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Chapter: Medical Microbiology: An Introduction to Infectious Diseases: Streptococci and Enterococci

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Entero Coccal Disease

Enterococci cause infection almost exclusively in hospitalized patients with significant compromise of their defenses.

ENTERO COCCAL DISEASE

Enterococci cause infection almost exclusively in hospitalized patients with significant compromise of their defenses. The primary sites are the urinary tract and soft tissue sites adjacent to the intestinal flora where enterococcal species are resident The infections themselves are often low grade and have no unique clinical features.

EPIDEMIOLOGY

Enterococci are part of the normal intestinal flora. Although they are capable of produc-ing disease in many settings, the hospital environment is where a substantial increase has occurred in the last two decades. Patients with extensive abdominal surgery, indwelling devices, or who are undergoing procedures such as peritoneal dialysis are at greatest risk. Most infections are acquired from the endogenous flora but spread between patients has been documented. From 10 to 15% of all nosocomial urinary tract, intra-abdominal, and bloodstream infections are due to enterococci.

PATHOGENESIS

Enterococci are a significant cause of disease in specialized hospital settings, but they are not highly virulent. On their own, they do not produce fulminant disease and in wound and soft tissue infections are usually mixed with other members of the intestinal flora. Some have even doubted their significance when isolated with more virulent members of the En-terobacteriaceae  or Bacteroides fragilis . Although some surface proteins are candidate adhesins, no virulence factors have been discovered.

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