Abstract
Enterococci are important causes of community-acquired and nosocomial infection. They cause endocarditis, bacteremia, urinary tract infections and neonatal sepsis. As causes of intra-abdominal and pelvic infection, enterococci are more commonly associated with abscess, biliary tract infection, spontaneous bacterial peritonitis, post-operative infection, post-partum endomyometritis and chronic or recurrent infection. As causes of soft tissue infection, enterococci are more commonly identified in burns, decubitus or diabetic foot ulcers, and wounds associated with intestinal surgery. Enterococci are often cultured in association with other pathogens when identified in intra-abdominal, pelvic or skin and soft tissue infection. Enterococcal superinfection after therapy with cephalosporins has been well described, and occurs as a result of the low in vitro activity of cephalosporins against enterococci. The epidemiology of enterococcal infection is complex and includes both endogenous and exogenous acquisition of the organism. Antibiotic resistance is an ever-increasing problem complicating therapy in patients with enterococcal infection.
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References
Thiercilin ME: Morphologie et modes de reproduction de l'enterocoque. Comptes Rendus des Séances de la Société de Biologie 1899, 11_551–553.
Noble CJ: Carriage of group D streptococci in the human bowel. Journal of Clinical Pathology 1978, 31: 1182–1186.
Mandell GL, Kaye D, Levinson ME: Enterococcal endocarditis: an analysis of 38 patients observed at the New York Hospital-Cornell Medical Center. Archives of Internal Medicine 1970, 125: 258–264.
Kaye E: Enterococci: biologic and epidemiologic characteristics and in vitro susceptibility. Archives of Internal Medicine 1982, 142: 2006–2009.
Facklam RR, Carey RB: Streptococci and aerococci. In: Lennette EH, Balows A, Hausler WJ (ed): Manual of Clinical Microbiology. American Society for Microbiology, Washington DC, 1985, p. 154–175.
Centers for Diseases Control: Nosocomial infections surveillance, 1984. Morbidity and Mortality Weekly Report 1986, 35: 17SS-22SS.
Whiteside M, Moore J, Ratzan K: An investigation of enterococcal bacteremia. American Journal of Infection Control 1983, 11: 125–129.
Mandell GL: Enterococcal endocarditis. In: Kaye D (ed): Infective endocarditis. University Park Press, Baltimore, 1976, p. 101–110.
Moellering RC, Watson BK, Kunz LJ: Endocarditis due to group D streptococci: a comparison of disease caused byStreptococcus bovis with that produced by the enterococci. 1974, 57: 239–249.
Koenig MG, Kaye D: Enterococcal endocarditis: a report of nineteen cases with long term follow-up data. New England Journal of Medicine 1961, 264: 257–264.
Reiner NE, Gopalakrishna KV, Lerner PI: Enterococcal endocarditis in heroin addicts. Journal of the American Medical Association 1976, 235: 1861–1863.
Levine DP, Crane LR, Zervos MJ: Bacteremia in narcotic addicts at the Detroit Medical Center. II: Infectious endocarditis: a prospective, comparative study. Reviews of Infectious Diseases 1986, 8: 374–396.
Saravolatz LD, Burch KH, Quinn EL, Cox F, Madhavan T, Fisher E: Polymicrobial infective endocarditis: an increasing clinical entity. American Heart Journal 1978, 95: 163–168.
Kathpalia S, Lorain V, Levandowski R, Jackson GG: Resistance to all aminoglycoside antibiotics in enterococcal endocarditis. Clinical Research 1984, 32: 372A.
Lipman ML, Silva J: Endocarditis due toStreptococcus faecalis with high-level resistance to gentamicin. Reviews of Infectious Diseases 1989, 11: 325–328.
Fernandez-Guerrero ML, Garros C, Rodriguez-Tudela JLR, Fernandez-Roblas F, Soriano F: Aortic endocarditis caused by gentamicin resistant enterococcus. European Journal of Clinical Microbiology and Infectious Diseases 1988, 7: 525–527.
Patterson JE, Colodny S, Masecar BL, Zervos MJ: Serious infection due to beta-lactamase producingStreptococcus faecalis with high-level resistance to gentamicin. Journal of Infectious Diseases 1988, 158: 1144–1145.
Bingen E, Lambert-Zechovski N, Mariani-Kurkdjian P, Cezard JP, Navarro J: Bacteremia caused by vancomycin resistant enterococcus. Pediatric Infectious Disease Journal 1989, 8: 475–476.
Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA: The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I: Laboratory and epidemiologic observations. Reviews of Infectious Diseases 1983, 5: 35–53.
Maki DG, Agger WA: Enterococcal bacteremia: clinical features, the risk of endocarditis and management. Medicine 1988, 67: 248–269.
Garrison RN, Fry DE, Berberich S, Polk HC: Enterococcal bacteremia: clinical implications and determinants of death. Annals of Surgery 1982, 196: 43–47.
Wells LD, von Graevenitz A: Clinical significance of enterococci in blood cultures from adult patients. Infection 1980, 8: 147–151.
