Skip to main content
SpringerLink
Log in

Enterococcus faecium in hospitals

  • Review
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

Most of the characteristics that have ensured the success of enterococci as nosocomial pathogens were described early in this century.Enterococcus faecium andEnterococcus faecalis, the enterococci most frequently isolated from clinical material, differ fundamentally. The intrinsic antimicrobial resistance ofEnterococcus faecium, supplemented by acquired resistance mechanisms, can generate a glycopeptide-multiply-resistant nosocomial pathogen that survives on hands and in the environment, and has the potential for intra-hospital and inter-hospital spread. The use of terms such as ‘an enterococcus’, ‘faecal streptococci’ and ‘group D streptococci’ have hindered, and still hinder, our understanding of a species rapidly emerging as the most problematic of nosocomial pathogens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cohen ML: Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 1992, 257: 1050–1055.

    Google Scholar 

  2. Thiercelin ME: Sur un diplocoque saprophyte de l'intestin susceptible de devenir pathogène. Comptes Rendus des Scéances de la Société de Biologie, Paris 1899, 51: 269–271.

    Google Scholar 

  3. MacCallum WG, Hastings TW: A case of acute endocarditis caused byMicmcoccus zymogenes (nov. spec.), with a description of the microorganism. Journal of Experimental Medicine 1899, 4: 521–534.

    Google Scholar 

  4. Andrewes FW, Horder TJ: A study of the streptococci pathogenic for man. Lancet 1906: 708–713, 775–782, 852–855.

  5. Gordon MH: A ready method of differentiating streptococci and some results obtained by its application. Lancet 1905, ii: 1400–1403.

    Google Scholar 

  6. Houston AC: Bacteriological examination of certain of our public water supplies. In: Annual Report of the Medical Officer of the Local Government Board for 1903–1904; Cd number 2611. Appendix B. Number 7. Her Majesty's Stationery Office, London, 1904, p. 472–608.

    Google Scholar 

  7. Lancefield RC: A serological differentiation of human and other groups of haemolytic streptococci. Journal of Experimental Medicine 1933, 57: 571–595.

    Google Scholar 

  8. Jones D: Composition and differentiation of the genusStreptococcus. In: Skinner FA, Quesnel LB (ed): Streptococci. Academic Press, London, 1978, p. 1–49.

    Google Scholar 

  9. Skadhauge K: Studies on enterococci with special reference to the serological properties. Ejnar Munksgaard, Copenhagen, 1950.

    Google Scholar 

  10. Shattock PMF: The streptococci of group D; the serological grouping ofStreptococcus bovis and observations on serologically refractory group D strains. Journal of General Microbiology 1949, 3: 80–92.

    Google Scholar 

  11. Smith DG, Shattock PMF: The serological grouping ofStreptococcus equinus. Journal of General Microbiology 1962, 29: 731–736.

    Google Scholar 

  12. Elliott SD: Streptococcal infection in young pigs. I: An immunochemical study of the causative agent (PM streptococcus). Journal of Hygiene 1966, 64: 205–212.

    Google Scholar 

  13. Sherman JM: The streptococci. Bacteriological Reviews 1937, 1: 3–97.

    Google Scholar 

  14. Orla-Jensen S: The lactic acid bacteria. AF Host & Son, Copenhagen, 1919, p. 139–140.

    Google Scholar 

  15. Orla-Jensen S: The lactic acid bacteria. Ejnar Munksgaard, Forlag, Copenhagen, 1943, p. 47–57.

    Google Scholar 

  16. Barnes EM: Tetrazolium reduction as a means of differentiatingStreptococcus faecalis fromStreptococcus faecium. Journal of General Microbiology 1956, 14: 57–68.

    Google Scholar 

  17. Deibel RH, Lake DE, Niven CF: Physiology of the enterococci as related to their taxonomy. Journal of Bacteriology 1963, 86: 1275–1282.

    Google Scholar 

  18. Deibel RH: The group D streptococci. Bacteriological Reviews 1964, 28: 330–366.

    Google Scholar 

  19. Hartman PA, Reinbold GW, Saraswat DS: Indicator organisms — a review. I: Taxonomy of the fecal streptococci. International Journal of Systematic Bacteriology 1966, 16: 197–221.

    Google Scholar 

  20. Whittenbury R: The differentiation ofStreptococcus faecalis and S.faecium. Journal of General Microbiology 1965, 38: 279–287.

    Google Scholar 

  21. Kalina AP: The taxonomy and nomenclature of enterococci. International Journal of Systematic Bacteriology 1970, 20: 185–189.

