Effects of Enterococcus faecium in pregnant, in sperm, and wound

What is Enterococcus faecium?
Definition
Enterococcus faecium is a Gram-positive, alpha-hemolytic, or non-hemolytic bacterium in the genus Enterococcus. It can be commensal (innocuous, coexisting organism) in the gastrointestinal tract of humans and animals, but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.

Enterococci are a type of bacteria that lives in your GI tract. There are at least 18 different species of these bacteria. Enterococcus faecalis (E. faecalis) is one of the most common species. These bacteria also live in the mouth and vagina. They are very resilient, so they can survive in hot, salty, or acidic environments.

Enterococci, leading causes of nosocomial bacteremia, surgical wound infection, and urinary tract infection are becoming resistant to many and sometimes all standard therapies. Most enterococcal infections are caused by Enterococcus faecalis and more likely to retain sensitivity to at least one effective antibiotic. The remaining infections are mostly caused by E. faecium, a species virtually devoid of known overt pathogenic traits but more likely to be resistant to even antibiotics of last resort.

Signs and symptoms
E. faecalis normally lives harmlessly in your intestines. However, if it spreads to other parts of your body it can cause a more serious infection. The bacteria can get into your blood, urine, or a wound during surgery. From there, it can spread to different sites causing more serious infections, including sepsis, endocarditis, and meningitis.

E. faecalis bacteria don’t usually cause problems in healthy people. But people with underlying health conditions or a weakened immune system are more likely to get sick. These infections often spread in hospitals.

Signs and symptoms depend on which type of infection you have. They can include:
fever
chills
fatigue
headache
abdominal pain
pain or burning when you urinate
nausea
vomiting
diarrhea
fast breathing or shortness of breath
chest pain when you breathe
stiff neck
swollen, red, tender, or bleeding gums

Characteristics
Synonym or Cross-reference:
Nonhemolytic streptococci, gamma hemolytic streptococci, enterococcus, group D streptococci, vancomycin-resistant enterococcus (VRE). Formerly known as Streptococcus faecalis and Streptococcus faecium.

Enterococcus spp. are facultatively anaerobic, catalase-negative Gram-positive cocci, arranged individually, in pairs, or short chains. The optimal temperature for growth of E. faecalis and E. faecium is 35°C. E. faecalis and E. faecium are normal inhabitants of the intestinal tract, female genital tract, and (less commonly) oral cavity.

Causes
E. faecalis infections spread from person to person through poor hygiene. Because these bacteria are found in feces, people can transmit the infection if they don’t wash their hands after using the bathroom. From there, they can pass to other people.
E. faecalis often spread through hospitals. The bacteria can spread thru improperly cleaned catheters, dialysis ports, and other medical devices. Thus, people who have an organ transplant, kidney dialysis, or cancer treatment are at increased risk for developing infections due to immune suppression or contamination through their catheters.

Is Enterococcus faecium harmful or helpful?
This ‘multitasking’ strain is commonly found in human probiotic supplements. E. faecium has long been recognized for its probiotic benefits and is widely used around the world. One of the major benefits of E. faecium is that it is uniquely suited to survive the digestive process and flourish in the gut. It promotes a balanced gut environment by competing for resources that harmful organisms would otherwise consume and use to grow. It also competes with harmful organisms for adhesion sites – areas on the surface of cells to which other cells and molecules can bind.

However, some strains of E. faecium may be pathogenic and harmful to humans and can cause bacteremia, endocarditis, urinary tract, and other infections.

Mode of transmission
Nosocomial and person-to-person transmission; can also be transmitted on food products

Is Enterococcus faecalis fatal?
E. faecalis contributes to several infections in people, some of which can be life-threatening. The bacteria may cause:
bacteremia (the presence of bacteria in the blood)
abdominal and pelvic infections
urinary tract infections
oral infections (particularly with root canals)
septicemia, or blood poisoning
wound infections
endocarditis (an infection of the lining of the heart)
enterococcal meningitis (an uncommon form of meningitis)

Treatment
E. faecalis infections are treated with antibiotics. One challenge is that these bacteria have become resistant to many types of antibiotics. This means that some antibiotics no longer work against these bacteria.
Ampicillin is the preferred antibiotic used to treat E. faecalis infections. However, there are other antibiotic options included such as:
Daptomycin
Gentamicin
Linezolid
Nitrofurantoin
Streptomycin
Tigecycline
Vancomycin

E. faecalis is sometimes also resistant to vancomycin. Strains that don’t respond to vancomycin are called vancomycin-resistant enterococcus, or VRE. In this case, linezolid or daptomycin are treatment options.

More severe infections, such as endocarditis or meningitis, are treated with a combination of antibiotics. Doctors often combine two different antibiotic classes like ampicillin or vancomycin plus gentamicin or streptomycin.

Are Enterococcus faecalis and Enterococcus faecium the same?
Two species are common commensal organisms in the intestines of humans are E. faecalis (90–95%) and E. faecium (5–10%).

Enterococcus faecalis – formerly classified as part of the group D Streptococcus system – is a Gram-positive, commensal bacterium inhabiting the gastrointestinal tracts of humans and other mammals. Like other species in the genus Enterococcus, E. faecalis is found in healthy humans but can cause life-threatening infections, especially in the nosocomial (hospital) environment, where the naturally high levels of antibiotic resistance found in E. faecalis contribute to its pathogenicity. Re-infected root canal-treated teeth are about nine times more likely to harbor E. faecalis than cases of primary infections.

Enterococcus faecium is a Gram-positive, alpha-hemolytic, or non-hemolytic bacterium in the genus Enterococcus. It can be commensal (innocuous, coexisting organism) in the gastrointestinal tract of humans and animals, but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.

Is Enterococcus faecalis as probiotics safe?
To date, the genus Enterococcus has not yet obtained the status generally recognized as safe (GRAS), but some members are used as probiotics and in the production of feed additives to prevent diarrhea or to improve growth in animals.

Clinical characteristics and risks of Enterococcus faecium

In wound
Enterococcus faecalis is one of the most frequently isolated bacterial species in wounds yet little is known about its pathogenic mechanisms in this setting. Using a mouse wound excisional model, these results comprehensively describe E. faecalis wound infection determinants, and suggest that both immune modulation and resistance contribute to persistent, non healing wounds.

In sperm
The findings confirmed that the bacterial contamination of semen samples of fertile individuals did not compromise the sperm quality, while in infertile men, it is possible that bacteria further deteriorated the whole quality of the seminal plasma.

In pregnant
Pregnant mothers are susceptible to bacterial infections, which may compromise the health of mothers and offspring. Enterococcus faecalis is a ubiquitous species found in common places where pregnant women frequently become exposed to this bacterium.
Orally administered E. faecalis were found to survive and disseminate to all regions of the intestinal tract. It also altered the bacterial community structure which may contribute to the bacterial translocation into the blood, spleen, placenta, and fetus. This may affect fetal and placental growth and development.

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