Enterococcus faecalis: the hiker of the perineum

General presentation

Ubiquitous in the environment, Enterococcus faecalis is a bacterium which is:

– very resistant -> can survive temperatures ranging between 10 and 45°c and pH values between 4.5 and 10

– endowed with marked virulence -> it is estimated that this species is involved in 80% of infections by Enterococcus

– particularly resistant to antibiotics -> which weighs heavily on the need for specific management (based on antibiogram)

It has been observed and proven that most Enterococcus faecalis urinary tract infections:

– they are transmitted in hospitals and health centers -> that is why they are called nosocomial infections

– are favored and facilitated by the presence of a catheter -> urinary catheter for example

– they are also allowed and favored by other invasive maneuvers in the urinary system such as cystoscopy, urodynamic maneuver, etc.

Enterococcus faecalis is a commensal bacterium of the digestive tract (= physiologically present in the intestinal microbiota in significant quantities), one of the main “colonizers” of the female perineum.

This feature means that all women are regularly in contact with this germ that usually “circulates” and “walks” in the urogenital sphere, including the urinary tract, without causing any particular problem. In fact, it is not uncommon to discover it fortuitously in the urine, during a routine examination (for example, an ECBU control during pregnancy) when the subject has no symptoms or even increased leukocyturia.

This element tells us, therefore, that E. faecalis is not, strictly speaking, a “uro-pathogenic” bacterium. It is also for this reason that the urology guidelines have set a threshold of significance for its presence at 10^4 CFU/ ml -> below this value, its presence in the bladder is therefore considered “not predictive of urinary tract infection” and antibiotic therapy is not indicated.

More simply, in small numbers and without symptoms, the presence of E. faecalis in the urinary tract can be seen as a simple physiological and “normal colonization” because the immune defenses of a healthy organism are perfectly capable of managing it.

On the other hand, this bacterium becomes the cause of a true symptomatic urinary infection when its entry into the urinary tract coincides with the existence of risk factors for cystitis such as:

– rarefaction of the Döderlein flora

– reduced immunological competence of the urogenital sphere

urothelial inflammation

In these cases, E. faecalis becomes “more aggressive” and must be managed like any other uropathogenic bacteria.

Entercoccus feacalis in urology

In the urogynecological field, it is interesting to note that Enterococcus faecalis is a germ that has the following characteristics:

1) has fimbriae = adhesins that allow it to adhere to the walls of the bladder

Therefore, it can be eradicated with D-Mannose without antibiotics (and without adverse effects).

2) it has a high mucogenic capacity = synthesis of biofilms

Therefore, it is highly recommended to combine N-Acetylcysteine with D-Mannose for a complete resolution of the problem.

More pragmatically, we would recommend the following approach:

-> a first cycle of 15 days with: Ausilium NAC (2 vials per day) + Ausilium 20 PLUS (1 sachet per day) + Deaflor (3 tablets per day)

-> a successive phase of 4 weeks with: Ausilium NAC (1 vial per day) + Ausilium 20 PLUS (2 sachets per day) + Deaflor (2 tablets per day)

+ Ausilium Mousse for all intimate hygiene

Ausilium Lavanda: 1 application, 2 times a week

Ausilium Flora: 1 vaginal tablet, 10 days a month

+ Ausilium Crema: application “as needed” + for the insertion of Ausilium Flora

Entercoccus feacalis vaginalis

As mentioned above, Enterococcus faecalis is a commensal intestinal bacterium that belongs to the same family as Escherichia coli.

Its presence, in significant quantity and symptomatology, at the vaginal and bladder level is not only abnormal but also and above all to be considered as a unique problem -> which therefore requires a global response to push this germ back to the intestinal tract where it is physiological.

It is common for this bacterium to settle in the genital tract due to a lack of Döderlein Lactobacilli.

Therefore, it is essential, in this type of situation, to implement measures:

– against mature vaginal and bladder biofilms

– in favor of a recolonization of the vaginal physiological flora

– in support of the flora as a whole (reducing the consumption of antibiotics plays a central role here)

– inhibition of the adhesion of bacteria to the walls of the urogenital sphere

For these reasons, in case of colonization or infection by urogenital E. faecalis, the dosage regimen previously proposed should be enhanced with: Ausilium Lavanda (twice a week) + Ausilium Flora (cycle of 10 days per month in local application) + Ausilium Crema (daily application).

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