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Current criteria for inclusion in the genus and for the description of new enterococcal species encompass a polyphasic approach resulting from a combination of different molecular techniques (frequently involving DNA-DNA reassociation experiments, 16S rRNA gene sequencing, and whole-cell protein profiling analysis) and phenotypic tests. Several other molecular methods, mostly nucleic acid-based assays, have been used as additional tools to assess the phylogenetic relationships among enterococcal species and to formulate the description of new species, but their use is still limited. Positive catalase testing has also been reported for strains of and when cultivated on blood-containing agar media. Phenotypic characteristics are used for the identification of species and some physiologically related species of other gram-positive cocci. Serologic tests for detecting antibody responses to different enterococcal antigens have been proposed. In addition to the intrinsic resistance traits, enterococci have acquired different genetic determinants that confer resistance to several classes of antimicrobial agents, including chloramphenicol, tetracyclines, macrolides, lincosamides and streptogramins, aminoglycosides, β-lactams, glycopeptides, quinolones, and even some of the more recently available drugs, such as linezolid, daptomycin, and quinupristin-dalfopristin. Antimicrobial resistance can be classified as either intrinsic or acquired. Molecular methods have been used to detect specific antimicrobial resistance genes and have substantially contributed to the understanding of the spread of acquired resistance among enterococci, especially resistance to vancomycin. However, because of their high specificity, molecular methods do not detect antimicrobial resistance due to mechanisms not targeted by the testing, including emerging resistance mechanisms.

Citation: Teixeira L, Carvalho M, Shewmaker P, Facklam R. 2011. , p 350-364. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch21

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LightCycler SeptiFast Test
Multiplex Real-Time PCR
Gram-Positive Cocci
Enterococcus faecium
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Phylogenetic tree based on comparative analysis of the 16S rDNA sequences, showing the relationships among the type strains of species of . was used as an outgroup, and bootstrap values at the nodes are displayed as percentages.

