Bacterial Infections, Spread, Management, and Safeguarding: E. faecalis Overview

Bacterial Infections, Spread, Management, and Safeguarding: E. faecalis Overview

Enterococcus faecalis (E. faecalis) is generally a harmless bacteria found in the gut. However, it can become a nasty infection when it multiplies or spreads to other parts of the body, potentially leading to some serious troubles. Here's what you need to know about this pesky little bug and how to keep it at bay.

Don't get too comfortable with E. faecalis—there are zillions of these critters around, with around 160 different types known to exist. About 60% of these are known to infect humans, and E. faecalis accounts for around 80% of those human infections. Yuck!

Who's at Risk?

Healthy persons with standard E. faecalis populations typically don't have anything to worry about. But if it colonizes other areas of the body, it can be life-threatening, causing nearly 5,400 deaths in the US in 2017 [MEDLINEPlus].

People at a higher risk of E. faecalis infections include:

1. Hospital Patients: Hospital environments harbor reduced immunity, making hospital-goers prime targets for E. faecalis.
2. People with AIDS, HIV, or other immune system disorders: Weakened immune systems make it easier for bacteria like E. faecalis to take over.
3. Those with open or healing wounds: E. faecalis can exploit any openings in the body, so keep your wounds covered.
4. Those with impaired mobility: Immobility increases the chance of E. faecalis finding a comfy home to call its own.
5. People with a history of urinary tract infections (UTIs): Repeated UTIs can make you more susceptible to E. faecalis infections, especially after a root canal or having cancer treatments.
6. People on dialysis or receiving an organ transplant: These treatments leave you vulnerable to infections like E. faecalis.

In hospitals, the common use of intravascular and urinary catheters increases the chances of E. faecalis spreading due to the formation of biofilms on these devices. This is one reason why E. faecalis is a frequent cause of UTIs.

What's E. faecalis, Really?

Before 1984, E. faecalis was known as Streptococcus faecalis. Scientists later reclassified these bacteria into a separate genus, Enterococcus, to better understand and categorize them.

E. faecalis can cause infections when it enters the body through wounds, blood, or urine.

Symptoms and Complications

The symptoms of an E. faecalis infection depend on where it's lurking. Signs might include:

1. Fatigue
2. Swelling in the gums
3. Painful urination
4. Stomach cramping
5. Vomiting and nausea
6. Fever and chills
7. Headache
8. Diarrhea
9. Fast, shallow breathing (tachypnea)
10. chest pain
11. Stiffness in the neck

Doctors may diagnose conditions like bacteremia (bacteria in the blood), abdominal or pelvic infections, UTIs, oral infections post-root canal, septicemia (a.k.a. blood poisoning), infections in wounds, endocarditis (infection of the heart lining), and meningitis (infection of the brain and spinal cord) based on the location of the infection.

Antibiotic Resistance

Bacteria, including E. faecalis, can naturally resist antibiotic treatments or acquire resistance. E. faecalis can develop resistance to any antibiotic, depending on the geographical region and the antibiotics in use.

Factors that contribute to E. faecalis' antibiotic resistance include:

1. Biofilm formation: E. faecalis bonds together to form a protective biofilm that enables it to stick to surfaces like catheters.
2. Nutritional needs: E. faecalis can endure long periods without a nutritional source and use human blood as a food source.
3. Penicillin-binding proteins: These proteins make E. faecalis naturally resistant to penicillin.
4. Environmental folic acid absorption: Unlike most other bacteria, E. faecalis can absorb folic acid from its environment, rendering medications that interfere with folic acid production ineffective.

The bacteria can also tolerate a range of temperatures and acidic or alkaline environments, further complicating prevention and treatment strategies.

Treatment

Given its natural and acquired antibiotic resistance, treating E. faecalis infections can be a significant challenge for healthcare professionals. The first step is to take samples of the bacteria and test their susceptibility to various antibiotics, including ampicillin, penicillin, and vancomycin.

A single antibiotic may treat an uncomplicated infection. If no antibiotic resistance is present, ampicillin is usually the antibiotic of choice.

More severe infections may require a combination of a cell wall-active agent and an aminoglycoside to target the bacterial cell wall, restrict growth, and destroy the bacteria.

Treatment can be lengthy, lasting up to several weeks in severe cases.

