肠球菌：修订间差异

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| ordo = [[Lactobacillales]]
| ordo = [[Lactobacillales]]
| familia = [[Enterococcaceae]]
| familia = [[Enterococcaceae]]
| genus = '''肠球菌屬''' '''''Enterococcus'''''
| genus = '''腸球菌屬''' '''''Enterococcus'''''
| genus_authority = (''ex'' Thiercelin & Jouhaud 1903)<br>Schleifer & Kilpper-Bälz 1984
| genus_authority = (''ex'' Thiercelin & Jouhaud 1903)<br>Schleifer & Kilpper-Bälz 1984
| subdivision_ranks = Species
| subdivision_ranks = Species
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}}
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腸球菌屬（學名：''Enterococcus''），革蘭氏陽性球菌。經常以成對（雙球菌）或短鏈方式存在，故從形態上與鏈球菌屬很難區分。<ref name=Gilmore_2002>{{cite book | title=The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance | publisher = ASM Press | location=Washington, D.C. | year=2002 | editor=Gilmore MS, et al. | isbn=978-1-55581-234-8}}</ref>在人類腸道裡有兩種常見的偏利共生腸球菌：糞腸球菌（90-95%）和屎腸球菌（5-10%）。其他人體中較少見的菌群還有''E. casseliflavus''、''E. gallinarum''和''E. raffinosus。''<ref name=Gilmore_2002/>在臨床上，腸球菌因為能生成抵抗藥物的物質，使它們不容易被抗生素殺死，且容易散播抗藥性基因，故近年來已成為重要的致病菌之一。<ref>{{Cite journal|title=The rise of the Enterococcus: beyond vancomycin resistance|url=https://www.ncbi.nlm.nih.gov/pubmed/22421879|last=Arias|first=Cesar A.|last2=Murray|first2=Barbara E.|date=2012-03-16|journal=Nature Reviews. Microbiology|issue=4|doi=10.1038/nrmicro2761|volume=10|pages=266–278|issn=1740-1534|pmc=PMC3621121|pmid=22421879}}</ref><ref>{{Cite journal|title=Genetic differences in inhibition of 2-aminofluorene N-acetyltransferase activity between C57BL/6J and A/J mice|url=https://www.ncbi.nlm.nih.gov/pubmed/3485979|last=Hultin|first=T. A.|last2=Weber|first2=W. W.|date=1986-04-01|journal=Biochemical Pharmacology|issue=7|volume=35|pages=1214–1216|issn=0006-2952|pmid=3485979}}</ref><ref>{{Cite journal|title=Enterococcus faecalis as multidrug resistance strains in clinical isolates in Imam Reza Hospital in Kermanshah, Iran|url=https://www.ncbi.nlm.nih.gov/pubmed/26738400|last=Mohammadi|first=F.|last2=Ghafourian|first2=S.|date=2015|journal=British Journal of Biomedical Science|issue=4|volume=72|pages=182–184|issn=0967-4845|pmid=26738400|last3=Mohebi|first3=R.|last4=Taherikalani|first4=M.|last5=Pakzad|first5=I.|last6=Valadbeigi|first6=H.|last7=Hatami|first7=V.|last8=Sadeghifard|first8=N.}}</ref><ref>{{Cite journal|title=Investigation of mechanisms and molecular epidemiology of linezolid nonsusceptible Enterococcus faecalis isolated from a teaching hospital in China|url=https://www.ncbi.nlm.nih.gov/pubmed/26210761|last=Li|first=Bin|last2=Ma|first2=Chuan-Ling|date=August 2016|journal=Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi|issue=4|doi=10.1016/j.jmii.2015.05.010|volume=49|pages=595–599|issn=1995-9133|pmid=26210761|last3=Yu|first3=Xiao|last4=Sun|first4=Yao|last5=Li|first5=Mei-Mei|last6=Ye|first6=Jian-Zhong|last7=Zhang|first7=Ya-Pei|last8=Wu|first8=Qing|last9=Zhou|first9=Tie-Li}}</ref><ref>{{Cite journal|title=The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System|url=https://www.ncbi.nlm.nih.gov/pubmed/23039210|last=de Kraker|first=M. E. A.|last2=Jarlier|first2=V.|date=September 2013|journal=Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases|issue=9|doi=10.1111/1469-0691.12028|volume=19|pages=860–868|issn=1469-0691|pmid=23039210|last3=Monen|first3=J. C. M.|last4=Heuer|first4=O. E.|last5=van de Sande|first5=N.|last6=Grundmann|first6=H.}}</ref><ref>{{Cite journal|title=Public Health Risks of Multiple-Drug-Resistant Enterococcus spp. in Southeast Asia|url=https://www.ncbi.nlm.nih.gov/pubmed/26150452|last=Daniel|first=Diane Sunira|last2=Lee|first2=Sui Mae|date=September 2015|journal=Applied and Environmental Microbiology|issue=18|doi=10.1128/AEM.01741-15|volume=81|pages=6090–6097|issn=1098-5336|pmc=PMC4542241|pmid=26150452|last3=Dykes|first3=Gary A.|last4=Rahman|first4=Sadequr}}</ref>
腸球菌屬（學名：''Enterococcus''），革蘭氏陽性球菌。經常以成對（雙球菌）或短鏈方式存在，故從形態上與鏈球菌屬很難區分<ref name=Gilmore_2002>{{cite book | title=The Enterococci: Pathogenesis, Molecular Biology, and Antibiotic Resistance | publisher = ASM Press | location=Washington, D.C. | year=2002 | editor=Gilmore MS, et al. | isbn=978-1-55581-234-8}}</ref>。在人類腸道裡有兩種常見的偏利共生腸球菌：糞腸球菌（''Enterococcus faecalis''）約佔90-95%和屎腸球菌（''Enterococcus faecium''）約佔5-10%。其他人體中較少見的菌群還有''E. casseliflavus''、''E. gallinarum''和''E. raffinosus''<ref name=Gilmore_2002/>''。''腸球菌因為能生成抵抗藥物的物質，使它們不容易被抗生素殺死，且容易散播抗藥性並可在惡劣環境中生存，故近年來已成為臨床感染的重要致病菌之一<ref>{{Cite journal|title=The rise of the Enterococcus: beyond vancomycin resistance|url=https://www.ncbi.nlm.nih.gov/pubmed/22421879|last=Arias|first=Cesar A.|last2=Murray|first2=Barbara E.|date=2012-03-16|journal=Nature Reviews. Microbiology|issue=4|doi=10.1038/nrmicro2761|volume=10|pages=266–278|issn=1740-1534|pmc=PMC3621121|pmid=22421879}}</ref><ref>{{Cite journal|title=Genetic differences in inhibition of 2-aminofluorene N-acetyltransferase activity between C57BL/6J and A/J mice|url=https://www.ncbi.nlm.nih.gov/pubmed/3485979|last=Hultin|first=T. A.|last2=Weber|first2=W. W.|date=1986-04-01|journal=Biochemical Pharmacology|issue=7|volume=35|pages=1214–1216|issn=0006-2952|pmid=3485979}}</ref><ref>{{Cite journal|title=Enterococcus faecalis as multidrug resistance strains in clinical isolates in Imam Reza Hospital in Kermanshah, Iran|url=https://www.ncbi.nlm.nih.gov/pubmed/26738400|last=Mohammadi|first=F.|last2=Ghafourian|first2=S.|date=2015|journal=British Journal of Biomedical Science|issue=4|volume=72|pages=182–184|issn=0967-4845|pmid=26738400|last3=Mohebi|first3=R.|last4=Taherikalani|first4=M.|last5=Pakzad|first5=I.|last6=Valadbeigi|first6=H.|last7=Hatami|first7=V.|last8=Sadeghifard|first8=N.}}</ref><ref>{{Cite journal|title=Investigation of mechanisms and molecular epidemiology of linezolid nonsusceptible Enterococcus faecalis isolated from a teaching hospital in China|url=https://www.ncbi.nlm.nih.gov/pubmed/26210761|last=Li|first=Bin|last2=Ma|first2=Chuan-Ling|date=August 2016|journal=Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi|issue=4|doi=10.1016/j.jmii.2015.05.010|volume=49|pages=595–599|issn=1995-9133|pmid=26210761|last3=Yu|first3=Xiao|last4=Sun|first4=Yao|last5=Li|first5=Mei-Mei|last6=Ye|first6=Jian-Zhong|last7=Zhang|first7=Ya-Pei|last8=Wu|first8=Qing|last9=Zhou|first9=Tie-Li}}</ref><ref>{{Cite journal|title=The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System|url=https://www.ncbi.nlm.nih.gov/pubmed/23039210|last=de Kraker|first=M. E. A.|last2=Jarlier|first2=V.|date=September 2013|journal=Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases|issue=9|doi=10.1111/1469-0691.12028|volume=19|pages=860–868|issn=1469-0691|pmid=23039210|last3=Monen|first3=J. C. M.|last4=Heuer|first4=O. E.|last5=van de Sande|first5=N.|last6=Grundmann|first6=H.}}</ref><ref>{{Cite journal|title=Public Health Risks of Multiple-Drug-Resistant Enterococcus spp. in Southeast Asia|url=https://www.ncbi.nlm.nih.gov/pubmed/26150452|last=Daniel|first=Diane Sunira|last2=Lee|first2=Sui Mae|date=September 2015|journal=Applied and Environmental Microbiology|issue=18|doi=10.1128/AEM.01741-15|volume=81|pages=6090–6097|issn=1098-5336|pmc=PMC4542241|pmid=26150452|last3=Dykes|first3=Gary A.|last4=Rahman|first4=Sadequr}}</ref>。


