Enterococcus Faecium Là Gì

Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University;

Maria T. Vazquez-Pertejo

, MD, FACP, Wellington Regional Medical Center

Enterococci are gram-positive, facultative anaerobic organisms. Enterococcus faecalis & E. Faecium cause a variety of infections, including endocarditis, urinary tract infections, prostatitis, intra-abdominal infection, cellulitis, & wound infection as well as concurrent bacteremia.

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Enterococci are part of the normal intestinal flora. They used to be classified as group D streptococci but are now considered a separate genus. There are > 17 species, but E. Faecalis và E. Faecium most commonly cause infections in humans.

(See also the American Heart Association"s Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications.)

Enterococci associated with endocarditis are difficult to eradicate unless a combination of certain cell wall–active drugs (eg, penicillin, ampicillin, amoxicillin, piperacillin, vancomycin) plus an aminoglycoside (eg, gentamicin, streptomycin) is used khổng lồ achieve bactericidal activity. However, some cell wall–active drugs have limited or no activity against enterococci; they include nafcillin, oxacillin, ticarcillin, ertapenem, most cephalosporins, & aztreonam. E. Faecium are more resistant to lớn penicillin than E. Faecalis. When an aminoglycoside cannot be used, the combination of an aminopenicillin, such as ampicillin, plus ceftriaxone is an effective alternative for the treatment of E. Faecalis endocarditis. Imipenem and, to a lesser degree, meropenem are active against E. Faecalis.

For complicated skin infections due khổng lồ vancomycin-susceptible enterococci, daptomycin, linezolid, tedizolid, tigecycline, & omadacycline are effective treatment options.

Piperacillin/tazobactam, imipenem or meropenem, tigecycline, & eravacycline are recommended for complicated intra-abdominal infections when enterococci are known or presumed lớn be involved.

Urinary tract infections vày not require bactericidal therapy and, if the causative organism is sensitive, are usually treated with a single antibiotic such as ampicillin. Nitrofurantoin và fosfomycin are often effective against vancomycin-resistant enterococcal urinary tract infection.

In the past several decades, resistance to lớn multiple antimicrobial drugs has increased rapidly, especially among E. Faecium.

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Resistance khổng lồ aminoglycosides (eg, gentamicin, streptomycin), particularly with E. Faecium, continues lớn emerge.

Vancomycin-resistant enterococci (VRE) may also be resistant to lớn other glycopeptides (eg, teicoplanin), aminoglycosides, & cell wall–active beta-lactams (eg, penicillin G, ampicillin). When identified, infected patients are strictly isolated. Recommended treatment includes streptogramins (quinupristin/dalfopristin for E. Faecium only) and oxazolidinones (linezolid, tedizolid). Daptomycin, oritavancin, tigecycline, và eravacycline have in vitro activity against VRE và may be off-label treatment options.

Beta-lactamase–producing enterococci are occasionally problematic, particularly when large numbers of organisms are present in tissues (eg, in endocarditis vegetation). Resistance may be present clinically even though the organism appears susceptible based on standard testing. Vancomycin or combination beta-lactam/beta-lactamase inhibitor antibiotics (eg, piperacillin/tazobactam, ampicillin/sulbactam) can be used.

Enterococci can incorporate exogenously produced folates và thereby reverse the effect of trimethoprim và sulfamethoxazole; therefore, therapy with these drugs may fail despite apparent in vitro susceptibility (for this reason, TMP/SMX is often left off of susceptibility panels for enterococci).

The following is an English-language resource that may be useful. Please cảnh báo that THE MANUAL is not responsible for the content of this resource.

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