Editing Enterococcus

{{Short description|Genus of bacteria}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Distinguish|Enterobacter}}
{{Automatic taxobox
| image = Enterococcus_histological_pneumonia_01.png
| image_caption = ''Enterococcus sp.'' infection in [[pulmonary]] tissue
| taxon = Enterococcus
| authority = (''ex'' Thiercelin & Jouhaud 1903)<br />Schleifer & Kilpper-Bälz 1984
| subdivision_ranks = Species
| subdivision_ref = <ref name=Eremococcus />
| subdivision = * ''[[Enterococcus alcedinis|E. alcedinis]]''<ref name=Eremococcus>{{cite web| vauthors = Parte AC |title=Enterococcus| work = List of Prokaryotic names with Standing in Nomenclature ([[LPSN]]) |url=https://lpsn.dsmz.de/genus/enterococcus}}</ref>
* ''[[Enterococcus aquimarinus|E. aquimarinus]]''<ref name=Eremococcus/>
* ''[[Enterococcus asini|E. asini]]''<ref name=Eremococcus/>
* ''[[Enterococcus avium|E. avium]]''<ref name=Eremococcus/>
* ''[[Enterococcus bulliens|E. bulliens]]''<ref name=Eremococcus/>
* ''[[Enterococcus burkinafasonensis|E. burkinafasonensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus caccae|E. caccae]]''<ref name=Eremococcus/>
* ''[[Enterococcus camelliae|E. camelliae]]''<ref name=Eremococcus/>
* ''[[Enterococcus canintestini|E. canintestini]]''<ref name=Eremococcus/>
* ''[[Enterococcus canis|E. canis]]''<ref name=Eremococcus/>
* ''[[Enterococcus casseliflavus|E. casseliflavus]]''<ref name=Eremococcus/>
* ''[[Enterococcus cecorum|E. cecorum]]''<ref name=Eremococcus/>
* ''[[Enterococcus columbae|E. columbae]]''<ref name=Eremococcus/>
* ''[[Enterococcus crotali|E. crotali]]''<ref name=Eremococcus/>
* ''[[Enterococcus devriesei|E. devriesei]]''<ref name=Eremococcus/>
* ''[[Enterococcus diestrammenae|E. diestrammenae]]''<ref name=Eremococcus/>
* ''[[Enterococcus dispar|E. dispar]]''<ref name=Eremococcus/>
* ''[[Enterococcus durans|E. durans]]''<ref name=Eremococcus/>
* ''[[Enterococcus eurekensis|E. eurekensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus faecalis|E. faecalis]]''<ref name=Eremococcus/>
* ''[[Enterococcus faecium|E. faecium]]''<ref name=Eremococcus/>
* <!-- Enterococcus flavescens was reclassified as Enterococcus casseliflavus -->
* ''[[Enterococcus gallinarum|E. gallinarum]]''<ref name=Eremococcus/>
* ''[[Enterococcus gilvus|E. gilvus]]''<ref name=Eremococcus/>
* ''[[Enterococcus haemoperoxidus|E. haemoperoxidus]]''<ref name=Eremococcus/>
* ''[[Enterococcus hermanniensis|E. hermanniensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus hirae|E. hirae]]''<ref name=Eremococcus/>
* ''[[Enterococcus hulanensis|E. hulanensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus innesii|E. innesii]]''<ref name=Eremococcus/>
* ''[[Enterococcus italicus|E. italicus]]''<ref name=Eremococcus/>
* ''[[Enterococcus lactis|E. lactis]]''<ref name=Eremococcus/>
* ''[[Enterococcus lemanii|E. lemanii]]''<ref name=Eremococcus/>
* ''[[Enterococcus malodoratus|E. malodoratus]]''<ref name=Eremococcus/>
* ''[[Enterococcus massiliensis|E. massiliensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus mediterraneensis|E. mediterraneensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus moraviensis|E. moraviensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus mundtii|E. mundtii]]''<ref name=Eremococcus/>
* ''[[Enterococcus olivae|E. olivae]]''<ref name=Eremococcus/>
* ''[[Enterococcus pallens|E. pallens]]''<ref name=Eremococcus/>
* ''[[Enterococcus phoeniculicola|E. phoeniculicola]]''<ref name=Eremococcus/>
* ''[[Enterococcus plantarum|E. plantarum]]''<ref name=Eremococcus/>
* <!-- Enterococcus porcinus was reclassified as Enterococcus villorum -->
* ''[[Enterococcus pseudoavium|E. pseudoavium]]''<ref name=Eremococcus/>
* ''[[Enterococcus quebecensis|E. quebecensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus raffinosus|E. raffinosus]]''<ref name=Eremococcus/>
* ''[[Enterococcus ratti|E. ratti]]''<ref name=Eremococcus/>
* ''[[Enterococcus rivorum|E. rivorum]]''<ref name=Eremococcus/>
* ''[[Enterococcus rotai|E. rotai]]''<ref name=Eremococcus/>
* ''[[Enterococcus saccharolyticus|E. saccharolyticus]]''<ref name=Eremococcus/>
* <!-- Enterococcus saccharominimus was reclassified as Enterococcus italicus -->
* <!-- Enterococcus seriolicida was reclassified as Lactococcus garvieae -->
* ''[[Enterococcus saigonensis|E. saigonensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus silesiacus|E. silesiacus]]''<ref name=Eremococcus/>
* ''[[Enterococcus sulfureus|E. sulfureus]]''<ref name=Eremococcus/>
* ''[[Enterococcus solitarius|E. solitarius]]''
* ''[[Enterococcus songbeiensis|E. songbeiensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus termitis|E. termitis]]''<ref name=Eremococcus/>
* ''[[Enterococcus thailandicus|E. thailandicus]]''<ref name=Eremococcus/>
* ''[[Enterococcus ureasiticus|E. ureasiticus]]''<ref name=Eremococcus/>
* ''[[Enterococcus ureilyticus|E. ureilyticus]]''<ref name=Eremococcus/>
* ''[[Enterococcus viikkiensis|E. viikkiensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus villorum|E. villorum]]''<ref name=Eremococcus/>
* ''[[Enterococcus wangshanyuanii|E. wangshanyuanii]]''<ref name=Eremococcus/>
* ''[[Enterococcus xiangfangensis|E. xiangfangensis]]''<ref name=Eremococcus/>
* ''[[Enterococcus xinjiangensis|E. xinjiangensis]]''<ref name=Eremococcus/>
}}