== 生理學 ==
== 生理學 ==
腸球菌是兼性厭氧菌，即它們能在有氧和無氧的環境中生長。<ref name=Fischetti_2000>{{cite book | editor = Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Rood JI | title = Gram-Positive Pathogens | publisher = ASM Press | year = 2000 | isbn = 1-55581-166-3}}</ref> 雖然腸球菌不能形成孢子，但他們對於生長環境卻有很高的耐受性，例如可在下列環境中生存：溫度10-45℃、酸鹼度4.5-10.0和高鹽濃度。<ref name=Fisher>{{cite journal |author=Fisher K, Phillips C |title=The ecology, epidemiology and virulence of Enterococcus |journal=Microbiology |volume=155 |issue=Pt 6 |pages=1749–57 |date=June 2009 |pmid=19383684 |doi=10.1099/mic.0.026385-0}}</ref>
腸球菌是兼性厭氧菌，即它們能在有氧和無氧的環境中生長<ref name=Fischetti_2000>{{cite book | editor = Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Rood JI | title = Gram-Positive Pathogens | publisher = ASM Press | year = 2000 | isbn = 1-55581-166-3}}</ref>。 雖然腸球菌不能形成孢子，但他們對於生長環境卻有很高的耐受性，例如可在下列環境中生存：溫度10-45℃、酸鹼度4.5-10.0和高鹽濃度<ref name=Fisher>{{cite journal |author=Fisher K, Phillips C |title=The ecology, epidemiology and virulence of Enterococcus |journal=Microbiology |volume=155 |issue=Pt 6 |pages=1749–57 |date=June 2009 |pmid=19383684 |doi=10.1099/mic.0.026385-0}}</ref>。


