Enterococcus faecalis

Enterococcus faecalis is a Gram-positive, coccoid, facultative anaerobic bacterium that belongs to the Enterococcaceae family. The bacterium belongs to the genus Enterococcus, which - in addition to Enterococcus faecalis - comprises a large number of other species, including E. faecium, E. casseliflavus, E. galinarum, E. avium/E. pseudoavium, E. durans, E. cecorum, E. dispar, E. gilvus, E. hirae, E. mundtii, E. pallens and E. raffinosus [1].

The species E. faecium and E. faecalis are the most clinically relevant [2]. Publications provide different assessments as to which species dominates in infections [2][3]. In the last decade, the proportion of E. faecium in infections increased [2][3].

E. faecalis is one of the most common triggers for multidrug-resistant hospital-acquired infections and causes a number of diseases [4][5]:

  • Urinary tract infections

  • Endocarditis

  • Bacteremia

  • Wound infections

The microorganisms are ubiquitously distributed and are found primarily in the digestive tract of humans and warm-blooded animals as part of the intestinal flora. Other reservoirs include foods of animal and plant origin [2].

Relevance of pathogen in transmission in endoscopy

  • Gastroenterology: Low

  • Pulmonology: Not relevant

  • Ear, nose, and throat: Not relevant

  • Urology: Low

Relevance for endoscope surveillance

  • High concern organism

Transmission route

Transmission takes place by direct or indirect contact, for example via contaminated foods, materials and objects as well as via the hands of medical professionals [2].

Enterococcus faecalis is one of the bacteria that contaminate endoscopes and, in simulated use studies, have been shown to survive the reprocessing process in the event of insufficient cleaning [6][7].

Resistance to antibiotics

Enterococcus faecalis has a wide range of natural and acquired resistances to antibiotics, for example resistance to vancomycin (VRE) and to reserve antibiotics such as linezolid and tigecycline. Resistance genes can be easily transferred from Enterococcus faecalis to other bacteria and contribute to the further spread of resistance to antibiotics [3][8].

Sources and further readings

  1. Gries O, Ly T. Infektologie – Kompendium humanpathogener Infektionskrankheiten und Erreger, Springer-Verlag Berlin Heidelberg 2019.

  2. Golob M et al.: Antimicrobial Resistance and Virulence Genes in Enterococcus faecium and Enterococcus faecalis from Humans and Retail Red Meat. BioMed Research International Volume. 2019, Article ID 2815279, 12 pages.

  3. Klare I et al.: Vancomycin-resistente Enterokokken (VRE). Aktuelle Daten und Trends zur Resistenzentwicklung. Bundesgesundheitsbl. 2012, 55:1387–1400.

  4. Fallah F et al.: Phenotypic and genotypic study of biofilm formation in Enterococci isolated from urinary tract infections. Microb Pathog. 2017, 108:85-90.

  5. Raza T et al. Vancomycin resistant Enterococci: A brief review. J Pak Med Assoc. 2018, 68 (5):768-772.

  6. Singh H et al. Impact of cleaning monitoring combined with channel purge storage on elimination of Escherichia coli and environmental bacteria from duodenoscopes. Gastrointest Endosc. 2018, 88 (2):292-302.

  7. Alfa MJ et al.: Improper positioning of the elevator lever of duodenoscopes may lead to sequestered bacteria that survive disinfection by automated endoscope reprocessors Am J Infect Control. 2018, 46 (1):73-75.

  8. Gilmore MS et al.: Genes contributing to the unique biology and intrinsic antibiotic resistance of Enterococcus faecalis. Molecular Biology and Physiology. 2020, Volume 11 Issue 6 e.