Klimek JJ, Ajemian E, Gracewski J, Klemas B, Rios I, Maderazo E, Quintiliani R: Enterococcal infection in a large community hospital with emphasis on bacteremia. Journal of Infection Control 1980, 8: 58–61.
Shlaes DM, Levy J, Wolinsky E: Enterococcal bacteremia without endocarditis. Archives of Internal Medicine 1981, 141: 578–581.
Malone DA, Wagner RA, Myers JP, Watanakunakorn C: Enterococcal bacteremia in two large community teaching hospitals. American Journal of Medicine 1986, 81: 601–606.
Gould JC: The comparative bacteriology of acute and chronic urinary tract infection. In: O'Grady F, Brumfitt W (ed): Urinary tract infection. Oxford University Press, London, 1968, p. 43–50.
Gross PA, Harkavy LM, Barden GE, Flower MF: The epidemiology of nosocomial enterococcal urinary tract infection. American Journal of Medical Science 1976, 272: 75–81.
Turck M, Stamm W: Nosocomial infection of the urinary tract. American Journal of Medicine 1981, 70: 651–654.
Platt R, Polk BF, Murdock B, Rosner B: Mortality associated with nosocomial urinary tract infection. New England Journal of Medicine 1982, 307: 637–642.
Buchino JJ, Ciambarella E, Light I: Systemic group D streptococcal infection in newborn infants. American Journal of Children 1979, 133: 270–273.
Bavikatte K, Schreiner RL, Lemons JA, Gresham EL: Group D streptococcal septicemia in the neonate. American Journal of Children 1979, 133: 493–496.
Coudron PE, Mayhall CG, Facklam RR, Spadora AC, Archer Lamb V, Lybrand MR, Dalton HP:Streptococcus faecium outbreak in a neonatal intensive care unit. Journal of Clinical Microbiology 1984, 20: 1044–1048.
Onderdonk AB, Bartlett JG, Louie T, Sullivan-Seigler N, Gorbach SL: Microbial synergy in experimental intra-abdominal abscess. Infection and Immunity 1976, 13: 22–26.
Barrall DT, Kenney PR, Slutman 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: 232–237.
Willey SH, Hindes RG, Eliopoulous GM, Moellering RC: Effects of clindamycin and gentamicin and other antimicrobial combinations against enterococci in an experimental model of intra-abdominal abscess. Surgery, Gynecology and Obstetrics 1989, 169: 199–202.
Ike Y, Hashimoto H, Clewell DB: Hemolysin ofStreptococcus faecalis subspecieszymogenes contributes to virulence in mice. Infection and Immunity 1984, 45: 528–530.
Moellering RC: Enterococcal infections in patients treated with moxalactam. Reviews of Infectious Diseases 1982, 4, Supplement: 708–711.
Yu VL: Enterococcal superinfection and colonization after therapy with moxalactam: a new broad spectrum antibiotic. Annals of Internal Medicine 1981, 39: 784–785.
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.
Berk SL, Verghese A, Holtsclaw SA, Smith JK: Enterococcal pneumonia: occurrence in patients receiving broad-spectrum antibiotic regimens and enteric feeding. American Journal of Medicine 1983, 74: 74: 153–154.
Bayer AS, Seidel JS, Yoshikawa TT, Anthony BF, Guze LB: Group D enterococcal meningitis. Archives of Internal Medicine 1976, 136: 883–886.
Skeel RT, Wright LJ, Leventhal CM: Group D streptococcal meningitis masked by meningeal leukemia. American Journal of Diseases of Children 1969, 117: 334–337.
Zervos MJ, Dembinski S, Mikesell TS, Schaberg D R: High-level resistance to gentamicin inStreptococcus faecalis: risk factors and evidence for exogenous acquisition of infection. Journal of Infectious Diseases 1986, 153: 1075–1083.
Zervos MJ, Kauffman CA, Therasse PM, Bergman AG, Mikesell TS, Schaberg DR: Nosocomial infection by gentamicin resistantStreptococcus faecalis: an epidemiologic study. Annals of Internal Medicine 1987, 106: 687–691.
Nachamkin I, Axelrod P, Talbot GH, Fischer SH, Wennersten CB, Moellering RC, MacGregor RR: Multiply high-level aminoglycoside-resistant enterococci isolated from patients in a university hospital. Journal of clinical Microbiology 1988, 26: 1287–1291.
Ikeda DP, Barry AL, Anderson SG: Emergence ofStreptococcus faecalis isolates with high-level resistance to multiple aminocyclitol aminoglycosides. Diagnostic Microbiology and Infectious Diseases 1984, 2: 171–177.
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Lewis, C.M., Zervos, M.J. Clinical manifestations of enterococcal infection. Eur. J. Clin. Microbiol. Infect. Dis. 9, 111–117 (1990). https://doi.org/10.1007/BF01963635
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DOI: https://doi.org/10.1007/BF01963635