Enterococcus faecalis is a bacterium commonly found in the human body. While often harmless, its presence during pregnancy may require medical attention. Understanding its characteristics and potential implications is important for expectant individuals.
What is Enterococcus faecalis
Enterococcus faecalis is a Gram-positive bacterium, often appearing in pairs or short chains. It is a facultative anaerobe, meaning it can grow with or without oxygen. This bacterium commonly inhabits the human gastrointestinal tract, and can also be found in the oral cavity and vagina.
Despite its usual commensal role, E. faecalis is an opportunistic pathogen. It typically coexists peacefully with its host but can cause infections if it moves to other body parts or if the host’s immune system is weakened.
Potential Complications During Pregnancy
During pregnancy, the body undergoes changes that can increase susceptibility to infections, making Enterococcus faecalis a concern for both the mother and the developing baby. For the mother, E. faecalis is a frequent cause of urinary tract infections (UTIs). This includes asymptomatic bacteriuria (ASB), where bacteria are present without noticeable symptoms, but which can progress to more severe infections like pyelonephritis (kidney infection) if left untreated. Physiological changes in pregnancy, such as urinary stasis, can increase the risk of UTIs.
E. faecalis can also contribute to other maternal infections. It has been associated with endometritis, an infection of the uterine lining, particularly after miscarriage or childbirth. Chorioamnionitis, an infection of the amniotic fluid and membranes surrounding the fetus, can also involve E. faecalis and is a serious condition that can spread from the vagina to the uterus. Untreated localized infections can lead to systemic infections or sepsis.
For the baby, maternal infections caused by E. faecalis carry several risks. Intrauterine infections can trigger inflammatory responses, which contribute to preterm labor and potential injury to the developing fetal lungs and brain. This can lead to complications such as low birth weight. Transmission of the bacterium can also occur during delivery, leading to neonatal infections.
These neonatal infections can manifest as serious conditions like sepsis, meningitis (infection of the brain and spinal cord membranes), or pneumonia. Infants with low birth weight and prematurity are particularly susceptible to these life-threatening infections.
Diagnosis and Treatment
Diagnosing Enterococcus faecalis infections during pregnancy typically begins with identifying the site of infection. For suspected urinary tract infections, a urine culture is performed to detect bacteria. If other infections like chorioamnionitis or endometritis are suspected, vaginal swabs or blood tests may be collected.
Antibiotic sensitivity testing determines which antibiotics are effective against the specific E. faecalis strain. This is important because E. faecalis can exhibit intrinsic and acquired resistance, making treatment challenging. Sensitivity testing results guide medication choice.
Treatment involves a course of antibiotics, chosen based on the infection type, severity, and the bacteria’s sensitivity profile. Common antibiotics for susceptible strains include ampicillin or amoxicillin. For resistant strains or severe infections, vancomycin, linezolid, or daptomycin may be considered, sometimes in combination with other drugs. Pregnant individuals must complete the entire prescribed course to ensure eradication and minimize recurrence or resistance. Follow-up testing may also be recommended to confirm successful treatment.
Steps for Prevention
Pregnant individuals can take steps to reduce their risk of Enterococcus faecalis and other infections. Maintaining good personal hygiene is important, including frequent handwashing, especially after using the bathroom and before preparing food. Proper wiping technique, from front to back, helps prevent bacteria transfer from the bowel to the urinary tract.
Adequate hydration by drinking plenty of water can help flush bacteria from the urinary system. Managing existing health conditions, such as diabetes, is also important, as elevated blood sugar levels can compromise the immune system and increase susceptibility to infections.
Regular prenatal check-ups are important for monitoring health throughout pregnancy. Open communication with healthcare providers about any unusual symptoms, such as changes in urination or vaginal discharge, enables early detection and prompt treatment of potential infections.