    Google Scholar 

  22. Schleifer KH, Kilpper-Bälz R: Transfer ofStreptococcus faecalis andStreptococcus faecium to the genusEnterococcus nom. rev. asEnterococcus faecalis comb. nov. andEnterococcus faecium comb. nov. International Journal of Systematic Bacteriology 1984, 34: 31–34.

    Google Scholar 

  23. Williams AM, Rodrigues UM, Collins MD: Intrageneric relationships ofEnterococci as determined by reverse transcriptase sequencing of small-subunit rRNA. Research in Microbiology 1991, 142: 67–74.

    Google Scholar 

  24. Hoffmann SA, Moellering RC: The enterococcus: Putting the bug in our ears. Annals of Internal Medicine 1987, 106: 757–761.

    Google Scholar 

  25. McGowan JE: Changing etiology of nosocomial bacteremia and fungemia and other hospital-acquired infections. Reviews of Infectious Diseases 1985, 7: 357–370.

    Google Scholar 

  26. Morrison AJ, Freer CV, Searcy MA, Landry SM, Wenzel RP: Nosocomial bloodstream infections: secular trends in a statewide surveillance program in Virginia. Infection Control 1986, 7: 550–553.

    Google Scholar 

  27. Maki DG, Agger WA: Enterococcal bacteremia: clinical features, the risk of endocarditis, and management. Medicine 1988, 67: 248–269.

    Google Scholar 

  28. Morrison AJ, Wenzel RP: Nosocomial urinary tract infections due to enterococcus. Ten years' experience at a university hospital. Archives of Internal Medicine 1986, 146: 1549–1551.

    Google Scholar 

  29. Andrewes FW: The evolution of the streptococci. Lancet 1906: 1415–1420.

  30. Garrison RN, Fry DE, Berberich S, Polk HC: Enterococcal bacteraemia: clinical implications and determinants of death. Annals of Surgery 1982, 196: 43–47.

    Google Scholar 

  31. Shlaes DM, Levy J, Wolinsky E: Enterococcal bacteremia without endocarditis. Archives of Internal Medicine 1981, 141: 578–581.

    Google Scholar 

  32. Whiteside M, Moore J, Ratzan K: An investigation of enterococcal bacteremia. American Journal of Infection Control 1983, 11: 125–129.

    Google Scholar 

  33. Hoge CW, Adams J, Buchanan B, Sears SD: Enterococcal bacteremia: to treat or not to treat, a reappraisal. Reviews of Infectious Diseases 1991, 13: 600–605.

    Google Scholar 

  34. Graninger W, Ragette R: Nosocomial bacteremia due toEnterococcus faecalis without endocarditis. Clinical Infectious Diseases 1992, 15: 49–57.

    Google Scholar 

  35. Noskin GA, Peterson LR, Warren JR:Enterococcus faecium andEnterococcus faecalis bacteraemia: acquisition and outcome. Clinical Infectious Diseases 1995, 20: 296–301.

    Google Scholar 

  36. Warren RE: Difficult streptococci. Journal of Hospital Infection 1988, 11: 352–357.

    Google Scholar 

  37. Wade JJ, Rolando N, Hayllar K, Philpott-Howard J, Casewell MW, Williams R: Bacterial and fungal infections after liver transplantation: an analysis of 284 patients. Hepatology 1995, 21: 1328–1336.

    Google Scholar 

  38. Coudron PE, Mayhall CG, Facklam RR. Spadora AC, Lamb VA, Lybrand MR, Dalton HP:Streptococcus faecium outbreak in a neonatal intensive care unit. Journal of Clinical Microbiology 1984, 20: 1044–1048.

    Google Scholar 

  39. Livornese LL, Dias S, Samel C, Romanowski B, Taylor S, May P, Pitsakis P, Woods G, Kaye D, Levison ME, Johnson CC: Hospital-acquired infection with vancomycin-resistantEnterococcus faecium transmitted by electronic thermometers. Annals of Internal Medicine 1992, 117: 112–116.

    Google Scholar 

  40. Boyce JM, Opal SM, Potter-Bynoe G, LaForge RG, Zervos MJ, Furtado G, Victor G, Medeiros AA: Emergence and nosocomial transmission of ampicillin-resistant enterococci. Antimicrobial Agents and Chemotherapy 1992, 36: 1032–1039.

    Google Scholar 

  41. Rubin LG, Tucci V, Cercenado E, Eliopoulos G, Isenberg HD: Vancomycin-resistantEnterococcus faecium in hospitalized children. Infection Control and Hospital Epidemiology 1992, 13: 700–705.

