Discussion:
Enterococcus
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i***@gmail.com
2007-07-13 00:56:11 UTC
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I had some questions regarding enterococcus because I have had a skin
rash under my arms for several weeks. I went to see the doctor a
couple weeks ago, she thought it might be fungal and thankfully took a
culture of the skin, after which she prescribed an antifungal agent.
When the results of the culture came back, the results indicated
enterococcus. I did some research about enterococcus and it appears
to be quite a nasty bug. I am currently taking Macrobid, but I have
been reading about the drug resistance to various antibiotics.

One question I had was whether Macrobid is still effective in treating
enterococcus in general. I'm not sure whether my culture indicated if
this particular strain of bacterium was sensitive to Macrobid, but I'm
guessing and hoping that it was. I'm going to talk to my doctor to
make sure that the particular strain is sensitive. Another question I
had was what precipitates antibiotic resistance in a particular
person? I have a spinal cord injury and have had numerous urinary
tract infections due to my condition even though I am very rigorous
about hygiene and fortunately do not have an indwelling catheter but
rather an external one. I had a bad UTI in October 2006, but the
bacteria was E. coli that time. Nonetheless, the E. coli did not seem
responsive to Macrobid, but Levaquin was able to eradicate it.
However, as a precaution, my doctor put me on prophylactic Macrobid
(I'm still not sure why, see above) for one month. I finished the
course of Macrobid in December 2006. I'm curious as to whether this
enterococcus I have now could have become resistant to Macrobid when I
was on it prophylactically? Because enterococci are normally found in
the intestine, I'm perplexed as to why I have an outbreak under my
arms and nowhere else? I bathe every day, and it makes no sense that
only my armpits were affected and how the bacteria got there if it is
an intestinal strain. Are there any species of enterococci which are
native to skin or perhaps sweat? That is my theory as to the cause of
the infection. I also wonder about whether using a coat of Betadine
under my arms would help to inhibit the infection. I read somewhere
that Betadine could prevent growth of enterococcus.

I'm going to discuss all of these questions with my doctor, but I
welcome any insight.

Thank you very much for your consideration.
JEDilworth
2007-07-13 01:43:51 UTC
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Macrobid (macrodantin bid - twice a day) is the trade name for
Nitrofurantoin, (the generic name), which, to my knowledge, is a urinary
tract drug only.

http://www.drugs.com/macrobid.html

We only report it out with enterococci if the organism is in a urine
culture. The drug concentrates itself in the bladder. You must drink
lots of water with it, I think. The only two drugs we report for
enterococci (it is also sometimes called Group D enterococci) are
ampicillin and vancomycin. To tell you the truth, the few armpit
cultures I see usually grow Staphylococcus aureus (which causes
abscesses) or Proteus mirabilis. Was it a pure culture of enterococcus?
I personally don't know about this bug causing skin infections as I do
not usually see this bug in that context. It could have been there in
your armpit but not causing an infection....

Enterococci are normal in the human intestine. However, they can cause
infections when they get into other places. I am a microbiologist, NOT a
physician, so I really can't comment on pathogenicity of this bug other
than what I see growing on plates. What the docs do with our culture
reports is up to them. I don't remember it as an armpit bug necessarily.

Did your doc take a fungal culture also? The bacterial culture will be
reported out in a couple of days. Fungal cultures take 4-6 weeks before
signing them out as negative, depending on the laboratory. So, it's
possible that there is still a fungal culture incubating on your armpit,
depending on when it was taken.

People that have spinal cord injuries tend to have low levels of
bacteria in their bladders due to self-catheterization, which I assume
is what you probably are doing. I would assume your doc put you on
Macrobid as a prophylactic antibiotic. Not all bacteria necessarily
cause infections in bladders. We get nursing home urine cultures that
have a lot of colonization around the catheters which do not necessarily
indicate infection per se. Sometimes it is difficult to determine true
infection in spinal cord injury patients, nursing home patients, MS
patients, etc. I would assume the docs correlate urinalysis results with
culture results in those cases. A full urinalysis will comment on how
many WBC's (white blood cells) are seen per low power [microscope]
field, how many RBC's, and will also report out other parameters that
help a doctor decide if there is a true infection going on.

Is your rash gone? If so, I wouldn't worry about it any more. This heat
can give a lot of people rashes. If you're in a wheel chair, and pushing
yourself around, you're probably working up quite a sweat with the
current hot weather going on. Keep your armpits dry and wear cotton
shirts. Use a lot of powder to help keep them dry. You could be allergic
to your deodorant/antiperpirant. Have you changed brands recently? Fungi
and bacteria thrive in hot, moist environments. That is why we incubate
our plates in warm, moist incubators. Our fungal incubators are at 30
degrees C (a warm room). Our bacterial cultures incubate at 35 degrees C
(body temperature, which is around 98 degrees F). I wouldn't think you'd
want to use betadine as this stains everything iodine color. If the rash
comes back you may want to see a dermatologist.

http://www.wrongdiagnosis.com/sym/underarm_rash.htm - check out this
page also.

