Enterococcus Faecalis: Types, Causes, Symptoms, Test, & Prevention

Enterococcus — the large genus of bacteria that cause no harm till you eat them (or enters the body by other means of transmission). Surprisingly, they are commonly found in our bowel and guts. But when they reach any other part of the body, it causes many complications (but majorly by Enterococcus Faecalis).

To depict all the information related to Enterococcus Faecalis, we had listed down its causes, symptoms, diagnosis, treatment, and preservation measures.

What is Enterococcus?

What is Enterococcus?

Enterococcus is the common name for a group of lactic acid bacteria of the phylum firmicutes. These bacterias often occur in pairs or short-chain which makes it difficult to distinguish by their physical anatomy. As these bacterias are always in groups or chains, they are a form of gram-positive cocci. 

While talking about the infection, enterococcus’s two species— E. Faecalis causes 90% infection and E. Faecium causes about 10% of infection. However, other enterococci bacteria causing agents are E.Casseliflavus, E. Gallinarum, and E. Raffinosus.

But, in this post, we try to narrow down the ‘enterococcus’ topic to a specific species that cause infection in humans i.e. Enterococcus Faecalis.

What is Enterococcus Faecalis?

Enterococcus Faecalis is the common bacteria of our gastrointestinal tract. However, people with poor hygiene can also have them in their mouths. Moreover, they can survive extreme conditions such as heat, salty or acidic environments. And that’s why they are so resilient

Naturally, they are present in our GI tract but when they spread to other parts of the body, it may create a nasty life-threatening infection. Even after spreading, it may facilitate other infections to grow like sepsis, endocarditis, and meningitis.

In general, with time enterococcus develops drug resistance to various antibiotics. This means a constant development of new drugs is necessary to treat these infections.

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Causes of Enterococcus Faecalis Infection

Causes of Enterococcus Faecalis Infection

For obvious, the responsible factor for these infections is— Enterococcus Faecalis. But what conditions can make them harm you?

The possible cause of these infections is poor hygiene habits. As they are gut bacterias, they are commonly found in feces. And when a person doesn’t wash your hands, then he may knock the door to welcome the E.faecalis into their system. 

However, there are other conditions that might be responsible for the development of E.faecalis infection in a person:

  • Use Immunosuppressants drugs
  • Have a weak immune response 
  • Recent surgery
  • Undergoing cancer treatment
  • On dialysis
  • are receiving an organ transplant
  • Immunosuppressant diseases such as HIV or AIDS
  • Mouth cavity and root canal

Additionally, hospitalized patients can also get this infection because they have less fighting power (low immunity) against these bacteria.

Various Types of Infection By Enterococcus Faecalis

Various Types of Infection By Enterococcus Faecalis

In general, infections caused by E.faecalis are life-threatening. And these are the following most common infections of E. faecalis:

  • Wound infections
  • UTI (Urinary Tract) Infection
  • Infection of abdominal and pelvic
  • Bacteremia— when bacteria in present the bloodstream
  • Septicemia— also called blood poisoning
  • Endocarditis—  infection of the endocardium of the heart
  • Enterococcal meningitis— very rare form of meningitis
  • Oral infections (Periodontitis)— majorly in the tooth root canal

What are the Symptoms of Enterococcus Faecalis Infection?

The symptoms of E.faecalis infections depend on which parts of the body it affects. However, in the majority of cases, these are the common symptoms of enterococcus infections:

  • Fatigue
  • Pain and burning sensation while urination
  • Abdominal Pain and stomach cramps
  • Fever, chills, and headache
  • Chest pain when you breathe
  • Vomiting
  • Nausea
  • Diarrhea
  • Swollen, red, or bleeding gums
  • Abnormal Breathing; fast or shortness of breath

What are the Diagnosis (tests) for Enterococcus Infection?

Diagnosis for Enterococcus Infection

Enterococci are readily and quickly identified in the clinical microbiology laboratory. 

Gram Stain Test

This is one of the rapid tests that give a preliminary idea of what type of infection you have. As stated earlier, enterococci are always in pairs or groups, therefore, it shows gram stain positive test. 

For this test, the sample is taken from the infected area. Now, the sample is brought on a clean glass slide and let it dry. After the sample is dried off, a few drops of special staining solution was introduced to the glass slide. Now, observation is done under the microscope. 

Now results might be:

  • Color: purple color shows gram-positive results while pink means a negative result.
  • Shape: Common shape would be round or rod-shaped. 