Citation: Teixeira L, Carvalho M, Shewmaker P, Facklam R. 2011. , p 350-364. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch21
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1. Alam, M. R.,, S. Donabedian,, W. Brown,, J. Gordon,, J. W. Chow,, M. J. Zervos,, and E. Hershberger. 2001. Heteroresistance to vancomycin in Enterococcus faecium. J. Clin. Microbiol. 39:33793381.
2. Baldassarri, L.,, R. Creti,, L. Montanaro,, G. Orefici,, and C. R. Arciola. 2005. Pathogenesis of implant infections by enterococci. Int. J. Artif. Organs 28:11011109.
3. Ballard, S. A.,, F. A. Grabsch,, P. D. R. Johnson,, and M. L. Grayson. 2006. Comparison of three PCR primer sets for identification of vanB gene carriage in feces and correlation with carriage of vancomycin-resistant enterococci: interference by vanB-containing anaerobic bacilli. Antimicrob. Agents Chemother. 49:7781.
4. Bearman, G. M. L.,, and R. P. Wenzel. 2005. Bacteraemias: a leading cause of death. Arch. Med. Res. 36:646659.
5. Bourgogne, A.,, D. A. Garsin,, X. Qin,, K. V. Singh,, J. Sillanpaa,, S. Yerrapragada,, Y. Ding,, S. Dugan-Rocha,, C. Buhay,, H. Shen,, G. Chen,, G. Williams,, D. Muzny,, A. Maadani,, K. A. Fox,, J. Gioia,, L. Chen,, Y. Shang,, C. A. Arias,, S. R. Nallapareddy,, M. Zhao,, V. P. Prakash,, S. Chowdhury,, H. Jiang,, R. A. Gibbs,, B. E. Murray,, S. K. Highlander,, and G. M. Weinstock. 2008. Large scale variation in Enterococcus faecalis illustrated by the genome analysis of strain OG1RF. Genome Biol. 9:R110.
6. Boyd, D. A.,, B. M. Willey,, D. Fawcett,, N. Gillani,, and M. R. Mulvey. 2008. Molecular characterization of Enterococcus faecalis N06-0364 with low-level vancomycin resistance harboring a novel D-Ala-D-Ser gene cluster, vanL. Antimicrob. Agents Chemother. 52:26672672.
7. Brigante, G.,, F. Luzzaro,, A. Bettaccini,, G. Lombarda,, F. Meacci,, B. Pini,, S. Stefani,, and A. Toniolo. 2006. Use of the Phoenix automated system for identification of Streptococcus and Enterococcus spp. J. Clin. Microbiol. 44:32633267.
8. Buschelman, B. J.,, M. J. Bale,, and R. N. Jones. 1993. Species identification and determination of high-level aminoglycoside resistance among enterococci. Comparison study of sterile body fluid isolates, 1985-1991. Diagn. Microbiol. Infect. Dis. 16:119122.
9. Carvalho, M. G.,, A. G. Steigerwalt,, R. E. Morey,, P. L. Shewmaker,, E. Falsen,, R. R. Facklam,, and L. M. Teixeira. 2008. Designation of the provisional new Enterococcus species CDC PNS-E2 as Enterococcus sanguinicola sp. nov., isolated from human blood, and identification of a strain previously named Enterococcus CDC PNS-E1 as Enterococcus italicus Fortina, Ricci, Mora, and Manachini 2004. J. Clin. Microbiol. 46:34733476.
10. Carvalho, M. G. S.,, A. G. Steigerwalt,, R. E. Morey,, P. L. Shewmaker,, L. M. Teixeira,, and R. R. Facklam. 2004. Characterization of three new enterococcal species, Enterococcus sp. nov. CDC PNS-E1, Enterococcus sp. nov. CDC PNS-E2, and Enterococcus sp. nov. CDC PNS-E3, isolated from human clinical specimens. J. Clin. Microbiol. 42:11921198.
11. Casalta, J. P.,, F. Gouriet,, V. Roux,, F. Thuny,, G. Habib,, and D. Raoult. 2009. Evaluation of the LightCycler® Septi- Fast test in the rapid etiologic diagnostic of infectious endocarditis. Eur. J. Clin. Microbiol. Infect. Dis. 28:569573.
12.Centers for Disease Control and Prevention. 1993. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR Morb. Mortal. Wkly. Rep. 42:597599.
13. Cetinkaya, Y.,, P. Falk,, and C. G. Mayhall. 2000. Vancomycinresistant enterococci. Clin. Microbiol. Rev. 13:686707.
14. Chang, J. C.,, M. L. Chien,, H. M. Chen,, J. J. Yan,, and J. J. Wu. 2008. Comparison of CPS ID 3 and CHROMagar Orientation chromogenic agars with standard biplate technique for culture of clinical urine samples. J. Microbiol. Immunol. Infect. 41:422427.
15. Cho, Y. S.,, H. S. Lee,, J. M. Kim,, M. H. Lee,, H. S. Yoo,, Y. H. Park,, and P. D. Ryu. 2008. Immunogenic proteins in the cell envelope and cytoplasm of vancomycin-resistant enterococci. J. Immunoassay Immunochem. 29:319331.
16. Clark, N. C.,, L. M. Teixeira,, R. R. Facklam,, and F. C. Tenover. 1998. Detection and differentiation of the vanC-1, vanC-2, and vanC-3 glycopeptide resistance genes in enterococci. J. Clin. Microbiol. 36:22942297.
17.Clinical and Laboratory Standards Institute. 2010. Performance Standards for Antimicrobial Susceptibility: Twentieth Informational Supplement. CLSI document M100-S20. Clinical and Laboratory Standards Institute, Wayne, PA.
18. Collins, M. D.,, D. Jones,, J. A. E. Farrow,, R. Kilpper-Balz,, and K. H. Schleifer. 1984. Enterococcus avium nom. rev., comb. nov.; E. casseliflavus nom. rev., comb. nov.; E. durans nom. rev., comb. nov.; E. gallinarum comb. nov.; and E. malodoratus sp. nov. Int. J. Syst. Bacteriol. 34:220223.