腸球菌通常會在羊血瓊脂 (sheep's blood agar) 上呈現γ-溶血反應<ref name=Sherris>{{cite book | editor = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | edition = 4th | pages = 294–5 |publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref>
腸球菌通常會在羊血瓊脂（sheep's blood agar）上呈現γ-溶血反應<ref name=Sherris>{{cite book | editor = Ryan KJ, Ray CG | title = Sherris Medical Microbiology | edition = 4th | pages = 294–5 |publisher = McGraw Hill | year = 2004 | isbn = 0-8385-8529-9 }}</ref>。


== 歷史 ==
== 分類 ==


腸球菌早期被分類為D群鏈球菌 (Group D ''Streptococcus'')，一直到1984年，基因體DNA分析指出腸球菌應為另一獨立的菌屬。<ref>{{cite journal | author = Schleifer KH; Kilpper-Balz R | title = Transfer of ''Streptococcus faecalis'' and ''Streptococcus faecium'' to the genus ''Enterococcus'' nom. rev. as ''Enterococcus faecalis'' comb. nov. and ''Enterococcus faecium'' comb. nov. | journal= Int. J. Sys. Bacteriol. | year= 1984 | volume= 34 | issue= | pages= 31–34 | url= | doi = 10.1099/00207713-34-1-31 }}</ref>
腸球菌早期被分類為D群鏈球菌（Group D ''Streptococcus''），一直到1984年，基因體DNA分析指出腸球菌應為另一獨立的菌屬<ref>{{cite journal | author = Schleifer KH; Kilpper-Balz R | title = Transfer of ''Streptococcus faecalis'' and ''Streptococcus faecium'' to the genus ''Enterococcus'' nom. rev. as ''Enterococcus faecalis'' comb. nov. and ''Enterococcus faecium'' comb. nov. | journal= Int. J. Sys. Bacteriol. | year= 1984 | volume= 34 | issue= | pages= 31–34 | url= | doi = 10.1099/00207713-34-1-31 }}</ref>。


== 病理學 ==
== 病理學 ==


腸球菌在臨床上引起的重要感染包括尿道感染、菌血症、細菌性心內膜炎、憩室炎和腦膜炎等。<ref name=Fisher/><ref name=Sherris/> 敏感性菌株的感染可用ampicillin、penicillin和vancomycin治療。<ref name=Baron>{{cite book | author = Pelletier LL Jr. | title = Microbiology of the Circulatory System. ''in:'' Baron's Medical Microbiology (Baron S et al., eds.)| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.5077 | isbn = 0-9631172-1-1 }}</ref> 泌尿道感染則可用nitrofurantoin進行特異性治療，即使在vancomycin抗藥性的情況下。<ref name="pmid11120989">{{cite journal | author = Zhanel GG, Hoban DJ, Karlowsky JA | title = Nitrofurantoin is active against vancomycin-resistant enterococci | journal = Antimicrob. Agents Chemother. | volume = 45 | issue = 1 | pages = 324–6 |date=January 2001 | pmid = 11120989 | pmc = 90284 | doi = 10.1128/AAC.45.1.324-326.2001 | url = }}</ref>
腸球菌在臨床上引起的重要感染包括尿道感染、菌血症、細菌性心內膜炎、憩室炎和腦膜炎等<ref name=Fisher/><ref name=Sherris/> 。敏感性菌株的感染可用ampicillin、penicillin和vancomycin治療<ref name=Baron>{{cite book | author = Pelletier LL Jr. | title = Microbiology of the Circulatory System. ''in:'' Baron's Medical Microbiology (Baron S et al., eds.)| edition = 4th | publisher = Univ of Texas Medical Branch | year = 1996 | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.5077 | isbn = 0-9631172-1-1 }}</ref>。 泌尿道感染則可用nitrofurantoin進行特異性治療，即使在vancomycin抗藥性的情況下<ref name="pmid11120989">{{cite journal | author = Zhanel GG, Hoban DJ, Karlowsky JA | title = Nitrofurantoin is active against vancomycin-resistant enterococci | journal = Antimicrob. Agents Chemother. | volume = 45 | issue = 1 | pages = 324–6 |date=January 2001 | pmid = 11120989 | pmc = 90284 | doi = 10.1128/AAC.45.1.324-326.2001 | url = }}</ref>。


從醫學觀點來看，腸球菌的一個重要特性是先天具有高度的內在抗藥性。一些腸球菌對β-內酰胺類抗生素（如penicillins、cephalosporins、carbapenems）及許多氨基糖苷類抗生素具有抗藥性。<ref name=Sherris /> 在過去二十年中，vancomycin抗藥性的致病腸球菌 (VRE) 越來越常在院內感染中被檢出，尤其是在美國。<ref name=Fisher/> VRE可用抗生素quinupristin/dalfopristin來治療，約有70％的人會有效果。<ref name=Tünger_2004>{{cite journal |author=Tünger A, Aydemir S, Uluer S, Cilli F |title=In vitro activity of linezolid & quinupristin/dalfopristin against Gram-positive cocci |journal=Indian J Med Res |volume=120 |issue=6 |pages=546–52 |year=2004 |pmid=15654141}}</ref>
從醫學觀點來看，腸球菌的一個重要特性是先天具有高度的內在抗藥性。一些腸球菌對β-內酰胺類抗生素（如penicillins、cephalosporins、carbapenems）及許多氨基糖苷類抗生素具有抗藥性<ref name=Sherris />。 在過去二十年中，vancomycin抗藥性的致病腸球菌（Vancomycin-Resistant ''Enterococcus''; VRE）越來越常在院內感染中被檢出，尤其是在美國<ref name=Fisher/>。 VRE可用抗生素quinupristin/dalfopristin來治療，約有70％的人會有效果<ref name=Tünger_2004>{{cite journal |author=Tünger A, Aydemir S, Uluer S, Cilli F |title=In vitro activity of linezolid & quinupristin/dalfopristin against Gram-positive cocci |journal=Indian J Med Res |volume=120 |issue=6 |pages=546–52 |year=2004 |pmid=15654141}}</ref>。
Tigecycline類抗生素也已證明能用來治療腸球菌感染，如rifampicin。[http://www.emedicine.medscape.com/article/216993-medication#showall.html]
Tigecycline類抗生素也已證明能用來治療腸球菌感染，如rifampicin。