    Google Scholar 

  42. Boyce JM, Opal SM, Chow JW, Zervos MJ, Potter-Bynoe G, Sherman CB, Romulo RLC, Fortna S, Medeiros AA: Outbreak of multidrug-resistantEnterococcus faecium with transferablevanB class vancomycin resistance. Journal of Clinical Microbiology 1994, 32: 1148–1153.

    Google Scholar 

  43. Montecalvo MA, Horowitz H, Gedris C, Carbonaro C, Tenover FC, Issah A, Cook P, Wormser GP: Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistantEnterococcus faecium bacteremia in an adult oncology unit. Antimicrobial Agents and Chemotherapy 1994, 38: 1363–1367.

    Google Scholar 

  44. Chow JW, Kuritza A, Shlaes DM, Green M, Sahm DF, Zervos MJ: Clonal spread of vancomycin-resistantEnterococcus faecium between patients in three hospitals in two states. Journal of Clinical Microbiology 1993, 31: 1609–1611.

    Google Scholar 

  45. Wade JJ: The emergence ofEnterococcus faecium resistant to glycopeptides and other standard agents — a preliminary report. Journal of Hospital Infection 1995, 30: 483–493.

    Google Scholar 

  46. Montecalvo MA, de Lencastre H, Carraher M, Gedris C, Chung M, VanHorn K, Wormser GP: Natural history of colonization with vancomycin-resistantEnterococcus faecium. Infection Control and Hospital Epidemiology 1995, 16: 680–685.

    Google Scholar 

  47. Morris JG, Shay DK, Hebden JN, McCarter RJ, Perdue BE, Jarvis W, Johnson JA, Dowling TC, Polish LB, Schwalbe RS: Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Annals of Internal Medicine 1995, 123: 250–259.

    Google Scholar 

  48. Chenoweth C, Schaberg D: The epidemiology of enterococci. European Journal of Clinical Microbiology & Infectious Diseases 1990, 9: 80–89.

    Google Scholar 

  49. Handwerger S, Raucher B, Altarac D, Monka J, Marchione S, Singh KV, Murray BE, Wolff J, Walters B: Nosocomial outbreak due toEnterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clinical Infectious Diseases 1993, 16: 750–755.

    Google Scholar 

  50. Wells CL, Juni BA, Cameron SB, Mason KR, Dunn DL, Ferrieri R, Rhame FS: Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients. Clinical Infectious Diseases 1995, 21: 45–50.

    Google Scholar 

  51. Karanfil LV, Murphy M, Josephson A, Gaynes R, Mandel L, Hill BC, Swenson JM: A cluster of vancomycin-resistantEnterococcus faecium in an intensive care unit. Infection Control and Hospital Epidemiology 1992, 13: 195–200.

    Google Scholar 

  52. Wade JJ, Desai N, Casewell MW: Hygienic hand disinfection for the removal of epidemic vancomycin-resistantEnterococcus faecium and gentamicin-resistantEnterobacter cloacae. Journal of Hospital Infection 1991, 18: 211–218.

    Google Scholar 

  53. Noskin GA, Stosor V, Cooper I, Peterson LR: Recovery of vancomycin-resistant enterococci on fingertips and environmental surfaces. Infection Control and Hospital Epidemiology 1995: 16: 577–581.

    Google Scholar 

  54. Rhinehart E, Smith NE, Wennersten C, Gorss E, Freeman J, Eliopoulos GM, Moellering RC, Goldmann DA: Rapid dissemination of β-lactamase-producing, aminoglycoside-resistantEnterococcus faecalis among patients and staff on an infant-toddler surgical unit. New England Journal of Medicine 1990, 323: 1814–1818.

    Google Scholar 

  55. Uttley AHC, George RC, Naidoo J, Woodford N, Johnson AR, Collins CH, Morrison D, Gilfillan AJ, Fitch LE, Heptonstall J: High-level vancomycin-resistant enterococci causing hospital infections. Epidemiology and Infection 1989, 103: 173–181.

    Google Scholar 

  56. Freeman R, Gould FK, Ryan DW, Chamberlain J, Sisson PR: Nosocomial infection due to enterococci attributed to a fluidized microsphere bed. The value of pyrolysis mass spectrometry. Journal of Hospital Infection 1994, 27: 187–193.

    Google Scholar 

  57. Woodford N, Morrison D, Johnson AR, George RC: Antimicrobial resistance amongst enterococci isolated in the United Kingdom: a reference laboratory perspective. Journal of Antimicrobial Chemotherapy 1993, 32: 344–346.