19. Contreras, G. A.,, C. A. DiazGranados,, L. Cortes,, J. Reyes,, S. Vanegas,, D. Panesso,, S. Rincón,, L. Díaz,, G. Prada,, B. E. Murray,, and C. A. Arias. 2008. Nosocomial outbreak of Enteroccocus gallinarum: untaming of rare species of enterococci. J. Hosp. Infect. 70:346352.
20. Courvalin, P. 2006. Vancomycin resistance in gram-positive cocci. Clin. Infect. Dis. 42:S25S34.
21. Cuzon, G.,, T. Naas,, N. Fortineau,, and P. Nordmann. 2008. Novel chromogenic medium for detection of vancomycinresistant Enterococcus faecium and Enterococcus faecalis. J. Clin. Microbiol. 46:24422444.
22. d’Azevedo, P. A.,, C. A. G. Dias,, A. L. S. Goncalves,, F. Rowe,, and L. M. Teixeira. 2001. Evaluation of an automated system for the identification and antimicrobial susceptibility testing of enterococci. Diagn. Microbiol. Infect. Dis. 42:157161.
23. Delmas, J.,, F. Robin,, C. Schweitzer,, O. Lesens,, and R. Bonnet. 2007. Evaluation of a new chromogenic medium, chromID VRE, for detection of vancomycin-resistant enterococci in stool samples and rectal swabs. J. Clin. Microbiol. 45:27312733.
24. Depardieu, F.,, B. Perichon,, and P. Courvalin. 2004. Detection of the van alphabet and identification of enterococci and staphylococci at the species level by multiplex PCR. J. Clin. Microbiol. 42:58575860.
25. Devriese, L.,, M. Baele,, and P. Butaye,. 2006. The genus Enterococcus: taxonomy, p. 163174. In M. Dworkin,, S. Falkow,, E. Rosenberg,, K.-H. Schleifer,, and E. Stackebrandt (ed.), The Prokaryotes: a Handbook on the Biology of Bacteria, 3rd ed., vol 4. Springer, New York, NY.
26. Domig, K. J.,, H. K. Mayer,, and W. Kneifel. 2003. Methods used for the isolation, enumeration, characterisation and identification of Enterococcus spp. 1. Media for isolation and enumeration. Int. J. Food Microbiol. 88:147164.
27. Domig, K. J.,, H. K. Mayer,, and W. Kneifel. 2003. Methods used for the isolation, enumeration, characterisation and identification of Enterococcus spp. 2. Pheno- and genotypic criteria. Int. J. Food Microbiol. 88:165188.
28. Donelli, G.,, and E. Guaglianone. 2004. Emerging role of Enterococcus spp in catheter-related infections: biofilm formation and novel mechanisms of antibiotic resistance. J. Vasc. Access 5:39.
29. Drews, S. J.,, G. Johnson,, F. Gharabaghi,, M. Roscoe,, A. Matlow,, R. Tellier,, and S. E. Richardson. 2006. A 24-hour screening protocol for identification of vancomycin-resistant Enterococcus faecium. J. Clin. Microbiol. 44:15781580.
30. Euzéby, J. P. 1997. List of bacterial names with standing in nomenclature: a folder available on the internet. Int. J. Syst. Bacteriol. 47:590592. (List of Prokaryotic Names with Standing in Nomenclature. [Online.] http://www.bacterio.cict.fr. Last full update 5 August 2010.)
31. Facklam, R. R.,, M. G. S. Carvalho,, and L. M. Teixeira,. 2002. History, taxonomy, biochemical characteristics, and antibiotic susceptibility testing of enterococci, p. 154. In M. S. Gilmore,, D. B. Clewell,, P. Courvalin,, G. M. Dunny,, B. E. Murray,, and L. B. Rice (ed.), The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance. ASM Press, Washington, DC.
32. Facklam, R. R.,, and M. D. Collins. 1989. Identification of Enterococcus species isolated from human infections by a conventional test scheme. J. Clin. Microbiol. 27:731734.
33. Facklam, R. R.,, and J. A. Elliott. 1995. Identification, classification, and clinical relevance of catalase-negative, grampositive cocci, excluding the streptococci and enterococci. Clin. Microbiol. Rev. 8:479495.
34. Forrest, G. N.,, M. C. Roghmann,, L. S. Toombs,, J. K. Johnson,, E. Weekes,, D. P. Lincalis,, and R. A. Venezia. 2008. Peptide nucleic acid fluorescent in situ hybridization for hospital-acquired enterococcal bacteremia: delivering earlier effective antimicrobial therapy. Antimicrob. Agents Chemother. 52:35583563.
35. Fortina, M. G.,, G. Ricci,, D. Mora,, and P. L. Manachini. 2004. Molecular analysis of artisanal Italian cheeses reveals Enterococcus italicus sp. nov. Int. J. Syst. Evol. Microbiol. 54:17171721.
36. Franz, C. M.,, M. E. Stiles,, K. H. Schleifer,, and W. H. Holzapfel. 2003. Enterococci in foods—a conundrum for food safety. Int. J. Food Microbiol. 88:105122.
37. Freitas, A. R.,, C. Novais,, P. Ruiz-Garbajosa,, T. M. Coque,, and L. Peixe. 2009. Clonal expansion within clonal complex 2 and spread of vancomycin-resistant plasmids among different genetic lineages of Enterococcus faecalis from Portugal. J. Antimicrob. Chemother. 63:11041111.
38. Garcia-Garrote, F.,, E. Cercenado,, and E. Bouza. 2000. Evaluation of a new system, VITEK 2, for identification and antimicrobial susceptibility testing of enterococci. J. Clin. Microbiol. 38:21082111.
39. Gescher, D. M.,, D. Kovaecevic,, D. Schmiedel,, S. Siemoneit,, C. Mallmann,, E. Halle,, U. B. Gobel,, and A. Moter. 2008. Fluorescence in situ hybridisation (FISH) accelerates identification of Gram-positive cocci in positive blood cultures. Int. J. Antimicrob. Agents 32(Suppl.):S51S59.