除了抗藥性，腸球菌也有很多毒性因子，毒性因子是作用於人體且會引發許多病灶，甚至造成嚴重疾病的物質；這些因子皆增加了腸球菌對人體的致病力<ref>{{Cite journal|title=Enterococcus in wound infections: virulence and antimicrobial resistance|url=https://www.ncbi.nlm.nih.gov/pubmed/22750786|last=Dworniczek|first=Ewa|last2=Piwowarczyk|first2=Justyna|date=June 2012|journal=Acta Microbiologica Et Immunologica Hungarica|issue=2|doi=10.1556/AMicr.59.2012.2.11|volume=59|pages=263–269|issn=1217-8950|pmid=22750786|last3=Bania|first3=Jacek|last4=Kowalska-Krochmal|first4=Beata|last5=Wałecka|first5=Ewa|last6=Seniuk|first6=Alicja|last7=Dolna|first7=Izabela|last8=Gościniak|first8=Grażyna}}</ref><ref>{{Cite journal|title=Drug resistance & virulence determinants in clinical isolates of Enterococcus species|url=https://www.ncbi.nlm.nih.gov/pubmed/23760387|last=Fernandes|first=Sanal C.|last2=Dhanashree|first2=B.|date=May 2013|journal=The Indian Journal of Medical Research|issue=5|volume=137|pages=981–985|issn=0971-5916|pmc=PMC3734693|pmid=23760387}}</ref><ref>{{Cite journal|title=Molecular characterization of resistance, virulence and clonality in vancomycin-resistant Enterococcus faecium and Enterococcus faecalis: A hospital-based study in Beijing, China|url=https://www.ncbi.nlm.nih.gov/pubmed/25976380|last=Yang|first=Jing-xian|last2=Li|first2=Tong|date=July 2015|journal=Infection, Genetics and Evolution: Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases|doi=10.1016/j.meegid.2015.05.012|volume=33|pages=253–260|issn=1567-7257|pmid=25976380|last3=Ning|first3=Yong-zhong|last4=Shao|first4=Dong-hua|last5=Liu|first5=Jing|last6=Wang|first6=Shu-qin|last7=Liang|first7=Guo-wei}}</ref>。
⚫
腸球菌性腦膜炎是神經外科上罕見的併發症。它一般需要透過靜脈或鞘內vancomycin來進行治療，但是治療效果仍有爭議。<ref name=Guardado_2006>{{cite journal |author=Guardado R |title=Post-surgical enterococcal meningitis: clinical and epidemiological study of 20 cases |journal=Scand. J. Infect. Dis. |volume=38 |issue=8 |pages=584–8 |year=2006 |pmid=16857599 |doi=10.1080/00365540600606416 |author-separator=, |author2=Asensi V |author3=Torres JM |display-authors=3 |last4=Pérez |first4=F. |last5=Blanco |first5=A. |last6=Maradona |first6=J. |last7=Cartón |first7=J.}}</ref>

⚫
腸球菌性腦膜炎是神經外科上罕見的併發症。它一般需要透過靜脈或鞘內vancomycin來進行治療，但是治療效果仍有爭議<ref name="Guardado_2006">{{cite journal |author=Guardado R |title=Post-surgical enterococcal meningitis: clinical and epidemiological study of 20 cases |journal=Scand. J. Infect. Dis. |volume=38 |issue=8 |pages=584–8 |year=2006 |pmid=16857599 |doi=10.1080/00365540600606416 |author-separator=, |author2=Asensi V |author3=Torres JM |display-authors=3 |last4=Pérez |first4=F. |last5=Blanco |first5=A. |last6=Maradona |first6=J. |last7=Cartón |first7=J.}}</ref>。
新的流行病學證據顯示，腸球菌亦是慢性細菌性前列腺炎的主要感染因子，腸球菌會在前列腺中形成生物膜，使其難以治療。
新的流行病學證據顯示，腸球菌亦是慢性細菌性前列腺炎的主要感染因子，腸球菌會在前列腺中形成生物膜，使其難以治療。
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== 食品應用 ==