Judy Dilworth, M.T. (ASCP)
Microbiology 33 years
Post by i***@gmail.com
I had some questions regarding enterococcus because I have had a skin
rash under my arms for several weeks.
JEDilworth
2007-07-13 02:21:08 UTC
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http://www.emedicine.com/ped/topic2703.htm

This page has LOTS of information regarding enterococci. Please realize
that VRE (vancomycin resistant enterococcus) is a serious problem in
ICU's and is probably not what you're dealing with at all.

This paragraph is very true, from my point of view of reading out
culture plates on a daily basis:

"Enterococci normally inhabit the bowel, so determining whether the
microbe is a true pathogen or just happens to be associated with an
illness is difficult. Enterococcus frequently is isolated from
polymicrobial wounds and intra-abdominal and pelvic infections, but
whether enterococci contribute to the pathogenesis of these infections
is often uncertain. Clinical trials have demonstrated that patients with
such infections recover without any specific anti-enterococcal therapy.
In animal models, injection of enterococci rarely causes peritonitis or
subcutaneous infection, but synergy may exist between enterococci and
other organisms (especially anaerobes)..."

Judy Dilworth, M.T. (ASCP)
Microbiology
Post by i***@gmail.com
I had some questions regarding enterococcus because I have had a skin
rash under my arms for several weeks.
David Rind
2007-07-14 01:08:42 UTC
Permalink
Raw Message
Post by i***@gmail.com
I had some questions regarding enterococcus because I have had a skin
rash under my arms for several weeks. I went to see the doctor a
couple weeks ago, she thought it might be fungal and thankfully took a
culture of the skin, after which she prescribed an antifungal agent.
When the results of the culture came back, the results indicated
enterococcus. I did some research about enterococcus and it appears
to be quite a nasty bug. I am currently taking Macrobid, but I have
been reading about the drug resistance to various antibiotics.
One question I had was whether Macrobid is still effective in treating
enterococcus in general. I'm not sure whether my culture indicated if
this particular strain of bacterium was sensitive to Macrobid, but I'm
guessing and hoping that it was. I'm going to talk to my doctor to
make sure that the particular strain is sensitive. Another question I
had was what precipitates antibiotic resistance in a particular
person? I have a spinal cord injury and have had numerous urinary
tract infections due to my condition even though I am very rigorous
about hygiene and fortunately do not have an indwelling catheter but
rather an external one. I had a bad UTI in October 2006, but the
bacteria was E. coli that time. Nonetheless, the E. coli did not seem
responsive to Macrobid, but Levaquin was able to eradicate it.
However, as a precaution, my doctor put me on prophylactic Macrobid
(I'm still not sure why, see above) for one month. I finished the
course of Macrobid in December 2006. I'm curious as to whether this
enterococcus I have now could have become resistant to Macrobid when I
was on it prophylactically? Because enterococci are normally found in
the intestine, I'm perplexed as to why I have an outbreak under my
arms and nowhere else? I bathe every day, and it makes no sense that
only my armpits were affected and how the bacteria got there if it is
an intestinal strain. Are there any species of enterococci which are
native to skin or perhaps sweat? That is my theory as to the cause of
the infection. I also wonder about whether using a coat of Betadine
under my arms would help to inhibit the infection. I read somewhere
that Betadine could prevent growth of enterococcus.
I'm going to discuss all of these questions with my doctor, but I
welcome any insight.
Thank you very much for your consideration.
You might want to see someone for a second opinion.