40. Gordon, S.,, J. S. Swenson,, B. C. Hill,, N. E. Pigott,, R. R. Facklam,, R. C. Cooksey,, C. Thornsberry,, the Enterococcal Study Group, W. R. Jarvis,, and F. C. Tenover. 1992. Antimicrobial susceptibility patterns of common and unusual species of enterococci causing infections in the United States. J. Clin. Microbiol. 30:23732378.
41. Grabsch, E. A.,, S. Ghaly-Derias,, W. Gao,, and B. P. Howden. 2008. Comparative study of selective chromogenic (chromID VRE) and bile esculin agars for isolation and identification of vanB-containing vancomycin-resistant enterococci from feces and rectal swabs. J. Clin. Microbiol. 46:40344036.
42. Hidron, A. I.,, J. R. Edwards,, J. Patel,, T. C. Horan,, D. M. Sievert,, D. A. Pollock,, and S. K. Fridkin for the National Healthcare Safety Network Team and Participating National Healthcare Safety Network Facilities. 2008. Antimicrobial-resistant pathogens associated with healthcare- associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect. Control Hosp. Epidemiol. 29:9961011.
43. Homan, W. L.,, D. Tribe,, S. Poznanski,, M. Li,, G. Hogg,, E. Spalburg,, J. D. Van Embden,, and R. J. Willems. 2002. Multilocus sequence typing scheme for Enterococcus faecium. J. Clin. Microbiol. 40:19631971.
44.Hospital Infection Control Practices Advisory Committee. 1995. Recommendations for preventing the spread of vancomycin resistance. Infect. Control Hosp. Epidemiol. 16:105113.
45. Huckabee, C. M.,, W. C. Huskins,, and P. R. Murray. 2009. Predicting clearance of colonization with vancomycinresistant enterococci and methicillin-resistant Staphylococcus aureus by use of weekly surveillance cultures. J. Clin. Microbiol. 47:12291230.
46. Huycke, M. M., 2002. Physiology of enterococci, p. 133175. In M. S. Gilmore,, D. B. Clewell,, P. Courvalin,, G. M. Dunny,, B. E. Murray,, and L. B. Rice (ed.), The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance. ASM Press, Washington, DC.
47. Huycke, M. M.,, D. F. Sahm,, and M. S. Gilmore. 1998. Multiple-resistant enterococci: the nature of the problem and an agenda for the future. Emerg. Infect. Dis. 4:239249.
48. Ieven, M.,, E. Vercauteren,, P. Descheemacker,, F. van Laer,, and H. Goossens. 1999. Comparison of direct plating and broth enrichment culture for detection of intestinal colonization by glycopeptide-resistant enterococci among hospitalized patients. J. Clin. Microbiol. 37:14361440.
49. Iwen, P. C.,, D. M. Kelly,, J. Linder,, S. H. Hinrichs,, E. A. Dominguez,, M. E. Rupp,, and K. D. Patil. 1997. Change in prevalence and antibiotic resistance of Enterococcus species isolated from blood cultures over an 8-year period. Antimicrob. Agents Chemother. 41:494495.
50. Jackson, C. R.,, P. J. Fedorka-Cray,, and J. B. Barrett. 2004. Use of a genus- and species-specific multiplex PCR for identification of enterococci. J. Clin. Microbiol. 42:35583565.
51. Kak, V.,, and J. W. Chow,. 2002. Acquired antibiotic resistances in enterococci, p. 355383. In M. S. Gilmore,, D. B. Clewell,, P. Courvalin,, G. M. Dunny,, B. E. Murray,, and L. B. Rice (ed.), The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance. ASM Press, Washington, DC.
52. Kaplan, A. H.,, P. H. Gilligan,, and R. R. Facklam. 1988. Recovery of resistant enterococci during vancomycin prophylaxis. J. Clin. Microbiol. 26:12161218.
53. Karlowsky, J. A.,, M. E. Jones,, D. C. Draghi,, C. Thornsberry,, D. F. Sahm,, and G. A. Volturo. 2004. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Ann. Clin. Microbiol. Antimicrob. 10:37.
54. Kawalec, M.,, M. Gniadkowski,, and W. Hryniewicz. 2000. Outbreak of vancomycin-resistant enterococci in a hospital in Gdansk, Poland, due to horizontal transfer of different Tn1546-like transposon variants and clonal spread of several strains. J. Clin. Microbiol. 38:33173322.
55. Kawalec, M.,, J. Kedzierska,, A. Gajda,, E. Sadowy,, J. Wegrzyn,, S. Naser,, A. B. Skotnicki,, M. Gniadkowski,, and W. Hryniewicz. 2007. Hospital outbreak of vancomycinresistant enterococci caused by a single clone of Enterococcus raffinosus and several clones of Enterococcus faecium. Clin. Microbiol. Infect. 13:893901.
56. Kramer, A.,, I. Schwebke,, and G. Kampf. 2006. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect. Dis. 6:130137.
57. Leavis, H. L.,, M. J. Bonten,, and R. J. Willems. 2006. Identification of high-risk enterococcal clonal complexes: global dispersion and antibiotic resistance. Curr. Opin. Microbiol. 9:454460.
58. Leclercq, R.,, E. Derlot,. J. Duval, and P. Courvalin. 1988. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N. Engl. J. Med. 319:157161.
59. Ledeboer, N. A.,, R. J. Tibbetts,, and W. M. Dunne. 2007. A new chromogenic agar medium, chromID VRE, to screen for vancomycin-resistant Enterococcus faecium and Enterococcus faecalis. Diagn. Microbiol. Infect. Dis. 59:477479.
