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Curr Clin Top Infect Dis 8 : 37 — Noble C. J Clin Pathol 31 : — Oppenheim B. J Antimicrob Chemother 41 suppl D , 7 — Learn all about the infection and what to do if…. Escherichia coli E. Most strains are not harmful, but some produce toxins that can lead to illnesses…. Dysentery is an inflammation of the intestines, especially the colon. Symptoms include stomach cramps and diarrhea with blood or mucus in the feces….
Bacteria are single-celled organisms that exist in their millions, in every environment, inside or outside other organisms. Some are harmful, but…. Clostridium difficile, now called Clostridioides difficile C. What's to know about Enterococcus faecalis? Medically reviewed by Alana Biggers, M. What is Enterococcus faecalis? Known infections Antibiotic resistance Transmission and prevention Preventing infection Treatment Outlook Enterococcus is a type of bacteria that is typically present in the gut and bowel.
Originally, this bacteria was associated with the Streptococcus. Known infections. Share on Pinterest A urinary tract infection can be caused by E.
Antibiotic resistance. Transmission and prevention. The aim of this review is to analyse recent literature data on the principles of antibiotic resistance formation in bacteria of the Enterococcus genus. Furthermore, the habitat of the Enterococcus genus, its pathogenicity and pathogenicity factors, its epidemiology, genetic and molecular aspects of antibiotic resistance, and the relationship between these bacteria and bowel diseases are discussed. So-called VREfm — vancomycin resistant Enterococcus faecium and its currently rapidly growing resistance as well as the significance of these bacteria in nosocomial diseases is described.
Enterococci have become the second most common agents of nosocomial diseases due to their constantly growing resistance and nowadays are ranked right after staphylococci. It was discovered and later proved, that present multi-resistant E. This separation must have happened around 75 years ago and is being connected to antibiotic usage in clinical practice.
This clade can be distinguished by its increased number of mobile genetic elements, metabolic alternations and hypermutability [ 1 ]. All of these attributes led to the development of a flexible genome, which is now able to easily adapt to the changes of the surroundings [ 2 , 3 ]. It is also necessary to mention some basic information about morphological diversity, physiological and biochemical characteristics and taxonomy in order to understand the resistance mechanisms completely.
Biochemical features must especially be mentioned since they play a huge role in the high increase of resistance in these bacteria. It is also crucial to describe the natural habitats of enterococci and their pathogenicity since these factors are really related to each other.
When in their natural habitat - such as soil or gastrointestinal tract — enterococci are quite harmless, but in the presence of a hospital environment, where they are exposed to antibiotics, they usually start to mutate, and that is how they become multidrug-resistant pathogens [ 2 , 3 , 4 ]. Another thing to focus on is an explanation of the resistance principles as such and then in relation to enterococci. Enterococci are nowadays adapting even more and to other anti-gram-positive substances such as linezolid [ 5 ].
Recent problems stemming from the growing resistance of species E. The aim of this review was to describe bacteria of the Enterococcus genus, their habitat, natural resistance, pathogenicity, and virulence.
Another objective was to summarize the resistance formation and its importance in this genus focusing especially on the species E. The influences of enterococci on inflammatory bowel diseases and the following changes of intestinal microbiome were also described. Enterococci cells are gram-positive with an ovoid shape. They usually occur in pairs Figure 1 or in chains of different lengths [ 1 , 4 ]. Enterococci form neither spores nor capsules, but some species may be capable of movement by the flagellum.
These motile species are Enterococcus casseliflavus and Enterococcus gallinarum. Their colonies are milky white when grown on usual agar plates, but some species produce carotenoid pigments which color them yellow. Among these yellow colored enterococci are E.
Enterococci belong to the group of gram-positive bacteria and most of the species of this genus have lysine-D-asparagin type of peptidoglycan except for E. The enterococci cell wall contains no proteins or lipids, but it has teichoic acid as a main surface antigen [ 17 ].
Enterococci are also very resistant to drying and therefore it is quite easy for them to persist in inappropriate conditions, which can be found for example in a hospital environment [ 4 , 18 ]. They are chemoorganotrophic, catalase negative and some species can show haemolytic activity. Complex media, rich with nutrients, are required for cultivation in laboratory conditions.
