Enterococcus faecium

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Scientific classification Edit this classification
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Binomial name
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(Orla-Jensen 1919)
Schleifer & Kilpper-Bälz 1984
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Enterococcus faecium is a Gram-positive, gamma-hemolytic or non-hemolytic bacterium in the genus Enterococcus.[1] It can be commensal (innocuous, coexisting organism) in the gastrointestinal tract of humans and animals,[2] but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.

Vancomycin-resistant E. faecium is often referred to as VRE.[3]

Pathogenic properties

This bacterium has developed multi-drug antibiotic resistance and uses colonization and secreted factors in virulence (enzymes capable of breaking down fibrin, protein, and carbohydrates to regulate adherence of bacteria to inhibit competitive bacteria). The enterococcal surface protein (Esp) allows the bacteria to aggregate and form biofilms. Additional virulence factors include aggregation substance (AS), cytosolin, and gelatinase. AS allows the microbe to bind to target cells, and it facilitates the transfer of genetic material between cells.[4]

By producing the enterocins A, B, and P (genus-specific bacteriocins), Enterococcus faecium can combat pathogenic gut microbes, such as Escherichia coli, reducing gastrointestinal disease in hosts.[5][6] As an alternative to adding antibiotics to livestock feed, which risks antimicrobial resistance, E. faecium Strain NCIMB 10415 is being used as a probiotic in animal feed.[7] However, the constant exposure to high levels of this microbe result in immunosuppression by reducing expression of IL-8, IL-10, and CD86, predisposing livestock to severe Salmonella infections.[8]

Metabolism

E. faecium exhibits a metabolically flexible and heterogeneous profile, particularly in clinical settings such as catheter-associated urinary tract colonization. A 2025 study of urinary isolates from intensive care unit patients revealed that E. faecium consistently metabolizes lactose and L-arabinose, while showing little to no ability to utilize melezitose or inositol. E. faecium isolates often varied and adapted their substrate usage even within the same patient, indicating high intra-host metabolic diversity.[9]

Vancomycin-resistant Enterococci (VRE)

Enterococcus faecium has been a leading cause of multidrug-resistant enterococcal infections over Enterococcus faecalis in the United States. Approximately 40% of medical intensive care units found that the majority (80% and 90.4%, respectively) of device-associated infections (namely, infections due to central lines, urinary drainage catheters, and ventilators) were due to vancomycin- and ampicillin-resistant E. faecium.[10]

The rapid increase in VRE has made it difficult for physicians to treat infections caused by E. faecium as few antimicrobial solutions are available. In the United States, infections by VRE occur more frequently.[2]

Persons infected or colonized with VRE are more likely to transmit the organism. Transmission depends primarily on which body site(s) harbor the bacteria, whether the body fluids are excreted, and how frequently health care providers touch these body sites. Patients infected or colonized with VRE may be cared for in any patient care setting with minimal risk of transmission to other patients, provided appropriate infection control measures are taken.[11]

A genome-wide E. faecium sRNA study suggested that some sRNAs are linked to the antibiotic resistance and stress response.[12]

Patients with bloodstream infections caused by E. faecium have a higher mortality rate compared to those caused by Enterococcus faecalis (37% vs 32%).[13]

VRE symptoms

Enterococcus infections, including VRE infections, cause a range of symptoms depending on the site of the infection. This includes bloodstream infections, urinary tract infections (UTI), and wound infections associated with catheters or surgery. Wound infections associated with catheters and surgery can cause soreness and swelling at the wound site, red, warm skin around wounds, and fluid leakage. Urinary tract infections can cause frequent or intense urges to urinate, pain or burning sensations while urinating, fatigue, and lower back or abdominal pain. Bloodstream infections can cause fever, chills, body aches, nausea and vomiting, and diarrhea.[14]