=== 做為益生菌食用 ===
腸球菌是人類和許多動物的一種腸道共生菌，糞腸球菌和屎腸球菌是最常見的菌種，這兩種腸球菌已有許多研究證明其促進人體和動物（豬、家禽等）健康的功效，因此在保健食品的應用上普遍被作為益生菌使用<ref>{{Cite journal|title=Probiotic Enterococcus faecium CRL 183 inhibit chemically induced colon cancer in male Wistar rats|url=https://link.springer.com/article/10.1007/s00217-008-0927-6|last=Sivieri|first=K.|last2=Spinardi-Barbisan|first2=A. L. T.|date=2008-12-01|journal=European Food Research and Technology|issue=2|doi=10.1007/s00217-008-0927-6|volume=228|pages=231–237|language=en|issn=1438-2377|last3=Barbisan|first3=L. F.|last4=Bedani|first4=R.|last5=Pauly|first5=N. D.|last6=Carlos|first6=I. Z.|last7=Benzatti|first7=F.|last8=Vendramini|first8=R. C.|last9=Rossi|first9=E. A.}}</ref><ref>{{Cite journal|title=Discontinuous DNA replication in mouse P-815 cells|url=https://www.ncbi.nlm.nih.gov/pubmed/1168572|last=Gautschi|first=J. R.|last2=Clarkson|first2=J. M.|date=1975-01-02|journal=European Journal of Biochemistry|issue=2|volume=50|pages=403–412|issn=0014-2956|pmid=1168572}}</ref><ref>{{Cite journal|title=[Coexistence of acute leukemia and gastric cancer in advanced ages]|url=https://www.ncbi.nlm.nih.gov/pubmed/3476767|last=Kato|first=Y.|last2=Okazaki|first2=T.|date=April 1987|journal=[Rinsho Ketsueki] The Japanese Journal of Clinical Hematology|issue=4|volume=28|pages=608–615|issn=0485-1439|pmid=3476767|last3=Mochizuki|first3=T.|last4=Tashima|first4=M.|last5=Sawada|first5=H.|last6=Uchino|first6=H.|last7=Obayashi|first7=T.}}</ref><ref>{{Cite journal|title=[Immediate results of treatment of children with complicated forms of primary tuberculosis]|url=https://www.ncbi.nlm.nih.gov/pubmed/5300979|last=Griko|first=S. P.|date=1966|journal=Problemy Tuberkuleza|issue=3|volume=44|pages=33–37|issn=0032-9533|pmid=5300979}}</ref><ref>{{Cite journal|title=[Effect of a new fermented soy milk product on serum lipid levels in normocholesterolemic adult men]|url=https://www.ncbi.nlm.nih.gov/pubmed/12942871|last=Rossi|first=Elizeu Antonio|last2=Vendramini|first2=Regina Célia|date=March 2003|journal=Archivos Latinoamericanos De Nutricion|issue=1|volume=53|pages=47–51|issn=0004-0622|pmid=12942871|last3=Carlos|first3=Iracilda Zeppone|last4=de Oliveira|first4=Maurício Gonçalves|last5=de Valdez|first5=Graciela Font}}</ref><ref>Enterococcus organisms and their use as probiotics in alleviating irritable bowel syndrome symptoms. ''European Patent 0508701 (B1),1996.''</ref>。在腸道中，腸球菌會搶奪病原菌的生存空間，所以當我們不小心吃入了病原菌，這些病原菌也沒有辦法留在腸道中，大幅減低了它們的致病力。此外，腸球菌具有抵抗消化液的能力，作為益生菌食用時，因不容易被消化液分解，所以能有更多的菌量到達腸道，使其更容易發揮改善腸道健康的作用；因為這些特性，所以腸球菌是常見的益生菌選擇之一<ref>{{Cite journal|title=Enterococci at the crossroads of food safety?|url=https://www.ncbi.nlm.nih.gov/pubmed/10357269|last=Franz|first=C. M.|last2=Holzapfel|first2=W. H.|date=1999-03-01|journal=International Journal of Food Microbiology|issue=1-2|volume=47|pages=1–24|issn=0168-1605|pmid=10357269|last3=Stiles|first3=M. E.}}</ref>。

早在80年代，腸球菌就被使用來治療細菌性的腹瀉<ref>Bellomo G, Mangiagli A, Nicastro L, Frigerio G. A controlled double-blind study of SF68 strain as a new biological preparation for the treatment of diarrhoea in pediatrics. Curr Ther Res. 1980;28:927–936.</ref><ref>Lewenstein A, Frigerio G, Moroni M. Biological properties of SF68, a new approach for the treatment of diarrhoeal diseases. Curr Ther Res. 1979;26:967–981.</ref><ref>{{Cite journal|title=A microbiological investigation on probiotic preparations used for animal feeding|url=https://doi.org/10.1016/s0944-5013(96)80041-3|last=Canganella|first=F.|last2=Gasbarri|first2=M.|journal=Microbiological Research|issue=2|doi=10.1016/s0944-5013(96)80041-3|volume=151|pages=167–175|last3=Massa|first3=S.|last4=Trovatelli|first4=L.D.}}</ref>，當時被認為是藥物治療以外的另一種選擇，主要因為腸球菌在腸道內生長快速，並可抑制其它致病菌，例如大腸桿菌的生長，因此能減緩腹瀉的症狀。除了細菌性腹瀉，腸球菌也被證實能用來預防藥物型腹瀉<ref>Borgia, M., Sepe, N., Brancato, V., Costa, G., Simone, P., Borgia, R. et al, A controlled clinical study on Streptococcus faecium preparation for the prevention of side reactions during long-term antibiotic treatments. Curr Ther Res. 1982;31:265–271.</ref><ref>{{Cite journal|title=Double-blind report on the efficacy of lactic acid-producing Enterococcus SF68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea|url=https://www.ncbi.nlm.nih.gov/pubmed/2676650|last=Wunderlich|first=P. F.|last2=Braun|first2=L.|date=July 1989|journal=The Journal of International Medical Research|issue=4|doi=10.1177/030006058901700405|volume=17|pages=333–338|issn=0300-0605|pmid=2676650|last3=Fumagalli|first3=I.|last4=D'Apuzzo|first4=V.|last5=Heim|first5=F.|last6=Karly|first6=M.|last7=Lodi|first7=R.|last8=Politta|first8=G.|last9=Vonbank|first9=F.}}</ref>；當服用抗生素時，腸道的菌群會因此失衡，一些致病菌就會趁機繁殖，進而造成腹瀉等症狀，腸球菌可避免服用抗生素時的不良反應發生。所以將具有抗藥性的腸球菌作為藥品，連同抗生素一同使用，達到治療效果的同時，也可以避免副作用的發生<ref>{{Cite journal|title=Towards a compatible probiotic-antibiotic combination therapy: assessment of antimicrobial resistance in the Japanese probiotics|url=https://www.ncbi.nlm.nih.gov/pubmed/20497275|last=Hammad|first=A. M.|last2=Shimamoto|first2=T.|date=October 2010|journal=Journal of Applied Microbiology|issue=4|doi=10.1111/j.1365-2672.2010.04762.x|volume=109|pages=1349–1360|issn=1365-2672|pmid=20497275}}</ref>。

