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Enterococci are a nasty, antibiotic resistant group of bacteria that until fairly recently were classified as a sub-group of streptococci.
There are at least twelve known species of enterococci and the majority do not affect red blood cells detrimentally. However, a few cause haemolysis, which is basically the destruction of the cell wall envelope resulting in the release of haemoglobin and destruction of the red blood cell.
Enterococci multiply quite well between about 10 degrees Celsius and 45 degrees Celsius, unlike their relatives the streptococci that grow within a much narrower range of temperature. This temperature range is one of the reasons why enterococci infections are so vicious in the human body.
Although around twelve species of Enterococci are known virtually all infections are found to be due to one of only two species. The most common species is Enterococcus faecalis, responsible for around 90% of infections. The other species Enterococcus faecium causes around 5-10% of infections in the general population.
(continued)
There are at least twelve known species of enterococci and the majority do not affect red blood cells detrimentally. However, a few cause haemolysis, which is basically the destruction of the cell wall envelope resulting in the release of haemoglobin and destruction of the red blood cell.
Enterococci multiply quite well between about 10 degrees Celsius and 45 degrees Celsius, unlike their relatives the streptococci that grow within a much narrower range of temperature. This temperature range is one of the reasons why enterococci infections are so vicious in the human body.
Although around twelve species of Enterococci are known virtually all infections are found to be due to one of only two species. The most common species is Enterococcus faecalis, responsible for around 90% of infections. The other species Enterococcus faecium causes around 5-10% of infections in the general population.
(continued)
Enterococci infections are fairly common nowadays in hospitals and lurk especially in Intensive Care Units. The bacteria are usually transmitted from one patient to another via the hands of hospital workers. It's not just a question of washing the hands before seeing each patient as unfortunately some people are carriers of the bacteria in their own gastro-intestinal tract. Sometimes, infection is transmitted via unsterilised medical instruments.
The most common sites of infection with the cocci are wounds, urine and the urinary tract, intra-abdominal areas and the blood. There are some differences regarding the main diseases depending on the age of the patient. In adults, a high proportion of infections result in endocarditis: in the newborn, the cocci can cause blood poisoning and meningitis.
Enterococci are very resistant to many antiobiotics. Of the two most common species Enterococcus faecium is more resistant to antibiotics than Enterococcus faecalis. Without going too deep into the pharmacology here, Enterococcus species are naturally resistant to the cephalosporins, monobactams and penicillinase-resistant penicillins. Aminoglycosides can have an effect on their growth as can some penicillins such as ampicillin. The latter drug is always used in combination nowadays with another antibiotic as ampicillin inhibits but does not kill the cocci.
(continued)
The most common sites of infection with the cocci are wounds, urine and the urinary tract, intra-abdominal areas and the blood. There are some differences regarding the main diseases depending on the age of the patient. In adults, a high proportion of infections result in endocarditis: in the newborn, the cocci can cause blood poisoning and meningitis.
Enterococci are very resistant to many antiobiotics. Of the two most common species Enterococcus faecium is more resistant to antibiotics than Enterococcus faecalis. Without going too deep into the pharmacology here, Enterococcus species are naturally resistant to the cephalosporins, monobactams and penicillinase-resistant penicillins. Aminoglycosides can have an effect on their growth as can some penicillins such as ampicillin. The latter drug is always used in combination nowadays with another antibiotic as ampicillin inhibits but does not kill the cocci.
(continued)
Treatment depends on the severity of the infection. In endocarditis, gentamicin and either ampicillin or vancomycin are used to treat the infection as the drug combination work together on different parts of the bacteria. There are also some specialised drugs available such as daptomycin and linezolid.
There was a time when vancomycin alone was effective in treating enterococcal infections. However, in some countries, notably the USA, the cocci are now almost 100% resistant to the antibiotic. In Europe, teicoplanin has been used as an alternative to vancomycin, but unfortunately technical difficulties have stopped the FDA in the USA from licencing the drug over there.
Although antibiotic treatment of Enterococci infections is difficult and has to be done in consultation with a microbiologist, we are not yet at the stage of total resistance to all antibiotics. Infections can be overcome.
If you need further information, please let me know.
There was a time when vancomycin alone was effective in treating enterococcal infections. However, in some countries, notably the USA, the cocci are now almost 100% resistant to the antibiotic. In Europe, teicoplanin has been used as an alternative to vancomycin, but unfortunately technical difficulties have stopped the FDA in the USA from licencing the drug over there.
Although antibiotic treatment of Enterococci infections is difficult and has to be done in consultation with a microbiologist, we are not yet at the stage of total resistance to all antibiotics. Infections can be overcome.