    Google Scholar 

  58. Jones RN, Sader HS, Erwin ME, Anderson SC, the Enterococcus Study Group: Emerging multiply resistant enterococci among clinical isolates. I: Prevalence data from 97 medical center surveillance study in the United States. Diagnostic Microbiology and Infectious Disease 1995, 21: 85–93.

    Google Scholar 

  59. Eliopoulos GM, Wennersten C, Zighelboim-Daum S, Reiszner E, Goldmann D, Moellering RC: High-level resistance to gentamicin in clinical isolates ofStreptococcus (Enterococcus) faecium. Antimicrobial Agents and Chemotherapy 1988, 32: 1528–1532.

    Google Scholar 

  60. Coudron PE, Markowitz SM, Wong ES: Isolation of β-lactamase-producing, aminoglycoside-resistant strain ofEnterococcus faecium. Antimicrobial Agents and Chemotherapy 1992, 36: 1125–1126.

    Google Scholar 

  61. Wennersten CB, Moellering RC: Mechanism of resistance to penicillin aminoglycoside synergism inStreptococcus faecium. Current Chemotherapy and Infectious Diseases 1980, 710–712.

  62. Clark NC, Cooksey RC, Hill BC, Swenson JM, Tenover FC: Characterization of glycopeptide-resistant enterococci from U.S. hospitals. Antimicrobial Agents and Chemotherapy 1993, 37: 2311–2317.

    Google Scholar 

  63. Gordts B, Van Landuyt H, Ieven M, Vandamme P, Goossens H: Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients. Journal of Clinical Microbiology 1995, 33: 2842–2846.

    Google Scholar 

  64. Van der Auwera P, Pensart N, Korten V, Murray BE, Leclercq R: Influence of oral glycopeptides on the fecal flora of human volunteers: selection of highly glycopeptide-resistant enterococci. Journal of Infectious Diseases 1996, 173: 1129–1136.

    Google Scholar 

  65. Bates J, Jordens Z, Griffiths DT: Farm animals as a putative reservoir for vancomycin-resistant enterococcal infection in man. Journal of Antimicrobial Chemotherapy 1994, 34: 507–516.

    Google Scholar 

  66. Klare I, Heier H, Claus H, Reissbrodt R, Witte W:vanA-mediated high-level glycopeptide resistance inEnterococcus faecium from animal husbandry. FEMS Microbiology Letters 1995, 125: 165–172.

    Google Scholar 

  67. Aarestrup FM: Occurrence of glycopeptide resistance amongEnterococcus faecium isolates from conventional and ecological poultry farms. Microbial Drug Resistance 1995, 1: 255–257.

    Google Scholar 

  68. Aarestrup FM, Ahrens P, Madsen M, Pallesen LV, Poulson RL, Westh H: Glycopeptide susceptibility among DanishEnterococcus faecium andEnterococcus faecalis isolates of animal and human origin and PCR identification of genes with VanA cluster. Antimicrobial Agents and Chemotherapy 1996, 40: 1938–1940.

    Google Scholar 

  69. Devriese LA, Ieven M, Goossens H, Vandamme P, Pot B, Hommez J, Haesebrouck F: Presence of vancomycin-resistant enterococci in farm and pet animals. Antimicrobial Agents and Chemotherapy 1996, 40: 2285–2287.

    Google Scholar 

  70. Murray BE: What can we do about vancomycin-resistant enterococci? Clinical Infectious Diseases 1995, 20: 1134–1136.

    Google Scholar 

  71. Wade JJ, Casewell MW: The evaluation of residual activity on hands and its clinical relevance. Journal of Hospital Infection 1991, 18: 23–28.

    Google Scholar 

  72. Wade JJ, Uttley AHC: Resistant enterococci — mechanisms, laboratory detection and control in hospitals. Journal of Clinical Pathology 1996, 49: 700–703.

    Google Scholar 

  73. Centers for Disease Control and Prevention: Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee. Morbidity and Mortality Weekly Report 1995, 4: 1–13.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dulwich Public Health Laboratory & Medical Microbiology, King's College School of Medicine & Dentistry, Bessemer Road, SE5 9PJ, London, UK

    J. J. Wade

Authors
  1. J. J. Wade
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wade, J.J. Enterococcus faecium in hospitals. Eur. J. Clin. Microbiol. Infect. Dis. 16, 113–119 (1997). https://doi.org/10.1007/BF01709469

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01709469

Keywords

Search

Navigation