'''''Enterococcus''''' is a large [[genus]] of [[lactic acid bacteria]] of the [[Phylum (biology)|phylum]] [[Bacillota]]. Enterococci are [[Gram-positive]] [[cocci]] that often occur in pairs ([[diplococcus|diplococci]]) or short chains, and are difficult to distinguish from [[Streptococcus|streptococci]] on physical characteristics alone.<ref name=Gilmore_2002>{{cite book | title=The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance | publisher = ASM Press | location=Washington, D.C. | year=2002 | editor=Gilmore MS | isbn=978-1-55581-234-8|display-editors=etal}}</ref> Two species are common [[commensal]] organisms in the intestines of humans: ''[[Enterococcus faecalis|E. faecalis]]'' (90–95%) and ''[[Enterococcus faecium|E. faecium]]'' (5–10%). Rare clusters of infections occur with other species, including ''E. casseliflavus'', ''[[Enterococcus gallinarum|E. gallinarum]]'', and [[Enterococcus raffinosus|''E. raffinosus'']].<ref name="Gilmore_2002" />

== Physiology and classification ==
Enterococci are [[facultative anaerobic organism]]s, i.e., they are capable of [[cellular respiration]] in both oxygen-rich and oxygen-poor environments.<ref name=Fischetti_2000>{{cite book | veditors = Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Rood JI | title = Gram-Positive Pathogens | publisher = ASM Press | year = 2000 | isbn = 1-55581-166-3}}</ref> Though they are not capable of forming [[spore]]s, enterococci are tolerant of a wide range of environmental conditions: extreme temperature (10–45&nbsp;°C), [[pH]] (4.6–9.9), and high [[sodium chloride]] concentrations.<ref name=Fisher>{{cite journal | vauthors = Fisher K, Phillips C | title = The ecology, epidemiology and virulence of Enterococcus | journal = Microbiology | volume = 155 | issue = Pt 6 | pages = 1749–1757 | date = June 2009 | pmid = 19383684 | doi = 10.1099/mic.0.026385-0 | doi-access = free }}</ref>