Transmission

E. faecalis lives in the gastrointestinal tract and is found in fecal matter. Poor hygiene practices, like insufficiently cleaning objects and failure to wash hands after using the bathroom, can lead to the spread of E. faecalis. Everyday objects, such as phones, doorknobs, towels, and soaps, may also be contaminated with E. faecalis.

In hospitals, E. faecalis can spread due to insufficient handwashing and the use of contaminated tools like catheters and dialysis ports.

Prevention

Good hygiene practices, particularly in healthcare settings, can help prevent E. faecalis infections.

The CDC recommends:

1. Thoroughly washing hands, including the fingertips and thumbs, after using the bathroom.
2. Washing hands before eating or drinking.
3. Washing hands after contact with pets or livestock.
4. Not sharing personal hygiene items, such as soaps, washcloths, towels, and razors.
5. Regularly cleaning bathrooms, especially toilets.
6. Avoiding unclean toilets.
7. Disinfecting doorknobs, remote controls, telephones, and other commonly shared objects.
8. Frequent handwashing—especially for hospital patients, staff, and visitors.
9. Ensuring that medical professionals wash their hands before contact with IV lines, catheters, and dressings.
10. Ensuring that medical professionals wash their hands between patients.
11. Not sitting on the beds of other patients.
12. Avoiding the toilets of other patients.

For anyone taking antibiotics for an E. faecalis infection, taking probiotics may help prevent the infection from returning by promoting the growth of helpful bacteria in the gut.

1. E. faecalis, despite being generally harmless, can become a dangerous infection when it multiplies or spreads outside the gut, potentially resulting in serious health issues.
2. Approximately 160 different types of Enterococcus faecalis (E. faecalis) exist, with around 100 of them known to infect humans, and E. faecalis accounting for about 80% of these human infections.
3. Healthy individuals with typical E. faecalis populations usually have nothing to worry about, but if it colonizes other body areas, it may become life-threatening.
4. Hospital patients are at a higher risk due to the reduced immunity in hospital environments.
5. People with HIV, AIDS, or other immune system disorders are more susceptible to E. faecalis infections due to weakened immune systems.
6. Those with open or healing wounds should take extra care since E. faecalis can exploit any body openings.
7. Individuals with impaired mobility have an increased chance of E. faecalis finding a comfortable dwelling within their bodies.
8. A history of urinary tract infections (UTIs) can make a person more susceptible to E. faecalis infections, especially after a root canal or cancer treatments.
9. People on dialysis or receiving an organ transplant are vulnerable to infections like E. faecalis due to the treatments they undergo.
10. In hospitals, the common use of intravascular and urinary catheters increases the chances of E. faecalis spreading due to the formation of biofilms on these devices.
11. Before 1984, E. faecalis was known as Streptococcus faecalis, but scientists later reclassified these bacteria into a separate genus, Enterococcus, for better understanding and categorization.
12. E. faecalis can cause infections when it enters the body through wounds, blood, or urine.
13. The symptoms of an E. faecalis infection depend on its location within the body.
14. Doctors may diagnose conditions like bacteremia, abdominal or pelvic infections, UTIs, oral infections post-root canal, septicemia, infections in wounds, endocarditis, and meningitis based on the location of the infection.
15. E. faecalis can naturally resist antibiotic treatments or acquire resistance, and it can develop resistance to any antibiotic, depending on the geographical region and antibiotics in use.
16. Factors that contribute to E. faecalis' antibiotic resistance include biofilm formation, nutritional needs, penicillin-binding proteins, and environmental folic acid absorption.
17. The bacteria can also tolerate a range of temperatures and acidic or alkaline environments, further complicating prevention and treatment strategies.
18. Given its natural and acquired antibiotic resistance, treating E. faecalis infections can be challenging for healthcare professionals.
19. The first step in treating an E. faecalis infection is to take samples of the bacteria and test their susceptibility to various antibiotics.
20. A single antibiotic may treat an uncomplicated infection, with ampicillin being the usually preferred antibiotic.
21. More severe infections may require a combination of a cell wall-active agent and an aminoglycoside to target the bacterial cell wall, restrict growth, and destroy the bacteria.
22. Treatment can be lengthy, lasting up to several weeks in severe cases.
23. E. faecalis lives in the gastrointestinal tract and is found in fecal matter.
24. Proper hygiene practices, particularly in healthcare settings, can help prevent E. faecalis infections, as recommended by the CDC. These practices include frequent handwashing, regular cleaning of bathrooms, disinfecting commonly shared objects, and ensuring medical professionals wash their hands before contact with patients.

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