Enterococcus

Enterococcus is a genus of lactic acid bacteria of the phylum Firmicutes. Enterococci are Gram-positive cocci that often occur in pairs (diplococci) or short chains, and are difficult to distinguish from Streptococci on physical characteristics alone. Two species are common commensal organisms in the intestines of humans: E. faecalis (90-95%) and E. faecium (5-10%). There are rare clusters of infections with other species including E. casseliflavus, E. gallinarum, and E. raffinosus.

Physiology and classification
Enterococci are facultative anaerobic organisms, i.e., they are capable of cellular respiration in both oxygen-rich and oxygen-poor environments. Though they are not capable of forming spores, enterococci are tolerant of a wide range of environmental conditions: extreme temperature (10-45°C), pH (4.5-10.0) and high sodium chloride concentrations.

Enterococci typically exhibit gamma-hemolysis on sheep's blood agar.

History
Members of the genus Enterococcus were classified as Group D Streptococcus until 1984, when genomic DNA analysis indicated a separate genus classification would be appropriate.

Pathology
Important clinical infections caused by Enterococcus include urinary tract infections, bacteremia, bacterial endocarditis, diverticulitis, and meningitis. Sensitive strains of these bacteria can be treated with ampicillin and vancomycin.

From a medical standpoint, an important feature of this genus is the high level of intrinsic antibiotic resistance. Some enterococci are intrinsically resistant to β-lactam-based antibiotics (some penicillins and virtually all cephalosporins), as well as many aminoglycosides. In the last two decades, particularly virulent strains of Enterococcus that are resistant to vancomycin (vancomycin-resistant Enterococcus, or VRE) have emerged in nosocomial infections of hospitalized patients, especially in the US. Other developed countries, such as the UK, have been spared this epidemic, and, in 2005, Singapore managed to halt an epidemic of VRE. VRE may be treated with quinupristin/dalfopristin (Synercid) with response rates of approximately 70%.

Enterococcal meningitis is a rare complication of neurosurgery. It often requires treatment with intravenous or intrathecal vancomycin, yet it is debatable as to whether its use has any impact on outcome: the removal of any neurological devices is a crucial part of the management of these infections.

Water quality
In bodies of water, the acceptable level of contamination is very low, for example in the state of Hawaii, with among the strictest tolerances in the United States, the limit for water off its beaches is 7 colony-forming units per 100 ml of water, above which the state may post warnings to stay out of the ocean. In 2004, Enterococcus spp. took the place of fecal coliform as the new federal standard for water quality at public beaches. It is believed to provide a higher correlation than fecal coliform with many of the human pathogens often found in city sewage.