60. Linden, P. K. 2007. Optimizing therapy for vancomycinresistant enterococci (VRE). Semin. Respir. Crit. Care Med. 28:632645.
61. Lindholm, L.,, and H. Sarkkinen. 2004. Direct identification of gram-positive cocci from routine blood cultures by using AccuProbe tests. J. Clin. Microbiol. 42:56095613.
62. Malani, P. N.,, C. A. Kauffman,, and M. J. Zervos,. 2002. Enterococcal disease, epidemiology, and treatment, p. 385408. In M. S. Gilmore,, D. B. Clewell,, P. Courvalin,, G. M. Dunny,, B. E. Murray,, and L. B. Rice (ed.), The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance. ASM Press, Washington, DC.
63. Malhotra-Kumar, S.,, K. Haccuria,, M. Michiels,, M. Ieven,, C. Poyart,, W. Hryniewicz, and, H. Goossens on behalf of the MOSAR WP2 Study Team. 2008. Current trends in rapid diagnostics for methicillin-resistant Staphylococcus aureus and glycopeptide-resistant Enterococcus species. J. Clin. Microbiol. 46:15771587.
64. McBride, S. M.,, V. A. Fischetti,, D. J. Leblanc,, R. C. Moellering, Jr.,, and M. S. Gilmore. 2007. Genetic diversity among Enterococcus faecalis. PLoS ONE 2:e582.
65. McKessar, S. J.,, A. M. Berry,, J. M. Bell,, J. D. Turnidge,, and J. C. Paton. 2000. Genetic characterization of vanG, a novel vancomycin resistance locus of Enterococcus faecalis, Antimicrob. Agents Chemother. 44:32243228.
66. Merlino, J.,, S. Siarakas,, G. J. Robertson,, G. R. Funnell,, T. Gottieb,, and R. Bradbury. 1996. Evaluation of CHROMagar Orientation for differentiation and presumptive identification of gram-negative bacilli and Enterococcus species. J. Clin. Microbiol. 34:17881793.
67. Merquior, V. L.,, F. P. G. Neves,, R. I. Ribeiro,, R. S. Duarte,, E. A. Marques,, and L. M. Teixeira. 2008. Bacteraemia associated with a vancomycin-resistant Enterococcus gallinarum strain harboring both the vanA and vanC1 genes. J. Med. Microbiol. 57:244245.
68. Merquior, V. L. C.,, J. M. Peralta,, R. R. Facklam,, and L. M. Teixeira. 1994. Analysis of electrophoretic whole-cell protein profiles as a tool for characterization of Enterococcus species. Curr. Microbiol. 28:149153.
69. Moellering, R. C., Jr. 1992. Emergence of Enterococcus as a significant pathogen. Clin. Infect. Dis. 14:11731178.
70. Mondino, S. S. B.,, A. C. D. Castro,, P. J. J. Mondino,, M. G. S. Carvalho,, K. M. F. Silva,, and L. M. Teixeira. 2003. Phenotypic and genotypic characterization of clinical and intestinal enterococci isolated from inpatients and outpatients in two Brazilian hospitals. Microb. Drug Resist. 9:167174.
71. Murray, B. E. 1990. The life and times of the Enterococcus. Clin. Microbiol. Rev. 3:4665.
72. Murray, B. E.,, K. V. Singh,, J. D. Heath,, B. R. Sharma,, and G. M. Weinstock. 1990. Comparison of genomic DNAs of different enterococcal isolates using restriction endonucleases with infrequent recognition sites. J. Clin. Microbiol. 28:20592063.
73.National Nosocomial Infections Surveillance System. 2000. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992-April 2000, issued June 2000. Am. J. Infect. Control 28:429448.
74.National Nosocomial Infections Surveillance System. 2004. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am. J. Infect. Control 32:470485.
75. Nauschuetz, W. F.,, S. B. Trevino,, L. S. Harrison,, R. N. Longfield,, L. Fletcher,, and W. G. Wortham. 1993. Enterococcus casseliflavus as an agent of nosocomial bloodstream infections. Med. Microbiol. Lett. 2:102108.
76. Neves, F. P.,, R. I. Ribeiro,, R. S. Duarte,, L. M. Teixeira,, and V. L. Merquior. 2009. Emergence of the vanA genotype among Enterococcus gallinarum isolates colonising the intestinal tract of patients in a university hospital in Rio de Janeiro, Brazil. Int. J. Antimicrob. Agents 33:211215.
77. Novicki, T. J.,, J. M. Schapiro,, B. K. Ulness,, A. Sebeste,, L. Busse-Johnston,, K. M. Swanson,, S. R. Swanzy,, W. Leisenring,, and A. P. Limaye. 2004. Convenient selective differential broth for isolation of vancomycin-resistant Enterococcus from fecal material. J. Clin. Microbiol. 42:16371640.
78. Oana, K.,, Y. Okimura,, Y. Kawakami,, N. Hayashida,, M. Shimosaka,, M. Okazaki,, T. Hayashi,, and M. Ohnishi. 2002. Physical and genetic map of Enterococcus faecium ATCC19434 and demonstration of intra- and interspecific genomic diversity in enterococci. FEMS Microbiol. Lett. 207:133139.
79. Palladino, S.,, I. D. Kay,, J. P. Flexman,, I. Boehm,, A. M. G. Costa,, E. J. Lambert,, and K. J. Christiansen. 2003. Rapid detection of vanA and vanB genes directly from clinical specimens and enrichment broths by real-time multiplex PCR assay. J. Clin. Microbiol. 41:24832486.