Tolerance to alcohol-based disinfectants

A study published in 2018 showed multidrug-resistant E. faecium exhibited tolerance to alcohol-based solutions. The authors speculated this explained an increase in E. faecium infections, indicating that other methods are required to slow the spread of E. faecium in a hospital setting. The study found that isolates of the bacterium from after 2010 were 10 times more tolerant of the alcohol-based disinfectants than older isolates. However, the isopropanol solutions tested in this study used isopropanol concentrations lower than those in most hand disinfectants, and the authors also stated that hand disinfectants using 70% isopropanol were effective in full strength, even against tolerant strains.[15] However, a mouse gut colonization model of E. faecium transmission showed that alcohol-tolerant E. faecium resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive E. faecium. This research has led some to question whether microbes can become entirely tolerant of alcohol.[16]

Treatment

Linezolid, daptomycin, and the streptogramins (e.g., quinupristin/dalfopristin) can have activity against VRE. VRE can be successfully treated with sultamicillin.[17] Tigecycline has activity against VRE;[18] however, its low plasma concentration and bacteriostatic nature may limit it's effectiveness to treat VRE.[19]

See also

References

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  1. ^ Page Module:Citation/CS1/styles.css has no content.Ryan KJ, Ray CG, Sherris JC (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 294–5. ISBN 0-8385-8529-9.
  2. ^ a b Page Module:Citation/CS1/styles.css has no content.Willem RJ. "Emerging Infectious Diseases". Centers for Disease Control and Prevention. Retrieved 23 October 2017.
  3. ^ Page Module:Citation/CS1/styles.css has no content.Mascini EM, Troelstra A, Beitsma M, Blok HE, Jalink KP, Hopmans TE, et al. (March 2006). "Genotyping and preemptive isolation to control an outbreak of vancomycin-resistant Enterococcus faecium". Clinical Infectious Diseases. 42 (6): 739–746. doi:10.1086/500322. PMID 16477546.
  4. ^ Page Module:Citation/CS1/styles.css has no content.Agudelo Higuita NI, Huycke MM (2014). "Enterococcal Disease, Epidemiology, and Implications for Treatment". In Gilmore MS, Clewell DB, Ike Y, Yasuyoshi S, Shankar N (eds.). Enterococci: From Commensals to Leading Causes of Drug Resistant Infection. Boston: Massachusetts Eye and Ear Infirmary. PMID 24649504.
  5. ^ Page Module:Citation/CS1/styles.css has no content.Zommiti M, Cambronel M, Maillot O, Barreau M, Sebei K, Feuilloley M, et al. (2018). "Evaluation of Probiotic Properties and Safety of Enterococcus faecium Isolated From Artisanal Tunisian Meat "Dried Ossban"". Frontiers in Microbiology. 9: 1685. doi:10.3389/fmicb.2018.01685. PMC 6088202. PMID 30127770.
  6. ^ Page Module:Citation/CS1/styles.css has no content.Hanchi H, Mottawea W, Sebei K, Hammami R (2018). "The Genus Enterococcus: Between Probiotic Potential and Safety Concerns-An Update". Frontiers in Microbiology. 9: 1791. doi:10.3389/fmicb.2018.01791. PMC 6085487. PMID 30123208.
  7. ^ Page Module:Citation/CS1/styles.css has no content.Bednorz C, Guenther S, Oelgeschläger K, Kinnemann B, Pieper R, Hartmann S, et al. (December 2013). "Feeding the probiotic Enterococcus faecium strain NCIMB 10415 to piglets specifically reduces the number of Escherichia coli pathotypes that adhere to the gut mucosa". Applied and Environmental Microbiology. 79 (24): 7896–7904. Bibcode:2013ApEnM..79.7896B. doi:10.1128/AEM.03138-13. PMC 3837809. PMID 24123741.
  8. ^ Page Module:Citation/CS1/styles.css has no content.Siepert B, Reinhardt N, Kreuzer S, Bondzio A, Twardziok S, Brockmann G, et al. (January 2014). "Enterococcus faecium NCIMB 10415 supplementation affects intestinal immune-associated gene expression in post-weaning piglets". Veterinary Immunology and Immunopathology. 157 (1–2): 65–77. doi:10.1016/j.vetimm.2013.10.013. PMID 24246154.