If you need further information, please let me know.
theprof, thank you so much for taking the time and trouble to explain it. I am currently visiting someone in hospital who is in a very poorly condition having suffered a major stroke, and has contracted the infection since he was hospitalised. Because of the infection, he has been moved from the main ward to a side room, but there is no restriction on visitors, and I am not required to wear any sort of protective clothing, eg gloves etc. I apologise if I sound particlarly naive, but in this case I am, so could you please tell me if I could become a carrier simply by holding his hand, or from tidying his bed, and could you please advise me if there are any special precautions I could take, apart from washing my hands, to avoid spreading the infection? Very many thanks.
Hi Naomi
I�m very sorry to hear about your friend and I do hope he makes a rapid recovery from the infection. Contracting an infection like this on top of a stroke is no joke.
Enterococci infections tend to be treated differently in hospitals depending which part of the world the patient lives in. In Australia for example, they pull out all the stops and treat the patient by full barrier nursing especially since they�ve encountered some nasty vancomycin-resistant infections down under. In the UK, if the Enterococcus species is not too virulent and/or antibiotic therapy is shown to be working effectively, most hospitals are happy to treat the patient in the way your friend is being treated. As long as you are in reasonably good health and have not undergone any medical or surgical procedures recently, you should be OK as your body�s internal defences will protect you reasonably well.
It is true that you could become a temporary carrier for the bacteria by holding his hand. All the same, I think you have to strike a balance here between the temporary risk and the importance of the patient knowing that he has a true friend beside him. Personally, I think the latter is more important than the former. Besides, there�s a lot you can do to minimise the risk involved.
(continued)
I�m very sorry to hear about your friend and I do hope he makes a rapid recovery from the infection. Contracting an infection like this on top of a stroke is no joke.
Enterococci infections tend to be treated differently in hospitals depending which part of the world the patient lives in. In Australia for example, they pull out all the stops and treat the patient by full barrier nursing especially since they�ve encountered some nasty vancomycin-resistant infections down under. In the UK, if the Enterococcus species is not too virulent and/or antibiotic therapy is shown to be working effectively, most hospitals are happy to treat the patient in the way your friend is being treated. As long as you are in reasonably good health and have not undergone any medical or surgical procedures recently, you should be OK as your body�s internal defences will protect you reasonably well.
It is true that you could become a temporary carrier for the bacteria by holding his hand. All the same, I think you have to strike a balance here between the temporary risk and the importance of the patient knowing that he has a true friend beside him. Personally, I think the latter is more important than the former. Besides, there�s a lot you can do to minimise the risk involved.
(continued)
To begin with, make sure that before you leave home, you cover any cuts and grazes on your hands with waterproof dressings no matter how small they are. This will reduce the risk of the bacteria entering the bloodstream. It also helps if you keep your nails short and avoid wearing false fingernails as bacteria can lurk there. For the same reason, try to avoid wearing rings with stones, bracelets, watches or fashion jewelery on your hands or wrists. Also either avoid wearing long-sleeved clothes or roll them up above the wrist area.
The problem that your facing when you�re holding the patients hands is that you may not be holding the same hand all the time you are in the room and you need to watch what he does with his hands. For example, if he�s in the habit of picking his nose or scratching himself, he�s more likely to have viable bacteria on his hand or hands for transfer. So clutching onto one hand throughout the time you�re there might be the best policy.
It�s also important that you don�t handle any medical instrumentation in the room unnecessarily. A 1995 study showed that the bacteria can survive for 30 minutes on stethoscopes and telephones and on the fingertips for up to an hour. Also, avoid touching your own skin with the hand or hands that have been in contact with the patients skin.
When you leave the side-room, you must wash your hands before leaving the ward at a scrub station. Now in practice, the sink will have a cleanser such as Hibiscrub, Hydrex or Betadine in a dispenser on the wall. Follow the instructions provided closely on how to wash your hands thoroughly with the stuff.
(continued)
The problem that your facing when you�re holding the patients hands is that you may not be holding the same hand all the time you are in the room and you need to watch what he does with his hands. For example, if he�s in the habit of picking his nose or scratching himself, he�s more likely to have viable bacteria on his hand or hands for transfer. So clutching onto one hand throughout the time you�re there might be the best policy.
It�s also important that you don�t handle any medical instrumentation in the room unnecessarily. A 1995 study showed that the bacteria can survive for 30 minutes on stethoscopes and telephones and on the fingertips for up to an hour. Also, avoid touching your own skin with the hand or hands that have been in contact with the patients skin.