80. Paulsen, I. T.,, L. Banerjei,, G. S. Myers,, K. E. Nelson,, R. Seshadri,, T. D. Read,, D. E. Fouts,, J. A. Eisen,, S. R. Gill,, J. F. Heidelberg,, H. Tettelin,, R. J. Dodson,, L. Umayam,, L. Brinkac,, M. Beanan,, S. Daugherty,, R. T. DeBoy,, S. Durkin,, J. Kolonay,, R. Madupu,, W. Nelson,, J. Vamathevan,, B. Tran,, J. Upton,, T. Hansen,, J. Shetty,, H. Khouri,, T. Utterback,, D. Radune,, K. A. Ketchum,, B. A. Dougherty,, and C. M. Fraser. 2003. Role of mobile DNA in the evolution of vancomycinresistant Enterococcus faecalis. Science 299:20712074.
81. Pendle, S.,, P. Jelfs,, T. Olma,, Y. Su,, N. Gilroy,, and G. L. Gilbert. 2008. Difficulties in detection and identification of Enterococcus faecium with low-level inducible resistance to vancomycin, during a hospital outbreak. Clin. Microbiol. Infect. 14:853857.
82. Peters, R. P.,, M. A. van Agtmael,, S. Gierveld,, S. A. Danner,, A. B. Groeneveld,, C. M. Vandenbroucke-Grauls,, and P. H. Savelkoul. 2007. Quantitative detection of Staphylococcus aureus and Enterococcus faecalis DNA in blood to diagnose bacteremia in patients in the intensive care unit. J. Clin. Microbiol. 45:36413646.
83. Pillar, C. M.,, and M. S. Gilmore. 2004. Enterococcal virulence-pathogenicity island of E. faecalis. Front. Biosci. 9:23352346.
84. Richards, M. J.,, J. R. Edwards,, D. H. Culver,, and R. P. Gaynes. 2000. Nosocomial infections in combined medicalsurgical intensive care units in the United States. Infect. Control Hosp. Epidemiol. 21:510515.
85. Ruiz-Garbajosa, P.,, M. J. M. Bonten,, D. A. Robinson,, J. Top,, S. R. Nallapareddy,, C. Torres,, T. M. C. Coque,, R. Canton,, F. Baquero,, B. E. Murray,, R. del Campo,, and R. J. Willems. 2006. A multilocus sequence typing scheme for Enterococcus faecalis reveals hospital-adapted genetic complexes in a background of high rates of recombination. J. Clin. Microbiol. 44:22202228.
86. Satake, S.,, N. Clark,, D. Rimland,, F. S. Nolte,, and F. C. Tenover. 1997. Detection of vancomycin-resistant enterococci in fecal samples by PCR. J. Clin. Microbiol. 35:23252330.
87. Schleifer, K. H.,, and R. Kilpper-Balz. 1984. Transfer of Streptococcus faecalis and Streptococcus faecium to the genus Enterococcus nom. rev. as Enterococcus faecalis comb. nov. and Enterococcus faecium comb. nov. Int. J. Syst. Bacteriol. 34:3134.
88. Shankar, N.,, A. S. Baghdayan,, and M. S. Gilmore. 2002. Modulation of virulence within a pathogenicity island in vancomycin resistant Enterococcus faecalis. Nature 417:746750.
89. Singh, K. V.,, and B. E. Murray. 1994. Revised estimates of enterococcal chromosomal sizes. DNA Cell Biol. 13: 11451146.
90. Sloan, L. M.,, J. R. Uhl,, E. A. Better,, C. D. Schleck,, W. W. Harmsen,, J. Manahan,, R. L. Thompson,, J. E. Rosenblatt,, and F. R. Cockerill III. 2004. Comparison of the Roche LightCycler vanA/vanB detection assay and culture for detection of vancomycin-resistant enterococci from perianal swabs. J. Clin. Microbiol. 42:26362643.
91. Solheim, M.,, A. Aakra,, L. G. Snipen,, D. A. Brede,, and I. F. Nes. 2009. Comparative genomics of Enterococcus faecalis from healthy Norwegian infants. BMC Genomics 10:194.
92. Stamper, P. D.,, M. Cai,, C. Lema,, K. Eskey,, and K. C. Carroll. 2007. Comparison of the BD GeneOhm VanR assay to culture for identification of vancomycin-resistant enterococci in rectal and stool specimens. J. Clin. Microbiol. 45:33603365.
93. Sulaiman, A.,, R. M. Rakita,, R. C. Arduino,, J. E. Patterson,, J. M. Steckelberg,, K. V. Singh,, and B. E. Murray. 1996. Serological investigation of enterococcal infections using western blot. Eur. J. Clin. Microbiol. Infect. Dis. 15:826829.
94. Švec, P.,, L. A. Devriese,, I. Sedlacek,, M. Baele,, M. Vancanneyt,, F. Haesbrouck,, J. Swings,, and J. Doskar. 2001. Enterococcus haemoperoxidus sp. nov. and Enterococcus moraviensis sp. nov., isolated from water. Int. J. Syst. Evol. Microbiol. 51:15671574.
95. Švec, P.,, M. Vancanneyt,, I. Sedlácek,, S. M. Naser,, C. Snauwaert,, K. Lefebvre,, B. Hoste,, and J. Swings. 2006. Enterococcus silesiacus sp. nov. and Enterococcus termitis sp. nov. Int. J. Syst. Evol. Microbiol. 56:577581.
96. Tambyah, P. A.,, J. A. Marx,, and D. G. Maki. 2004. Nosocomial infection with vancomycin-dependent enterococci. Emerg. Infect. Dis. 10:12771281.
97. Tannock, G. W.,, and G. Cook,. 2002. Enterococci as members of the intestinal microflora of humans, p. 101132. In M. S. Gilmore,, D. B. Clewell,, P. Courvalin,, G. M. Dunny,, B. E. Murray,, and L. B. Rice (ed.), The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance. ASM Press, Washington, DC.
98. Teixeira, L. M.,, M. G. S. Carvalho,, V. L. Merquior,, A. G. Steigerwalt,, D. J. Brenner,, and R. R. Facklam. 1997. Phenotypic and genotypic characterization of Vagococcus fluvialis, including strains isolated from human sources. J. Clin. Microbiol. 35:27782781.
99. Teixeira, L. M.,, R. R. Facklam,, A. G. Steigerwalt,, N. E. Pigott,, V. L. C. Merquior,, and D. J. Brenner. 1995. Correlation between phenotypic characteristics and DNA relatedness with Enterococcus faecium strains. J. Clin. Microbiol. 33:15201523.