=== 食用的健康風險 ===
腸球菌具有很強的抗藥性散播能力<ref name=":0">Enterococci: From Commensals to Leading Causes of Drug Resistant Infection. Boston: Massachusetts Eye and Ear Infirmary; 2014 Feb 24.</ref><ref name=":1">{{Cite journal|title=Enterococci as probiotics and their implications in food safety|url=https://www.ncbi.nlm.nih.gov/pubmed/21962867|last=Franz|first=Charles M. A. P.|last2=Huch|first2=Melanie|date=2011-12-02|journal=International Journal of Food Microbiology|issue=2|doi=10.1016/j.ijfoodmicro.2011.08.014|volume=151|pages=125–140|issn=1879-3460|pmid=21962867|last3=Abriouel|first3=Hikmate|last4=Holzapfel|first4=Wilhelm|last5=Gálvez|first5=Antonio}}</ref><ref>{{Cite journal|title=Vancomycin-resistant enterococcal infections|url=https://www.ncbi.nlm.nih.gov/pubmed/10706902|last=Murray|first=B. E.|date=2000-03-09|journal=The New England Journal of Medicine|issue=10|doi=10.1056/NEJM200003093421007|volume=342|pages=710–721|issn=0028-4793|pmid=10706902}}</ref>，造成原本可以被殺死的細菌變成殺不死，因此不認為是GRAS（一般公認安全）的菌種<ref name=":2">{{Cite book|url=https://www.worldcat.org/oclc/965781424|last=Murlidhar,|first=Meghwal,|last2=Raj,|first2=Goyal, Megh|last3=S.,|first3=Chavan, Rupesh|isbn=9781771883801|location=Oakville, ON|chapter=Dairy engineering : advanced technologies and their applications|oclc=965781424}}</ref><ref name=":3">{{Cite journal|title=Variations in clinical presentation of patients with esophageal contraction abnormalities|url=https://www.ncbi.nlm.nih.gov/pubmed/4053917|last=Reidel|first=W. L.|last2=Clouse|first2=R. E.|date=November 1985|journal=Digestive Diseases and Sciences|issue=11|volume=30|pages=1065–1071|issn=0163-2116|pmid=4053917}}</ref>，作為益生菌使用仍有安全上的問題，特別是在細菌感染、免疫低下的患者和老年人身上<ref name=":2" /><ref name=":4">{{Cite journal|title=Molecular Screening of EnterococcusVirulence Determinants and Potential for Genetic Exchange between Food and Medical Isolates|url=http://aem.asm.org/content/67/4/1628|last=Eaton|first=Tracy J.|last2=Gasson|first2=Michael J.|date=2001-04-01|journal=Applied and Environmental Microbiology|issue=4|doi=10.1128/AEM.67.4.1628-1635.2001|volume=67|pages=1628–1635|language=en|issn=0099-2240|pmid=11282615}}</ref><ref name=":5">{{Cite journal|title=Probiotic Enterococcus faecium strain is a possible recipient of the vanA gene cluster|url=https://www.ncbi.nlm.nih.gov/pubmed/11303279|last=Lund|first=B.|last2=Edlund|first2=C.|date=2001-05-01|journal=Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America|issue=9|doi=10.1086/319994|volume=32|pages=1384–1385|issn=1058-4838|pmid=11303279}}</ref>。除了抗藥性的散播能力，腸球菌也會散播毒性因子，造成毒性因子的擴散<ref name=":4" /><ref name=":5" /><ref name=":6">{{Cite journal|title=Stromal changes in early invasive and non-invasive breast carcinoma: an ultrastructural study|url=https://www.ncbi.nlm.nih.gov/pubmed/3023597|last=Tamimi|first=S. O.|last2=Ahmed|first2=A.|date=September 1986|journal=The Journal of Pathology|issue=1|doi=10.1002/path.1711500108|volume=150|pages=43–49|issn=0022-3417|pmid=3023597}}</ref><ref name=":7">{{Cite journal|title=Enterococci in foods--a conundrum for food safety|url=https://www.ncbi.nlm.nih.gov/pubmed/14596984|last=Franz|first=Charles M. A. P.|last2=Stiles|first2=Michael E.|date=2003-12-01|journal=International Journal of Food Microbiology|issue=2-3|volume=88|pages=105–122|issn=0168-1605|pmid=14596984|last3=Schleifer|first3=Karl Heinz|last4=Holzapfel|first4=Wilhelm H.}}</ref><ref name=":8">{{Cite journal|title=The genus Enterococcus as probiotic: safety concerns|url=http://www.scielo.br/scielo.php?script=sci_abstract&pid=S1516-89132013000300014&lng=en&nrm=iso&tlng=en|last=Araújo|first=Tatiane Ferreira|last2=Ferreira|first2=Célia Lúcia de Luces Fortes|date=June 2013|journal=Brazilian Archives of Biology and Technology|issue=3|doi=10.1590/S1516-89132013000300014|volume=56|pages=457–466|issn=1516-8913}}</ref>，增加了腸球菌在食品應用上的疑慮，故腸球菌作為益生菌原料的安全性必須審慎評估。

腸球菌專家、美國哈佛大學醫學院的Michael S. Gilmore博士團隊在其所撰寫的《Enterococci》書中，除了提及美國FDA與歐盟不建議使用腸球菌作為益生菌給人類食用之外，更寫到益生菌的菌株不該具有基因轉移的能力（會導致抗藥性的散播），到2014年為止，科學界並沒有找到不具基因轉移能力的腸球菌菌株，因此腸球菌作為益生菌使用仍有相當大的爭議。<ref>{{Cite book|url=http://www.ncbi.nlm.nih.gov/books/NBK190424/|date=2014|publisher=Massachusetts Eye and Ear Infirmary|editor-last=Gilmore|editor-first=Michael S.|location=Boston|chapter=Enterococci: From Commensals to Leading Causes of Drug Resistant Infection|pmid=24649510}}</ref>

