Sood Seema, Malhotra Meenakshi, Das B K, Kapil Arti
Department of Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Indian J Med Res. 2008 Aug;128(2):111-21.
Enterococci have traditionally regarded as low grade pathogens, have emerged as an increasingly important cause of nosocomial infections in the last decade. Although about a dozen enterococcus species have been identified, only two are responsible for the majority of human infections, i.e., Enterococcus faecalis and E. faecium. The most common nosocomial infections produced by these organisms are urinary tract infections (associated with instrumentation and antimicrobial resistance), followed by intra-abdominal and pelvic infections. They also cause surgical wound infections, bacteraemia, endocarditis, neonatal sepsis and rarely meningitis. A major reason why these organisms survive in hospital environment is the intrinsic resistance to several commonly used antibiotics and, perhaps more importantly, their ability to acquire resistance to all currently available antibiotics, either by mutation or by receipt of foreign genetic material through the transfer of plasmids and transposons. The emergence of vancomycin-resistant enterococci (VRE) is a cause of concern, as once established, it is very difficult to control. Moreover, there can be transfer of resistant gene from enterococci to Staphylococcus aureus thereby posing a threat to the patient safety and also challenges for the treating physicians. This review highlights the shifting spectrum of enterococcal infections, along with their geographical distribution and growing nosocomial importance. Emergence of antimicrobial resistance, pathogenicity and virulence factors, current preventive, control and treatment modalities of severe enterococcal infections are also dealt with.
肠球菌传统上被视为低级别病原体，但在过去十年中已成为医院感染日益重要的原因。虽然已鉴定出约十二种肠球菌，但只有两种导致大多数人类感染，即粪肠球菌和屎肠球菌。这些微生物引起的最常见医院感染是尿路感染（与器械操作和抗菌药物耐药性有关），其次是腹腔和盆腔感染。它们还会导致手术伤口感染、菌血症、心内膜炎、新生儿败血症，很少引起脑膜炎。这些微生物在医院环境中存活的一个主要原因是对几种常用抗生素具有内在耐药性，也许更重要的是，它们能够通过突变或通过质粒和转座子转移接收外来遗传物质而获得对所有现有抗生素的耐药性。耐万古霉素肠球菌（VRE）的出现令人担忧,因为一旦形成，就很难控制。此外，耐药基因可从肠球菌转移到金黄色葡萄球菌，从而对患者安全构成威胁，也给治疗医生带来挑战。本综述强调了肠球菌感染范围的变化，以及它们的地理分布和在医院感染中日益增加的重要性。还讨论了抗菌药物耐药性的出现、致病性和毒力因子，以及严重肠球菌感染目前的预防、控制和治疗方式。