  9. ^ Page Module:Citation/CS1/styles.css has no content.Karlsson, Philip A.; Zhang, Taoran; Järhult, Josef D.; Joffré, Enrique; Wang, Helen (2025-06-12). Ponraj, Vittal Prakash (ed.). "Heterogeneity and metabolic diversity among Enterococcus species during long-term colonization". Microbiology Spectrum. doi:10.1128/spectrum.03160-24. ISSN 2165-0497. PMC 12323598.
  10. ^ Page Module:Citation/CS1/styles.css has no content.Gilmore MS, Clewell DB, Ike Y, Shankar N, Agudelo Higuita NI, Huycke MM (February 2014). "Enterococcal Disease, Epidemiology, and Implications for Treatment". In Gilmore MS, Clewell DB, Ike Y (eds.). Enterococci: From Commensals to Leading Causes of Drug Resistant Infection. Massachusetts Eye and Ear Infirmary. PMID 24649504.
  11. ^ Page Module:Citation/CS1/styles.css has no content."Enterococcal Infections, Vancomycin Resistant" (PDF). Infectious Disease Epidemiology Section Office of Public Health, Louisiana Dept of Health & Hospitals. 8 September 2008.
  12. ^ Page Module:Citation/CS1/styles.css has no content.Sinel C, Augagneur Y, Sassi M, Bronsard J, Cacaci M, Guérin F, et al. (September 2017). "Small RNAs in vancomycin-resistant Enterococcus faecium involved in daptomycin response and resistance". Scientific Reports. 7 (1): 11067. Bibcode:2017NatSR...711067S. doi:10.1038/s41598-017-11265-2. PMC 5593968. PMID 28894187.
  13. ^ Page Module:Citation/CS1/styles.css has no content.Zerbato, Verena; Pol, Riccardo; Sanson, Gianfranco; Suru, Daniel Alexandru; Pin, Eugenio; Tabolli, Vanessa; Monticelli, Jacopo; Busetti, Marina; Toc, Dan Alexandru; Crocè, Lory Saveria; Luzzati, Roberto; Di Bella, Stefano (2024-06-27). "Risk Factors for 30-Day Mortality in Nosocomial Enterococcal Bloodstream Infections". Antibiotics. 13 (7): 601. doi:10.3390/antibiotics13070601. ISSN 2079-6382. PMC 11273391.
  14. ^ Page Module:Citation/CS1/styles.css has no content."VRE in Healthcare Settings". United States Centers for Disease Control. Retrieved 23 May 2017.
  15. ^ Page Module:Citation/CS1/styles.css has no content.Pidot SJ, Gao W, Buultjens AH, Monk IR, Guerillot R, Carter GP, et al. (August 2018). "Increasing tolerance of hospital Enterococcus faecium to handwash alcohols". Science Translational Medicine. 10 (452) eaar6115. doi:10.1126/scitranslmed.aar6115. PMID 30068573.
  16. ^ Page Module:Citation/CS1/styles.css has no content."Some Bacteria Are Becoming 'More Tolerant' Of Hand Sanitizers, Study Finds". NPR.org. Retrieved 2018-08-06.
  17. ^ Page Module:Citation/CS1/styles.css has no content.Chewning JH (July 2011). "Vancomycin-resistant Enterococcus faecium bacteremia successfully treated with high-dose ampicillin-sulbactam in a pediatric patient after hematopoietic stem cell transplantation". Journal of Pediatric Hematology/Oncology. 33 (5): 401. doi:10.1097/MPH.0b013e31820db7eb. PMID 21602724.
  18. ^ Page Module:Citation/CS1/styles.css has no content.Cai Y, Wang R, Liang B, Bai N, Liu Y (March 2011). "Systematic review and meta-analysis of the effectiveness and safety of tigecycline for treatment of infectious disease". Antimicrobial Agents and Chemotherapy. 55 (3): 1162–1172. doi:10.1128/AAC.01402-10. PMC 3067123. PMID 21173186.
  19. ^ Page Module:Citation/CS1/styles.css has no content.Munita, Jose M.; Murray, Barbara E.; Arias, Cesar A. (2014). "Daptomycin for the treatment of bacteraemia due to vancomycin-resistant enterococci". International Journal of Antimicrobial Agents. 44 (5): 387–395. doi:10.1016/j.ijantimicag.2014.08.002. ISSN 1872-7913. PMC 4417356. PMID 25261158.

Further reading

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