen JR, Hughes JM
: Emergence of methicillin resistant
. infections in United States hospitals: possible role of the house staff patient transfer circuit. Annals of Internal Medicine 1982, 97: 297–308.
Weinstein RA, Kabins SA
: Strategies for prevention and control of multiple drug-resistant nosocomial infection. American Journal of Medicine 1981, 70: 449–454.
Coudron PE, Mayhall CG, Kocklam RR, Spadora AC, Lamb VA, Lybrand MR, Dalton HP
outbreak in a neonatal intensive care unit. Journal of Clinical Microbiology 1984, 20: 1044–1048.
Luginbuhl LM, Rotbart HA, Facklam RR, Roe MH, Elliot JA
: Neonatal enterococcal sepsis: casecontrol study and description of an outbreak. Pediatric Infectious Disease Journal 1987, 6: 1022–1030.
Meers PD, Aylyfe GA, Emmerson AM, Leigh DA, Mayon-White RT, Macintosh CA, Stronge JL
: Report on the national survey of infections in hospital 1980. Journal of Hospital Infections 1981, 2: 23–29.
Lemoine L, Hunter PR
: Enterococcal urinary tract infections in a teaching hospital. European Journal of Clinical Microbiology 1987, 6: 274–275.
Warren JW, Tenney JH, Hoopes JM
: A prospective microbiologic study of bacteremia in patients with chronic indwelling catheters. Journal of Infectious Diseases 1982, 146:719.
McGowan JE, Barnes MW, Finland M
: Bacteremia at Boston City Hospital: occurrence and mortality during 12 selected years (1935–1972), with special reference to hospital acquired cases. Journal of Infectious Diseases 1975, 132: 316–335.
Garrison RN, Fry DE, Berberich S, Polk HC
: Enterococcal bacteremia: clinical implications and determinants of death. Annals of Surgery 1982, 196: 43–47.
Malone DA, Wagner RE, Myers JP, Watanakunakorn C
: Enterococcal bacteremia in two large community teaching hospitals. American Journal of Medicine 1986, 81: 601–606.
Ledger WJ, Norman M, Gee C, Lewis W
: Bacteremia on an obstetric-gynecologic service. American Journal of Obstetrics and Gynecology 1975, 121: 205–212.
Barrall DT, Kenney PR, Slotman GJ, Burchard KW
: Enterococcal bacteremia in surgical patients. Archives of Surgery 1985, 120: 57–63.
Dougherty SH, Flohr AB, Simmons RL
: Breakthrough enterococcal septicemia in surgical patients: 19 cases and a review of the literature. Archives of Surgery 1983, 118: 232–238.
Gibbs RS, Listwa HM, Dreskin RB
: A pure enterococcal abscess after cesarean section. Journal of Reproductive Medicine 1977, 19: 17–20.
Jones WG, Barie PS, Yuri RW, Goodwin CW
: Enterococcal burn sepsis: a highly lethal complication in severely burned patients. Annals of Surgery 1986, 121: 649–653.
Siegel JD, McCracken GH
: Group D streptococcal infections. Journal of Pediatrics 1978, 93: 542–543.
Buchino JJ, Ciamberella E, Light I
: Systemic group D streptococcal infection in newborn infants. American Journal of Diseases of Childhood 1979, 133: 270–273.
Scheld WM, Mandell GL
: Enigmatic enterococcal endocarditis. Annals of Internal Medicine 1984, 100: 904–905.
Teixeira OH, Carpenter B, Vald P
: Enterococcal endocarditis in early infancy. Canadian Medical Association Journal 1982, 127: 612–613.
Zakrzewski T, Keith JD
: Bacterial endocarditis in infants and children. Journal of Pediatrics 1965, 67: 1179–1193.
Koenig MG, Kaye D
: Enterococcal endocarditis report of nineteen cases with long term follow up data. New England Journal of Medicine 1961, 264: 257–264.
Mandell GL, Kaye D, Levison ME, Hook EW
: Enterococcal endocarditis: an analysis of 38 patients observed at the New York Hospital-Cornell Medical Center. Archives of Internal Medicine 1970, 125: 258–264.
Wilson WR, Wilkowski CJ, Wright AJ, Sande MA, Geraci JE
: Treatment of streptomycin-susceptible and streptomycin-resistant enterococcal endocarditis. Annals of Internal Medicine 1984, 100: 816–823.
Rigilano J, Mahapatra R, Barnhill J, Gutierrez J
: Enterococal endocarditis following sigmoidoscopy and mitral valve prolapse. Archives of Internal Medicine 1984, 144: 850–851.
Moellering RC, Watson BK, Kunz LJ
: Endocarditis due to group D streptococci: comparison of diseases caused by
with that produced by the enterococci. American Journal of Medicine 1974, 57: 239–250.
Reiner NE, Gopalakrishna KV, Lerner PI
: Enterococcal endocarditis in heroin addicts. Journal of the American Medical Association 1976, 235: 1861–1863.
: Role of enterococcus in intra abdominal sepsis. American Journal of Surgery 1984, 148: 308–312.
Onderdonk AB, Bartlett JG, Louie TJ, Sullivan-Seigler N, Gorbach SL
: Microbial synergy in experimental intra-abdominal abscess. Infection and Immunity 1976, 13: 22–26.
: Treatment of mixed bacterial infections with clindamycin and gentamicin. Journal of Infectious Diseases 1977, 135: 74–79.
Canadian Metronidazole Study Group
: Prospective, randomized comparison of metronidazole and clindamycin, each with gentamicin for the treatment of serious intra-abdominal infection. Surgery 1983, 93: 221–229.
Zervos MJ, Bacon AE, Patterson JE, Schaberg DR, Kauffman CA
: Enterococcal superinfection in patients treated with ciprofloxacin. Journal of Antimicrobial Chemotherapy 1988, 21: 113–115.
Curry N, McCallum RW, Guth PH
: Spontaneous peritonitis in cirrhotic ascites: a decade of experience. American Journal of Digestive Diseases 1974, 19: 685–692.
: Peritoneal infections in long term peritoneal dialysis before and after human cadaveric tranplanation. Journal of Clinical Pathology 1969, 22: 539–544.
Bayer AS, Seidel JS, Yoshikawa TT, Anthony BF, Guze LB
: Group D enterococcal meningitis: clinical and therapeutic considerations with report of three cases and review of the literature. Archives of Internal Medicine 1976, 136: 883–886.
Schoenbaum SC, Gardner P, Shillito J
: Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations and therapy. Journal of Infectious Diseases 1975, 131: 543–552.
Ryan JL, Pachner A, Andriole VT, Root RK
: Enterococcal meningitis: combined vancomycin and rifampin therapy. American Journal of Medicine 1980, 68: 449–451.
Berk SL, Verghese A, Holtsclaw SA, Smith JK
: Enterococcal pneumonia: occurrence in patients receiving broad-spectrum antibiotic regimens and enteral feeding. American Journal of Medicine 1983, 74: 153–154.
Feeley TW, DuMoulin GC, Hedley-White J, Bushnell LS, Gilbert JP, Feingold DS
: Aerosol polymixin and pneumonia in seriously ill patients. New England Journal of Medicine 1975, 293: 471–475.
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