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Biofilm-associated infection by enterococci

Nature Reviews Microbiology volume 17, pages 82–94 (2019)Cite this article

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An Author Correction to this article was published on 20 November 2018

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Abstract

Enterococci are ubiquitous members of the human gut microbiota and frequent causes of biofilm-associated opportunistic infections. Enterococci cause 25% of all catheter-associated urinary tract infections, are frequently isolated in wounds and are increasingly found in infective endocarditis, and all of these infections are associated with biofilms. Enterococcal biofilms are intrinsically tolerant to antimicrobials and thus are a serious impediment for treating infections. In this Review, we describe the spatiotemporal development of enterococcal biofilms and the factors that promote or inhibit biofilm formation. We discuss how the environment, including the host and other co-colonizing microorganisms, affects biofilm development. Finally, we provide an overview of current and future interventions to limit enterococcal biofilm-associated infections. Overall, enterococcal biofilms remain a pressing clinical problem, and there is an urgent need to better understand their development and persistence and to identify novel treatments.

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Fig. 1: Stages of biofilm development in enterococci.
Fig. 2: Differences and similarities between factors involved in E. faecalis and E. faecium biofilm formation.
Fig. 3: Interactions of enterococci with other species in polymicrobial biofilms.

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Change history

  • 20 November 2018

    In the section on initial attachment and in Figure 1 it was erroneously indicated that enterococcal surface protein (Esp) binds collagen and fibrinogen. The text and figure were changed to remove this binding interaction both online and in the pdf. The authors apologize for any confusion caused.

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Acknowledgements

Work in the Kline laboratory related to this article is supported by the Ministry of Education Singapore under its Research Centre of Excellence Program and by the Ministry of Education Singapore under its Tier 2 programme (MOE2014-T2-2-124) and the National Institutes of Health (NIH; 1 R21 AI126023-01).

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Nature Reviews Microbiology thanks D. Garsin, M. Gilmore and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Jun-Hong Ch’ng

  2. Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore, Singapore

    Jun-Hong Ch’ng

  3. Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore

    Kelvin K. L. Chong, Ling Ning Lam, Jun Jie Wong & Kimberly A. Kline

  4. Nanyang Technological University Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore

    Kelvin K. L. Chong

  5. School of Biological Sciences, Nanyang Technological University, Singapore, Singapore

    Ling Ning Lam & Kimberly A. Kline

  6. Singapore Centre for Environmental Life Sciences Engineering, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore

    Jun Jie Wong

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J.-H.C., K.K.L.C., L.N.L. and J.J.W. researched data for the article. All authors made substantial contributions to discussions of the content, wrote the article and reviewed and edited the manuscript before submission.

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Glossary

Endocarditis

The potentially deadly inflammation of the heart valves and endocardium; infectious endocarditis is characterized by the formation of vegetations composed of platelets, fibrin and microorganisms.

Quorum sensing

A cell density-dependent gene regulatory response, which results in beneficial phenotypes to the population as a whole.

Catheter-associated UTI

(CAUTI). A urinary tract infection (UTI) that is associated with the use of urinary catheters, which increase the risk of infection of bladder and kidneys.

Pheromone

A secreted chemical that is used to communicate between cells of the same species and triggers a population response.

Minimum biofilm eradication concentration

(MBEC). The minimum concentration of an antimicrobial compound required to kill all cells in a preformed biofilm; the test is typically performed in vitro using biofilm grown on a Calgary biofilm device.

Horizontal gene transfer

The transfer of genetic material between organisms that are not parent-offspring, also known as lateral gene transfer.

Endodontic infection

A bacterial infection of the dental pulp located within the teeth and root canals.

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Ch’ng, JH., Chong, K.K.L., Lam, L.N. et al. Biofilm-associated infection by enterococci. Nat Rev Microbiol 17, 82–94 (2019). https://doi.org/10.1038/s41579-018-0107-z

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