Enterococci belong amongst facultative anaerobic bacteria with the preference of anaerobic environment; however, they do not mind living in aerobic conditions [ 8 , 19 ]. Survival in an environment with oxygen is provided by superoxide dismutase, which can transform toxic superoxide into less toxic peroxide and whose synthesis is induced by the presence of molecular oxygen in the air [ 20 ].
Enterococci are not capable of porphyrin synthesis; therefore, they lack cytochrome pigments and the ability to photosynthesize. However, some species may contain NADH peroxidases with flavin, which take part in fermentative metabolism, protect cells against oxidative stress within aerobic processes and can contribute to the bacterial virulence [ 21 ].
Enterococci have fermentative metabolism with homofermentative type. During this fermentation, glucose is being transformed to lactose, which is also the final product of this reaction. The process is called Embden-Meyerhof-Parnas pathway and it is actually a type of glycolysis. When in the environment with oxygen, glucose is metabolized to the acetic acid, acetoin, and carbon dioxide. Pyruvate is then metabolized according to the pH of the environment. In a mildly acid environment, at pH , pyruvate is transformed to lactate, while in the neutral or basic environment, pyruvate is metabolized to formate, ethanol and acetate in the ratio [ 22 ].
Pyruvate is transformed into ethanol and acetate only when in the environment with a lack of nutrients [ 23 ]. Consequent 16S rRNA researches confirmed this division and on top of that, they showed differences among enterococci and the Lactococcus genus, which belongs to the family Streptococcaceae as well [ 24 , 25 ].
Nowadays, it is certain, that the Enterococcus genus belongs to the family Enterococcaceae , order Lactobacillales , class Bacilli , phylum Firmicutes and of course to the domain Bacteria [ 16 ].
There are 36 different species of enterococci known today, while 30 of them are divided into five groups according to their phylogenetic similarity: E. Six species stand out of these groups [ 26 ]. This division is shown in the Table 1. Division of phylogenetically similar species of the Enterococcus genus [ 26 ]. Outside of the official nomenclature, enterococci can be placed into the group of lactic acid bacteria LAB.
Enterococci survive in various environments due to their ability to easily adapt. They can be most often found in the soil, surface and waste waters, then in the gastrointestinal tract of birds, mammals, and even reptiles and insects. It can be found in fermented milk products as well, due to the fact that they belong to LAB [ 6 ]. Some species are capable of epiphytic life on plants. These species used to be mainly E.
Even greater diversity amongst species can be observed in several water sources. Quite new discoveries are E. Their survival in saltwater is an amazing example of enterococci adaptation to their environment.
It was discovered that some species can grow on zooplankton present in both fresh and saltwater, and therefore survive. Research has shown that the growing amount of plankton means a growing number of enterococci as well. The amount of zooplankton, and therefore enterococci, is dependent on the water temperature, which leads to the highest occurrence during the summer months [ 29 ]. The species E. Intestinal bacteria, including enterococci can therefore be used for clean water testing where they function as so-called fecal indicators and their presence or higher concentration signifies fecal contamination in the water [ 29 ].
The most common enterococci occurring in the gastrointestinal tract are species E. Pathogenicity is described as the ability of a microorganism to cause an illness in several host species. This ability is determined by the pathogenicity factors such as transmissibility, toxicity and invasiveness. Quantitatively expressed pathogenicity for one strain is then called virulence. Pathogenicity factors are encoded in both chromosomal and plasmid genes.
It is the presence of these genes in plasmids that enables the transmission of pathogenicity factors amongst strains and even species, leading to virulence increase in strains that were not that virulent once [ 31 ].
The species of enterococci living in the environment have quite low levels of virulence. However, the factors which can change the harmless strains into clinically problematic ones were found. Among these factors belongs mainly natural antibiotic resistance clindamycin, cephalosporins, aminoglycosides , then the ability to gain and further spread plasmids coding other resistance vancomycin and finally a flexible genome able to adapt to different environments [ 1 , 6 ].
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