腸球菌因抗藥因子和毒性因子的高度散播能力，使腸球菌容易獲得或傳遞這些對健康有風險的因子，最後衍生出藥物殺不死的病菌，造成了治療上的困難，顯示腸球菌對人體健康的潛在危害<ref name=":0" /><ref name=":1" /><ref name=":3" /><ref name=":6" /><ref name=":7" /><ref name=":8" />。因此，考慮到腸球菌感染在人類流行病學上的進展，以及腸球菌對人體健康可能具有的風險，WHO<ref>Probiotics in food: Health and nutritional properties and guidelines for evaluation. ISSN: 0254-4725.</ref>和美國FDA<ref>Dietary Supplements: New Dietary Ingredient Notifications and Related Issues: Guidance for Industry. U.S. FDA, Center for Food Safety and Applied Nutrition; August 2016.</ref>皆不建議使用腸球菌作為益生菌使用，歐盟<ref>Scientific Opinion on the maintenance of the list of QPS biological agents intentionally added to food and feed (2013 update). EFSA Journal 2013;11(11):3449 [106 pp.].</ref>、中國<ref>卫生部关于印发真菌类和益生菌类保健食品评审规定的通知。中华人民共和国国家卫生和计划生育委员会 卫法监发〔2001〕84号</ref> 、加拿大<ref>Report submitted to the Natural Health Products Directorate, Health Canada. Nutritech Consulting Winnipeg, Manitoba; March 2005.</ref>等國也禁止或不建議腸球菌作為益生菌成分。根據許多研究結果及主要國家的安全評估，腸球菌作為益生菌對人體健康的不良影響實無法完全排除，因此禁止或有條件的使用是有其必要性的。


== 水質要求 ==
== 水質要求 ==


水質中的腸球菌標準非常嚴格，例如在夏威夷州和美國的大部分地區，其海灘周圍的水域是每100毫升水中，五個星期的平均值不得超過35個單位 (CFU)，若超過，該地區可能會發布警告，要求遠離海洋。<ref name=Hawaii_DOH>{{cite web | title=Clean Water Branch | work=Hawaii State Department of Health | url=http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-54.pdf | accessdate=2012-05-18 | deadurl=yes | archiveurl=https://web.archive.org/web/20111111031411/http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-54.pdf | archivedate=2011-11-11 }}</ref> 2004年，腸球菌更取代了糞大腸菌群和大腸桿菌作為新的美國聯邦公共鹽水和淡水海域水質標準。<ref name="Water Quality Standards for Coastal and Great Lakes Recreation Waters">{{cite web|title=Water Quality Standards for Coastal and Great Lakes Recreation Waters | url=http://www.epa.gov/fedrgstr/EPA-WATER/2004/July/Day-09/w15614.htm|publisher=EPA|accessdate=7/9/2004}}</ref>
水質中的腸球菌標準非常嚴格，例如在夏威夷州和美國的大部分地區，其海灘周圍的水域是每100毫升水中，五個星期的平均值不得超過35單位 (CFU) 的腸球菌，否則該地區可能會發布警告，要求遠離海洋。<ref name=Hawaii_DOH>{{cite web | title=Clean Water Branch | work=Hawaii State Department of Health | url=http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-54.pdf | accessdate=2012-05-18 | deadurl=yes | archiveurl=https://web.archive.org/web/20111111031411/http://gen.doh.hawaii.gov/sites/har/AdmRules1/11-54.pdf | archivedate=2011-11-11 }}</ref> 2004年，腸球菌更取代了糞大腸菌群和大腸桿菌作為新的美國聯邦公共鹽水和淡水海域水質標準。<ref name="Water Quality Standards for Coastal and Great Lakes Recreation Waters">{{cite web|title=Water Quality Standards for Coastal and Great Lakes Recreation Waters | url=http://www.epa.gov/fedrgstr/EPA-WATER/2004/July/Day-09/w15614.htm|publisher=EPA|accessdate=7/9/2004}}</ref>


== 參考資料 ==
== 參考資料 ==

2017年8月31日 (四) 04:33的版本

肠球菌
感染肺部組織的Enterococcus sp.
感染肺部組織的Enterococcus sp.
科學分類
界： Bacteria
門： Firmicutes
綱： Bacilli
目： Lactobacillales
科： Enterococcaceae
屬： 腸球菌屬 Enterococcus
(ex Thiercelin & Jouhaud 1903)
Schleifer & Kilpper-Bälz 1984
Species

E. malodoratus
E. avium
E. durans
E. faecalis
E. faecium
E. gallinarum
E. hirae
E. solitarius
etc.

腸球菌屬（學名：Enterococcus），革蘭氏陽性球菌。經常以成對（雙球菌）或短鏈方式存在，故從形態上與鏈球菌屬很難區分[1]。在人類腸道裡有兩種常見的偏利共生腸球菌：糞腸球菌（Enterococcus faecalis）約佔90-95%和屎腸球菌（Enterococcus faecium）約佔5-10%。其他人體中較少見的菌群還有E. casseliflavus、E. gallinarum和E. raffinosus[1]。腸球菌因為能生成抵抗藥物的物質，使它們不容易被抗生素殺死，且容易散播抗藥性並可在惡劣環境中生存，故近年來已成為臨床感染的重要致病菌之一[2][3][4][5][6][7]。