Enterococci exhibit variable [[Hemolysis (microbiology)|hemolysis]] on [[blood agar]]. Differences occur between species, and between strains of species. More [[Virulence|virulent]] organisms are more likely to exhibit alpha (partial) or beta (complete) hemolysis than less virulent specimens of ''Enterococcus'', which frequently exhibit gamma (absent) hemolysis.<ref>{{cite journal | vauthors = Semedo T, Almeida Santos M, Martins P, Silva Lopes MF, Figueiredo Marques JJ, Tenreiro R, Barreto Crespo MT | title = Comparative study using type strains and clinical and food isolates to examine hemolytic activity and occurrence of the cyl operon in enterococci | journal = Journal of Clinical Microbiology | volume = 41 | issue = 6 | pages = 2569–2576 | date = June 2003 | pmid = 12791882 | pmc = 156526 | doi = 10.1128/jcm.41.6.2569-2576.2003 }}</ref>

=== History ===

Members of the genus ''Enterococcus'' (from [[Greek language|Greek]] έντερο, ''éntero'' 'intestine' and κοκκος, ''coccos'' 'granule') were classified as group D ''[[Streptococcus]]'' until 1984, when genomic DNA analysis indicated a separate genus classification would be appropriate.<ref>{{cite journal |vauthors=Schleifer KH, Kilpper-Balz R | title = Transfer of ''Streptococcus faecalis'' and ''Streptococcus faecium'' to the genus ''Enterococcus'' nom. rev. as ''Enterococcus faecalis'' comb. nov. and ''Enterococcus faecium'' comb. nov. | journal= Int. J. Syst. Bacteriol.| year= 1984 | volume= 34 | pages= 31–34 | doi = 10.1099/00207713-34-1-31 | doi-access= free }}</ref>

==Evolution==

This genus appears to have evolved {{ma|425}} to {{Ma|500}}.<ref name=Lebreton2017>{{cite journal | vauthors = Lebreton F, Manson AL, Saavedra JT, Straub TJ, Earl AM, Gilmore MS | title = Tracing the Enterococci from Paleozoic Origins to the Hospital | journal = Cell | volume = 169 | issue = 5 | pages = 849–861.e13 | date = May 2017 | pmid = 28502769 | pmc = 5499534 | doi = 10.1016/j.cell.2017.04.027 }}</ref>

== Pathology ==

Important clinical infections caused by ''Enterococcus'' include [[urinary tract infection]]s (see  ''[[Enterococcus faecalis]]''), [[bacteremia]], [[bacterial endocarditis]], [[diverticulitis]], [[meningitis]], and [[spontaneous bacterial peritonitis]].<ref name="Fisher" /><ref name="Sherris">{{cite book | veditors = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | edition = 4th | pages = 294–5 |publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref><ref>{{cite journal | vauthors = Fiore M, Maraolo AE, Gentile I, Borgia G, Leone S, Sansone P, Passavanti MB, Aurilio C, Pace MC | title = Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis | journal = World Journal of Hepatology | volume = 9 | issue = 30 | pages = 1166–1175 | date = October 2017 | pmid = 29109849 | pmc = 5666303 | doi = 10.4254/wjh.v9.i30.1166 | doi-access = free }}</ref> Sensitive strains of these bacteria can be treated with [[ampicillin]], [[penicillin]] and [[vancomycin]].<ref name="Baron">{{cite book | vauthors = Pelletier Jr LL | chapter = Microbiology of the Circulatory System|title= Baron's Medical Microbiology | veditors = Albrecht T, Baron S | edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | pmid = 21413321| url = https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.5077 | isbn = 0-9631172-1-1 }}</ref> In catheterized patients receiving [[Intensive care unit|intensive care]], ''Enterococcus'' spp., have been reported the dominant cause of urinary tract infections, particularly in patients treated with [[cephalosporin]] antibiotics.<ref>{{Cite journal |last=Karlsson |first=Philip A. |last2=Bolin |first2=Christian |last3=Spång |first3=Labolina |last4=Frithiof |first4=Robert |last5=Hultström |first5=Michael |last6=Lipcsey |first6=Miklos |last7=Wang |first7=Helen |last8=Järhult |first8=Josef D. |date=2024-11-07 |title=Bacteriuria and antibiotic use during the third wave of COVID-19 intensive care in Sweden |url=https://www.tandfonline.com/doi/full/10.1080/23744235.2024.2423884 |journal=Infectious Diseases |language=en |pages=1–10 |doi=10.1080/23744235.2024.2423884 |issn=2374-4235|doi-access=free }}</ref> Urinary tract infections can be treated specifically with [[nitrofurantoin]], even in cases of vancomycin resistance.<ref name="pmid11120989">{{cite journal | vauthors = Zhanel GG, Hoban DJ, Karlowsky JA | title = Nitrofurantoin is active against vancomycin-resistant enterococci | journal = Antimicrobial Agents and Chemotherapy | volume = 45 | issue = 1 | pages = 324–326 | date = January 2001 | pmid = 11120989 | pmc = 90284 | doi = 10.1128/AAC.45.1.324-326.2001 }}</ref>
[[File:Diagnostic algorithm of possible bacterial infection.png|thumb|left|Example of a workup algorithm of possible bacterial infection in cases with no specifically requested targets (non-bacteria, mycobacteria etc.), with most common situations and agents seen in a New England community hospital setting. ''Enterococcus'' is included near bottom-center.]]