When you leave the side-room, you must wash your hands before leaving the ward at a scrub station. Now in practice, the sink will have a cleanser such as Hibiscrub, Hydrex or Betadine in a dispenser on the wall. Follow the instructions provided closely on how to wash your hands thoroughly with the stuff.
(continued)
It�s important that you insist on washing your hands in this manner to any nurse or doctor that may question your motives. Don�t be put off if they try to insist you�re being over-zealous or paranoid � it�s your right. If the worse comes to the worse, tell them you have young children outside and you don�t want to pass any infection on � this generally receives a more sympathetic attitude.
Most hospitals nowadays also use various types of an alcohol gel product such as Purell, which kills almost 100% of germs instantly on contact. This is a better option than the products I�ve mentioned above as it takes only a few seconds to apply and dries naturally on the hands. This is now the bactericidal of choice in all hospitals where MRSA infections and the like have occurred. To apply this product, your hands must be dry and you can use it to be doubly sure after washing your hands as above.
(continued)
Most hospitals nowadays also use various types of an alcohol gel product such as Purell, which kills almost 100% of germs instantly on contact. This is a better option than the products I�ve mentioned above as it takes only a few seconds to apply and dries naturally on the hands. This is now the bactericidal of choice in all hospitals where MRSA infections and the like have occurred. To apply this product, your hands must be dry and you can use it to be doubly sure after washing your hands as above.
(continued)
If you do come across any problems with hospital staff over these issues, ask to see the hospital infection control nurse and put your concerns to him or her. The infection control nurses are very knowledgeable, have wide powers to put matters right and will insist that you are allowed to wash your hands before leaving the ward. Many years ago a professor told me that hand hygiene is the single most important means of preventing cross-infection and that stands as good today as it did then.
Another method you might like to consider is to apply a hand cream or barrier cream to your hands before going in to see the patient. The cream will hinder the movement of the bacteria and can be washed off immediately after leaving the room.
It�s possible for the Enterococci to be transferred via bed linen but unless the fabric has been contaminated within the last hour and/or is moist or wet, the risk is minimal.
Incidentally, I don�t think you are na�ve at all to ask these questions. If other people were as careful as you clearly feel you need to be, MRSA and the like would not be so endemic in hospital environments.
I hope your friend gets better soon.
Another method you might like to consider is to apply a hand cream or barrier cream to your hands before going in to see the patient. The cream will hinder the movement of the bacteria and can be washed off immediately after leaving the room.
It�s possible for the Enterococci to be transferred via bed linen but unless the fabric has been contaminated within the last hour and/or is moist or wet, the risk is minimal.
Incidentally, I don�t think you are na�ve at all to ask these questions. If other people were as careful as you clearly feel you need to be, MRSA and the like would not be so endemic in hospital environments.
I hope your friend gets better soon.
Oh good.
Can I just say to both yourself and Naomi how wonderful your answers always are. Detailed and informative and most importantly understandable!... Always a pleasure to read them.
(Actually useful too for me this thread as I think we've been monitored for this or something like it recently).
Take care both of you and hope your friend gets better soon Naomi.
Can I just say to both yourself and Naomi how wonderful your answers always are. Detailed and informative and most importantly understandable!... Always a pleasure to read them.
(Actually useful too for me this thread as I think we've been monitored for this or something like it recently).
Take care both of you and hope your friend gets better soon Naomi.
Thanks China Doll. You make it all worthwhile.
I've never been one to baffle people with science unless they are a fellow academic. That's one of the reasons why I take time out every so often to lecture chemistry/biology in primary and secondary schools near my universities - it keeps my feet firmly on the ground!
I've never been one to baffle people with science unless they are a fellow academic. That's one of the reasons why I take time out every so often to lecture chemistry/biology in primary and secondary schools near my universities - it keeps my feet firmly on the ground!
Hello Prof, thank you very much indeed. There is no hope of him recovering, but nevertheless, I thank you for your good wishes and I am so very grateful for your help and advice. Although this particular infection is quite new to me, I do have some experience of hospital-acquired infections since my husband contracted MRSA after a minor operation at the same hospital last year. That resulted in many months in hospital, and recovery, and in three more operations, two involving transplants, one of them complex plastic surgery lasting eleven hours. He now has a permanent disfigurement and a permanent disability, so I have no reservations whatsoever in insisting on proper hygiene in hospitals or in stating my views very clearly to hospital personnel.
Thank you again for taking the time and trouble to explain it to me.
China Doll, thank you for your kind words and for the compliment. No doubt I'll see you over on news and R&S.
Thank you again for taking the time and trouble to explain it to me.
China Doll, thank you for your kind words and for the compliment. No doubt I'll see you over on news and R&S.
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