1. ENTEROCOCCI TEAM CASE STUDY 2 Team Table 6: Emerita Arias Ofili Okolonwamu Romelene Juban Microbioloy Bio 16 Dr. Janet Fulks 12 October 2006

2. Diagnosis  Joseph Lincoln is a 62 year old coronary-by- pass patient that has been in ICU since his surgery.  This week he began to exhibit symptoms of pneumonia. A sputum specimen was sent for culture and sensitivity.  The lab reported a Gram stain with GPC and numerous WBCs.  The culture displayed organisms identified as Enterococci.  The sensitivity for the organism reveals a resistance to Vancomycin.

3. Pictures (1) Vancomycin- Resistant Enterococci (VRE) (2) (3)

4. Characteristics  GP cocci  Environmental conditions  Facultative anaerobe  Tolerate sodium azide & concentrated bile salts  Strains are homofermentative  Glucose fermentation  Inhibit in humans & other animals  Species: E. faecium & E. faecalis  Two types: Intrinsic and Acquired (4)

5. Meaning of the Resistance Displayed  Prophylactic practice  Opportunistic Microorganisms  Over-prescription of Vancomycin  Treatment of MRSA=VRE  VanA, VanB

6. Bacteria DNA Exchange  Intrinsic Resistance vs. Acquired Resistance  Conjugation

7. Suggested treatment for patient  Isolates bacteria  VRE treatment driven bacterial antibiotic resistance VRE resistant to gentamicin VRE high-level penicillin resistant VRE intrinsic pen G/AMP resistance VRE: Ampicillin, Vancomycin, & Aminoglycoside resistance  Current treatments by microbiology report

8. Patient Prognosis  Prognosis based on patient level of resistant & other factors  Recovering rate is 50/50 chance

9. Special Precautions  Isolated room  Universal precaution  IV ABT Therapy  Series of microbiology lab test  Therapeutic level test (Peak & Trough)

10. References  Picture # 1:http://abc.net.au/science/slab/bughttp://abc.net.au/science/slab/bug  Picture # 2: https://www.moffitt.usf.edu/pubs/ccj/v3n1/dept5/dept5.htm l https://www.moffitt.usf.edu/pubs/ccj/v3n1/dept5/dept5.htm l  Picture # 3: https://www.moffitt.usf.edu/pubs/ccj/v3n1/dept5/dept5.htm l https://www.moffitt.usf.edu/pubs/ccj/v3n1/dept5/dept5.htm l  Picture # 4: www.idsociety.org/Template.cfm?Section=Antimi... www.idsociety.org/Template.cfm?Section=Antimi...  http://www.annals.org  http://bmj.bmjjournals.com/content/vol324/issue7338/twib.shtml  http://www.cdc.gov/ncidod/eid/vol4no2 http://www.cdc.gov/ncidod/eid/vol4no2  w3.ouhsc.edu/enterococcus/news.asp  www.cdc.gov/ncidod www.cdc.gov/ncidod  Bauman, Robert. Microbiology Alternate Edition with Disease by Body System. Copyright 2006 by Pearson Education Inc., San Francisco, CA.  https://www.moffitt.usf.edu/pubs/ccj/v3n1/dept5/dept5.html  The Stanford Guide to Antimicrobial Therapy 2006  www.medscape.com.viewarticle/47705