=== Meningitis ===
{{Main|Meningitis}}
Enterococcal meningitis is a rare complication of neurosurgery. It often requires treatment with intravenous or [[intrathecal]] vancomycin, yet it is debatable as to whether its use has any impact on outcome: the removal of any neurological devices is a crucial part of the management of these infections.<ref name="Guardado_2006">{{cite journal | vauthors = Guardado R, Asensi V, Torres JM, Pérez F, Blanco A, Maradona JA, Cartón JA | title = Post-surgical enterococcal meningitis: clinical and epidemiological study of 20 cases | journal = Scandinavian Journal of Infectious Diseases | volume = 38 | issue = 8 | pages = 584–588 | year = 2006 | pmid = 16857599 | doi = 10.1080/00365540600606416 | s2cid = 24189202 }}</ref>
New epidemiological evidence has shown that enterococci are major infectious agent in chronic bacterial [[prostatitis]].<ref>{{cite web | title = Enterococcus sp rRNA [Presence] in Specimen by Probe | url = https://loinc.org/5001-3 | id = 5001-3 | work = Logical Observation Identifiers Names and Codes (LOINC) | publisher = Regenstrief Institute, Inc. }}</ref> Enterococci are able to form [[biofilm]] in the prostate gland, making their eradication difficult.{{citation needed|date=February 2023}} Cases of enterococcal meningitis, in the absence of trauma or surgery, should raise suspicion of an underlying intestinal pathology (e.g., strongyloidiasis).<ref>{{cite journal | vauthors = Cosimi L, Di Bella S, Luzzati R, Simeth CT, Pinamonti M, Cominotto F, Sisto UG | title = Enterococcal meningitis associated with ''Strongyloides'' infection: a case report and literature review | journal = Le Infezioni in Medicina | volume = 31 | issue = 4 | pages = 583–590 | date = 2023-12-01 | pmid = 38075422 | pmc = 10705849 | doi = 10.53854/liim-3104-18 }}</ref>

== Antibacterial resistance ==
From a medical standpoint, an important feature of this genus is the high level of [[wikt:intrinsic|intrinsic]] [[antibiotic resistance]]. Some enterococci are intrinsically resistant to [[Β-lactam antibiotic|β-lactam-based antibiotics]] ([[penicillin]]s, [[cephalosporin]]s, [[carbapenem]]s), as well as many [[aminoglycoside]]s.<ref name="Sherris" /> In the last two decades, particularly virulent strains of ''Enterococcus'' that are resistant to vancomycin ([[Vancomycin-resistant Enterococcus|vancomycin-resistant ''Enterococcus'']], or VRE) have emerged in [[nosocomial]] infections of hospitalized patients, especially in the US.<ref name="Fisher" /> Other developed countries, such as the UK, have been spared this epidemic, and, in 2005, Singapore managed to halt an epidemic of VRE.<ref>{{cite journal | vauthors = Kurup A, Chlebicki MP, Ling ML, Koh TH, Tan KY, Lee LC, Howe KB | title = Control of a hospital-wide vancomycin-resistant Enterococci outbreak | journal = American Journal of Infection Control | volume = 36 | issue = 3 | pages = 206–211 | date = April 2008 | pmid = 18371517 | pmc = 7115253 | doi = 10.1016/j.ajic.2007.06.005 }}</ref> Although [[quinupristin]]/[[dalfopristin]] (Synercid) was previously indicated for treatment of VRE in the USA, the FDA approval for this indication has since been retracted.<ref>{{cite journal | vauthors = Batts DH, Lavin BS, Eliopoulos GM | title = Quinupristin/dalfopristin and linezolid: spectrum of activity and potential roles in therapy--a status report | journal = Current Clinical Topics in Infectious Diseases | volume = 21 | pages = 227–251 | date = 2001 | pmid = 11572153 | url = https://pubmed.ncbi.nlm.nih.gov/11572153/ }}</ref> The rationale for the retraction of Synercid's indication for VRE was based upon poor efficacy in ''E. faecalis'', which is implicated in the vast majority of VRE cases.<ref>{{cite journal | vauthors = Collins LA, Malanoski GJ, Eliopoulos GM, Wennersten CB, Ferraro MJ, Moellering RC | title = In vitro activity of RP59500, an injectable streptogramin antibiotic, against vancomycin-resistant Gram-positive organisms | journal = Antimicrobial Agents and Chemotherapy | volume = 37 | issue = 3 | pages = 598–601 | date = March 1993 | pmid = 8460927 | pmc = 187713 | doi = 10.1128/aac.37.3.598 }}</ref><ref>{{cite journal | vauthors = Singh KV, Weinstock GM, Murray BE | title = An Enterococcus faecalis ABC homologue (Lsa) is required for the resistance of this species to clindamycin and quinupristin-dalfopristin | journal = Antimicrobial Agents and Chemotherapy | volume = 46 | issue = 6 | pages = 1845–1850 | date = June 2002 | pmid = 12019099 | pmc = 127256 | doi = 10.1128/AAC.46.6.1845-1850.2002 | doi-access = free }}</ref> Tigecycline has also been shown to have antienterococcal activity, as has [[rifampicin]].<ref>{{cite web | title = Enterococcus sp DNA [Presence] by NAA with probe detection in Positive blood culture | url = https://loinc.org/92784-8 | id = 92784-8 | work = Logical Observation Identifiers Names and Codes (LOINC) | publisher = Regenstrief Institute, Inc. }}</ref>