100. Tendolkar, P. M.,, A. S. Baghdayan,, and N. Shankar. 2003. Pathogenic enterococci: new developments in the 21st century. Cell. Mol. Life Sci. 60:26222636.
101. Tenover, F. C.,, R. D. Arbeit,, R. V. Goering,, P. A. Mickelsen,, B. E. Murray,, D. H. Persing,, and B. Swaminathan. 1995. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J. Clin. Microbiol. 33:22332239.
102. Titze-de-Almeida, R.,, R. J. L. Willems,, J. Top,, I. P. Rodrigues,, R. F. Ferreira II,, H. Boelens,, M. C. C. Brandileone,, R. C. Zanella,, M. S. S. Felipe,, and A. van Belkum. 2004. Multilocus variable-number tandem-repeat polymorphism among Brazilian Enterococcus faecalis strains. J. Clin. Microbiol. 42:48794881.
103. Top, J.,, N. M. Banga,, R. Hayes,, R. J. Willems,, M. J. Bonten,, and M. K. Hayden. 2008. Comparison of multiplelocus variable-number tandem repeat analysis and pulsedfield gel electrophoresis in a setting of polyclonal endemicity of vancomycin-resistant Enterococcus faecium. Clin. Microbiol. Infect. 14:363369.
104. Top, J.,, L. M. Schouls,, M. J. Bonten,, and R. J. Willems. 2004. Multiple-locus variable-number tandem repeat analysis, a novel typing scheme to study the genetic relatedness and epidemiology of Enterococcus faecium isolates. J. Clin. Microbiol. 42:45034511.
105. Top, J.,, R. Willems,, H. Blok,, M. de Regt,, K. Jalink,, A. Troelstra,, B. Goorhuis,, and M. Bonten. 2007. Ecological replacement of Enterococcus faecalis by multiresistant clonal complex 17 Enterococcus faecium. Clin. Microbiol. Infect. 13:316319.
106. Uttley, A. H. C.,, C. H. Collins,, J. Naidoo,, and R. C. George. 1988. Vancomycin-resistant enterococci. Lancet 1:5758.
107. Valdezate, S.,, C. Labayru,, A. Navarro,, M. A. Mantecón,, M. Ortega,, T. M. Coque,, M. García,, and J. A. Saéz-Nieto. 2009. Large clonal outbreak of multidrug-resistant CC17 ST17 Enterococcus faecium containing Tn5382 in a Spanish hospital. J. Antimicrob. Chemother. 63:1720.
108. Van Horn, K.,, C. Tóth,, R. Kariyama,, R. Mitsuhata,, and H. Kumon. 2002. Evaluation of 15 motility media and a direct microscopic method for detection of motility in enterococci. J. Clin. Microbiol. 40:24762479.
109. Watanabe, S.,, N. Kobayashi,, D. Quiñones,, S. Hayakawa,, S. Nagashima,, N. Uehara,, and N. Watanabe. 2009. Genetic diversity of the low-level vancomycin resistance gene vanC-2/vanC-3 and identification of a novel vanC subtype (vanC-4) in Enterococcus casseliflavus. Microb. Drug Resist. 15:19.
110. Weber, S. G.,, S. S. Huang,, S. Oriola,, W. C. Huskins,, G. A. Noskin,, K. Harriman,, R. N. Olmsted,, M. Bonten,, T. Lundstrom,, M. W. Climo,, M. C. Roghmann,, C. L. Murphy,, and T. B. Karchmer. 2007. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the joint SHEA and APIC task force. Infect. Control Hosp. Epidemiol. 28:249260.
111. Weinstein, M. P. 2001. Comparative evaluation of penicillin, ampicillin, and imipenem MICs and susceptibility breakpoints for vancomycin-susceptible and vancomycinresistant Enterococcus faecalis and Enterococcus faecium. J. Clin. Microbiol. 39:27292731.
112. Werner, G.,, T. M. Coque,, A. M. Hammerum,, R. Hope,, W. Hryniewicz,, A. Johnson,, I. Klare,, K. G. Kristinsson,, R. Leclercq,, C. H. Lester,, M. Lillie,, C. Novais,, B. Olsson-Liljequist,, L. V. Peixe,, E. Sadowy,, G. S. Simonsen,, J. Top,, J. Vuopio-Varkila,, R. J. Willems,, W. Witte,, and N. Woodford. 2008. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 13:111.
113. Wilke, W. W.,, S. A. Marshall,, S. L. Coffman,, M. A. Pfaller,, M. B. Edmund,, R. P. Wenzel,, and R. N. Jones. 1997. Vancomycin-resistant Enterococcus raffinosus: molecular epidemiology, species identification error, and frequency of occurrence in national resistance surveillance program. Diagn. Microbiol. Infect. Dis. 28:4349.
114. Willems, R. J.,, and M. J. Bonten. 2007. Glycopeptideresistant enterococci: deciphering virulence, resistance and epidemicity. Curr. Opin. Infect. Dis. 20:384390.
115. Willems, R. J.,, J. Top,, M. van Santen,, D. A. Robinson,, T. M. Coque,, F. Baquero,, H. Grundmann,, and M. J. Bonten. 2005. Global spread of vancomycin-resistant Enterococcus faecium from distinct nosocomial genetic complex. Emerg. Infect. Dis. 11:821828.
116. Young, H. L.,, S. A. Ballard,, P. Roffey,, and M. L. Grayson. 2007. Direct detection of vanB2 using the Roche LightCycler vanA/B detection assay to indicate vancomycin-resistant enterococcal carriage—sensitive but not specific. J. Antimicrob. Chemother. 58:809810.
117. Zehnder, M.,, and B. Guggenheim. 2009. The mysterious appearance of enterococci in filled root canals. Int. Endod. J. 42:277287.
118. Zirakzadeh, A.,, and R. Patel. 2006. Vancomycin-resistant enterococci: colonization, infection, detection, and treatment. Mayo Clin. Proc. 81:529536.