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PYR (Pyrrolidonyl Aminopeptidase) Test

It is another test for identifying the cause of infection. The test is based on the action of a specific enzyme called Pyrrolidonyl arylamidase enzyme. 

For this test, add some infected fluid in the PYR broth and culture it for 18-24 hours. Now, add 2-3 drops of PYR reagent and observe the color change.

If the color changes to red, then it means you have streptococcus pyogenes which are mainly Enterococcus spp.

Note: Another test (which is not currently in use) is the bile-esculin test. However, the identification of new species of enterococcus is only done by the evaluation of DNA content.

Treatment for Enterococcus Infection

Treatment for Enterococcus Infection

For any sort of bacteria, antibiotics are the medication that is being employed. But with time bacterias develop resistance to certain medications, hence, there is always a need for the development of new ones.

Before prescribing any antibiotics, your doctor might check the activity of drugs with your infected fluid sample. However, the most common antibiotics for enterococcus faecalis infection are ampicillin and daptomycin.

In addition, these are the following other medication that can be helpful in treating the E. faecalis infection:

  • Tigecycline
  • Streptomycin
  • Gentamicin
  • Nitrofurantoin
  • Linezolid
  • Vancomycin

In general, a combination of two or more antibiotics is prescribed in case of severe infection such as meningitis. 

Enterococci Infections And Antibiotic Resistance

E. faecalis is one of the bacterias that can readily develop antibiotic resistance. Additionally, these bacteria can also tolerate a variety of conditions like heat or alkaline environments. 

Moreover, these are the factors that cause antibiotic resistivity in enterococci. 

1. Formation of Biofilm: All sorts of bacterias make a sticky layer to protect themselves from any external means. They act as a cell wall for them.

2. Nutritional Needs: They are not hungrier i.e. without food they are able to survive for a long time. However, commonly available body fluid— blood serum can also be a source of nutrition for enterococci bacterias.

3. Penicillin-Binding Proteins (PBPs): You can call them the cause of E.faecalis resistance to penicillin drugs. Though PBPs inhibit enterococcus activity, it doesn’t destroy them.

4. Environmental Folic Acid Absorption: For instance, bacteria require folic acid for their growth, and most bacteria make their own folic acid. So, some medications that resist the production of folic acid can reduce the infection. But in the case of enterococci, these medications are useless. This is because they can also absorb folic acid from their environment. 

Preventions From Enterococcus Infections

Preventions From Enterococcus Infections

These are the following prevention measures that you can take to prevent yourself from getting enterococcus infections:

1. Maintaining Good Hygiene: Make a habit of regular hand washing along with your fingertips to half of the elbow region. And in case of eating, drinking, touching any unsanitized products, use of washrooms, public transportation, etc. you must clean your hands first (or afterward).

2. Try to Minimize Contacting: You should avoid touching others (or resist yours) personal objects such as forks, spoons, dinner plates, drinks, etc. 

3. Use your own Personal Care Object: Objects like soaps, washcloths, towels, razors, toothbrushes, etc. should not be exchanged with other people.

4. Regular Sanitize Shared Objects: Shared objects are more likely to be the home of bacteria and germs, so, regular sanitizing them using 65% sanitizing solution would nearly kill 99.99% of bacteria including enterococci.

5. In Hospital Premises: Before and after any surgery, the surgeons must wash their hands. Moreover, equipment like thermometers, blood pressure cuffs, catheters, IVs, etc. should be regularly sanitized.

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In short, Enterococcus is a group of bacteria that are usually present in the human GI tract. But when they spread it can cause a number of life-threatening complications and conditions like meningitis. However, 90% of cases are due to one species Enterococcus Faecalis (or E. faecalis).

While talking about its symptoms, it varies with the type, severity, and the affecting part of the body. But the common symptoms are vomiting, pain while urinating, fever, chills, abnormal heart rate, and stomach cramps.

And the most promising medication from their treatment is ampicillin. But any medication should be given only before diagnosing specific enterococci types. 

Now, these are the following questions that users ask on google.

General FAQ

Where is enterococcus found?

Ans. They are present in the GI tract i.e. in gut and bowel. But in some cases, they are commonly found in the mouth of the person.

Is enterococcus serious?

Ans. If it is in your GI tract it will cause no harm. But when they spread it can cause very serious conditions like bacteremia, septicemia, meningitis, etc.

How is enterococcus treated?

Ans. For enterococci infections, a prolonged high dosage of ampicillin is given along with some other antibiotics like ceftriaxone.

How is enterococcus transmitted?

Ans. It spreads from any contact with the infected surface whether it is another person’s hand or any other surface like computer keyboards or mobile.

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