''Bacillus haynesii'' CD223 and ''Advenella mimigardefordensis'' SM421 can inhibit the growth of ''Enterococcus'' spp. <ref>{{cite journal | vauthors = Rahman MM, Paul SI, Rahman A, Haque MS, Ador MA, Foysal MJ, Islam MT, Rahman MM | title = Suppression of Streptococcosis and Modulation of the Gut Bacteriome in Nile Tilapia (<i>Oreochromis niloticus</i>) by the Marine Sediment Bacteria Bacillus haynesii and Advenella mimigardefordensis | journal = Microbiology Spectrum | volume = 10 | issue = 6 | pages = e0254222 | date = December 2022 | pmid = 36453920 | pmc = 9769507 | doi = 10.1128/spectrum.02542-22 | veditors = Rogovskyy AS, Weththasinghe P, Rodriguez-Estrada U }}</ref>

== Water quality ==

In bodies of water, the acceptable level of contamination is very low; for example in the state of [[Hawaii]], and most of the United States, the limit for water off its beaches is a five-week geometric mean of 35 colony-forming units per 100 ml of water, above which the state may post warnings to stay out of the ocean.<ref name=Hawaii_DOH>{{cite web|title=Clean Water Branch |work=Hawaii State Department of Health |url=http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-54.pdf |access-date=2012-05-18 |url-status=dead |archive-url=https://web.archive.org/web/20111111031411/http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-54.pdf |archive-date=2011-11-11 }}</ref> In 2004, measurement of enterococci took the place of [[fecal coliform]]s as the new American federal standard for water quality at public saltwater beaches and alongside ''[[Escherichia coli]]'' at freshwater beaches.<ref>{{cite journal|title=Water Quality Standards for Coastal and Great Lakes Recreation Waters; Final Rule|journal=Federal Register|date=16 November 2004|volume=69|issue=220|pages=67218–67243|url=https://www.federalregister.gov/articles/2004/11/16/04-25303/water-quality-standards-for-coastal-and-great-lakes-recreation-waters|access-date=26 November 2014}}</ref> It is believed to provide a higher correlation than fecal coliform with many of the human pathogens often found in city sewage.<ref name=Jin_2004>{{cite journal | vauthors = Jin G, Jeng HW, Bradford H, Englande AJ | title = Comparison of E. coli, enterococci, and fecal coliform as indicators for brackish water quality assessment | journal = Water Environment Research | volume = 76 | issue = 3 | pages = 245–255 | year = 2004 | pmid = 15338696 | doi = 10.2175/106143004X141807 | bibcode = 2004WaEnR..76..245J | s2cid = 35780753 }}</ref>

== References ==
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== External links ==
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[[Category:Enterococcus| ]]
[[Category:Bacteria genera]]
[[Category:Gram-positive bacteria]]
[[Category:Pathogenic bacteria]]