A surface culture of the skin is extremely inaccurate in determining the
cause of an infection. It is very unlikely that a rash would ever be due
to enterococcus, and particularly a rash that appeared in both
underarms. If someone actually had a skin infection (cellulitis or
abscess) due to enterococcus, Macrobid would probably not be a good
antibiotic choice.
--
David Rind
***@caregroup.harvard.edu
c***@gmail.com
2017-03-15 22:47:24 UTC
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Post by David Rind
Post by i***@gmail.com
I had some questions regarding enterococcus because I have had a skin
rash under my arms for several weeks. I went to see the doctor a
couple weeks ago, she thought it might be fungal and thankfully took a
culture of the skin, after which she prescribed an antifungal agent.
When the results of the culture came back, the results indicated
enterococcus. I did some research about enterococcus and it appears
to be quite a nasty bug. I am currently taking Macrobid, but I have
been reading about the drug resistance to various antibiotics.
One question I had was whether Macrobid is still effective in treating
enterococcus in general. I'm not sure whether my culture indicated if
this particular strain of bacterium was sensitive to Macrobid, but I'm
guessing and hoping that it was. I'm going to talk to my doctor to
make sure that the particular strain is sensitive. Another question I
had was what precipitates antibiotic resistance in a particular
person? I have a spinal cord injury and have had numerous urinary
tract infections due to my condition even though I am very rigorous
about hygiene and fortunately do not have an indwelling catheter but
rather an external one. I had a bad UTI in October 2006, but the
bacteria was E. coli that time. Nonetheless, the E. coli did not seem
responsive to Macrobid, but Levaquin was able to eradicate it.
However, as a precaution, my doctor put me on prophylactic Macrobid
(I'm still not sure why, see above) for one month. I finished the
course of Macrobid in December 2006. I'm curious as to whether this
enterococcus I have now could have become resistant to Macrobid when I
was on it prophylactically? Because enterococci are normally found in
the intestine, I'm perplexed as to why I have an outbreak under my
arms and nowhere else? I bathe every day, and it makes no sense that
only my armpits were affected and how the bacteria got there if it is
an intestinal strain. Are there any species of enterococci which are
native to skin or perhaps sweat? That is my theory as to the cause of
the infection. I also wonder about whether using a coat of Betadine
under my arms would help to inhibit the infection. I read somewhere
that Betadine could prevent growth of enterococcus.
I'm going to discuss all of these questions with my doctor, but I
welcome any insight.
Thank you very much for your consideration.
You might want to see someone for a second opinion.
After fighting a rash under my grandsons arms for months, first treated as a fungal infection, and then later as a bacterial infection. 40 days on various different antibiotics, and finally a culture showed it to be enterococcus. He's been on ampicillin for 1 week, but I have not seen any improvement yet. I am curious to know if your rash finally cleared up, and if so what medication worked?
A surface culture of the skin is extremely inaccurate in determining the
cause of an infection. It is very unlikely that a rash would ever be due
to enterococcus, and particularly a rash that appeared in both
underarms. If someone actually had a skin infection (cellulitis or
abscess) due to enterococcus, Macrobid would probably not be a good
antibiotic choice.
--
David Rind
c***@gmail.com
2017-03-15 23:52:00 UTC
Permalink
Raw Message
After fighting a rash under my grandsons arms for months, first treated as a fungal infection, and then later as a bacterial infection. 40 days on various different antibiotics, and finally a culture showed it to be enterococcus. He's been on ampicillin for 1 week, but I have not seen any improvement yet. I am curious to know if your rash finally cleared up, and if so what medication worked?
Post by i***@gmail.com
I had some questions regarding enterococcus because I have had a skin
rash under my arms for several weeks. I went to see the doctor a
couple weeks ago, she thought it might be fungal and thankfully took a
culture of the skin, after which she prescribed an antifungal agent.
When the results of the culture came back, the results indicated
enterococcus. I did some research about enterococcus and it appears
to be quite a nasty bug. I am currently taking Macrobid, but I have
been reading about the drug resistance to various antibiotics.
One question I had was whether Macrobid is still effective in treating
enterococcus in general. I'm not sure whether my culture indicated if
this particular strain of bacterium was sensitive to Macrobid, but I'm
guessing and hoping that it was. I'm going to talk to my doctor to
make sure that the particular strain is sensitive. Another question I
had was what precipitates antibiotic resistance in a particular
person? I have a spinal cord injury and have had numerous urinary
tract infections due to my condition even though I am very rigorous
about hygiene and fortunately do not have an indwelling catheter but
rather an external one. I had a bad UTI in October 2006, but the
bacteria was E. coli that time. Nonetheless, the E. coli did not seem
responsive to Macrobid, but Levaquin was able to eradicate it.
However, as a precaution, my doctor put me on prophylactic Macrobid
(I'm still not sure why, see above) for one month. I finished the
course of Macrobid in December 2006. I'm curious as to whether this
enterococcus I have now could have become resistant to Macrobid when I
was on it prophylactically? Because enterococci are normally found in
the intestine, I'm perplexed as to why I have an outbreak under my
arms and nowhere else? I bathe every day, and it makes no sense that
only my armpits were affected and how the bacteria got there if it is
an intestinal strain. Are there any species of enterococci which are
native to skin or perhaps sweat? That is my theory as to the cause of
the infection. I also wonder about whether using a coat of Betadine
under my arms would help to inhibit the infection. I read somewhere
that Betadine could prevent growth of enterococcus.
I'm going to discuss all of these questions with my doctor, but I
welcome any insight.
Thank you very much for your consideration.
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