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Phenotypic characteristics used for the identification of species and some physiologically related species of other gram-positive cocci

Abbreviations and symbols: MAN, mannitol; SOR, sorbose; ARG, arginine; ARA, arabinose; SBL, sorbitol; RAF, raffinose; TEL, 0.04% tellurite; MOT, motility; PIG, pigment; SUC, sucrose; PYU, pyruvate; MGP, methyl-α-D-glucopyranoside; TRE, trehalose; XYL, xylose; GAL, 2-naphthyl-β-D-galactopyranoside; +, 90% or more of the strains are positive; –, 90% or more of the strains are negative; V, variable (11 to 89% of the strains are positive).

Phenotypic characteristics are based on data from type strains.

Late positive (3 days' incubation or longer).

Occasional exceptions occur (<3% of strains show atypical reactions).

w, weak reaction.

Citation: Teixeira L, Carvalho M, Shewmaker P, Facklam R. 2011. , p 350-364. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch21
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Types of resistance to glycopeptides among members of the genus

R, resistant; S, susceptible; I, intermediate.

Subtypes exist: and .

D-Ala-D-Lac, D-alanine–D-lactate; D-Ala-D-Ser, D-alanine–D-serine.

Citation: Teixeira L, Carvalho M, Shewmaker P, Facklam R. 2011. , p 350-364. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch21

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