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Enterococci Grp D

- Discussion:
    - type of gram positive bacteria;
    - term enterococcus derives from French (enterocoque) describing its enertic origin;
    - enterococci include: Strep faecalis, faicium, and durans;
    - strep faecalis inhabits the human intestinal tract and is a nonhemolytic strain of generally low pathogenicity;
    - enterococcus is a common participant in diabetic infections & can give rise to bacteremia (and endocarditis);
    - these organisms are most often a secondary invader of urinary tract and they are present only in complicated UTI;
    - this organism is extremely hardy and can often grow adequately under conditions lethal to most other micro-organisms;

- Treatment:
    - enterococci are always resistant to cephalosporins & clindamycin but are sensitive to semisynthetic penicillins, ampicillin, imipenem, & cipro;
    - enterococal group D streptococci, unlike streptococcal, are resistant to penicillins and aminoglycosides, but synergy in killing is achieved with the combination of both drugs;
            - this combination is indicated in endocarditis, some cases of osteomyelitis, and possibly in diabetic foot infections;
    - vancomycin is the agent of choice for organisms resistant to ampicillin;
    - vancomycin resistant enterococcus:
            - note that these organisms can survive on non-organic objects for prolonged periods of time (eg blood pressure cuffs and/or stethoscopes), and therefore a "true" isolation environment is required for these patients (gowns, masks, hand washing, gloves, as well as a dedicated blood pressure cuff, stethoscope ect);
                    - handwashing with an antiseptic after glove removal;
                    - dedication of equipment such as stethoscopes to the patients room;
                    - avoiding contact with environmental surfaces such as doorknobs;
            - synercid (quinupristin/dalfopristin) IV is approved for systemic infections due to VRE

Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections 

Medical Intelligence: Plasmid-Mediated Resistance To Vancomycin And Teicoplanin In Enterococcus Faecium.

Enterococcus species in urinary tract infection.