生理學

腸球菌是兼性厭氧菌，即它們能在有氧和無氧的環境中生長[8]。 雖然腸球菌不能形成孢子，但他們對於生長環境卻有很高的耐受性，例如可在下列環境中生存：溫度10-45℃、酸鹼度4.5-10.0和高鹽濃度[9]。

腸球菌通常會在羊血瓊脂（sheep's blood agar）上呈現γ-溶血反應[10]。

分類

腸球菌早期被分類為D群鏈球菌（Group D Streptococcus），一直到1984年，基因體DNA分析指出腸球菌應為另一獨立的菌屬[11]。

病理學

腸球菌在臨床上引起的重要感染包括尿道感染、菌血症、細菌性心內膜炎、憩室炎和腦膜炎等[9][10] 。敏感性菌株的感染可用ampicillin、penicillin和vancomycin治療[12]。 泌尿道感染則可用nitrofurantoin進行特異性治療，即使在vancomycin抗藥性的情況下[13]。

從醫學觀點來看，腸球菌的一個重要特性是先天具有高度的內在抗藥性。一些腸球菌對β-內酰胺類抗生素（如penicillins、cephalosporins、carbapenems）及許多氨基糖苷類抗生素具有抗藥性[10]。 在過去二十年中，vancomycin抗藥性的致病腸球菌（Vancomycin-Resistant Enterococcus; VRE）越來越常在院內感染中被檢出，尤其是在美國[9]。 VRE可用抗生素quinupristin/dalfopristin來治療，約有70％的人會有效果[14]。 Tigecycline類抗生素也已證明能用來治療腸球菌感染，如rifampicin。

除了抗藥性，腸球菌也有很多毒性因子，毒性因子是作用於人體且會引發許多病灶，甚至造成嚴重疾病的物質；這些因子皆增加了腸球菌對人體的致病力[15][16][17]。

腸球菌性腦膜炎是神經外科上罕見的併發症。它一般需要透過靜脈或鞘內vancomycin來進行治療，但是治療效果仍有爭議[18]。 新的流行病學證據顯示，腸球菌亦是慢性細菌性前列腺炎的主要感染因子，腸球菌會在前列腺中形成生物膜，使其難以治療。

Enterococcus
分类和外部资源
ICD-11XN1F7
ICD-9-CM041.04
[编辑此条目的维基数据]

食品應用

做為益生菌食用

腸球菌是人類和許多動物的一種腸道共生菌，糞腸球菌和屎腸球菌是最常見的菌種，這兩種腸球菌已有許多研究證明其促進人體和動物（豬、家禽等）健康的功效，因此在保健食品的應用上普遍被作為益生菌使用[19][20][21][22][23][24]。在腸道中，腸球菌會搶奪病原菌的生存空間，所以當我們不小心吃入了病原菌，這些病原菌也沒有辦法留在腸道中，大幅減低了它們的致病力。此外，腸球菌具有抵抗消化液的能力，作為益生菌食用時，因不容易被消化液分解，所以能有更多的菌量到達腸道，使其更容易發揮改善腸道健康的作用；因為這些特性，所以腸球菌是常見的益生菌選擇之一[25]。

早在80年代，腸球菌就被使用來治療細菌性的腹瀉[26][27][28]，當時被認為是藥物治療以外的另一種選擇，主要因為腸球菌在腸道內生長快速，並可抑制其它致病菌，例如大腸桿菌的生長，因此能減緩腹瀉的症狀。除了細菌性腹瀉，腸球菌也被證實能用來預防藥物型腹瀉[29][30]；當服用抗生素時，腸道的菌群會因此失衡，一些致病菌就會趁機繁殖，進而造成腹瀉等症狀，腸球菌可避免服用抗生素時的不良反應發生。所以將具有抗藥性的腸球菌作為藥品，連同抗生素一同使用，達到治療效果的同時，也可以避免副作用的發生[31]。

食用的健康風險

腸球菌具有很強的抗藥性散播能力[32][33][34]，造成原本可以被殺死的細菌變成殺不死，因此不認為是GRAS（一般公認安全）的菌種[35][36]，作為益生菌使用仍有安全上的問題，特別是在細菌感染、免疫低下的患者和老年人身上[35][37][38]。除了抗藥性的散播能力，腸球菌也會散播毒性因子，造成毒性因子的擴散[37][38][39][40][41]，增加了腸球菌在食品應用上的疑慮，故腸球菌作為益生菌原料的安全性必須審慎評估。

腸球菌專家、美國哈佛大學醫學院的Michael S. Gilmore博士團隊在其所撰寫的《Enterococci》書中，除了提及美國FDA與歐盟不建議使用腸球菌作為益生菌給人類食用之外，更寫到益生菌的菌株不該具有基因轉移的能力（會導致抗藥性的散播），到2014年為止，科學界並沒有找到不具基因轉移能力的腸球菌菌株，因此腸球菌作為益生菌使用仍有相當大的爭議。[42]

腸球菌因抗藥因子和毒性因子的高度散播能力，使腸球菌容易獲得或傳遞這些對健康有風險的因子，最後衍生出藥物殺不死的病菌，造成了治療上的困難，顯示腸球菌對人體健康的潛在危害[32][33][36][39][40][41]。因此，考慮到腸球菌感染在人類流行病學上的進展，以及腸球菌對人體健康可能具有的風險，WHO[43]和美國FDA[44]皆不建議使用腸球菌作為益生菌使用，歐盟[45]、中國[46] 、加拿大[47]等國也禁止或不建議腸球菌作為益生菌成分。根據許多研究結果及主要國家的安全評估，腸球菌作為益生菌對人體健康的不良影響實無法完全排除，因此禁止或有條件的使用是有其必要性的。

水質要求

水質中的腸球菌標準非常嚴格，例如在夏威夷州和美國的大部分地區，其海灘周圍的水域是每100毫升水中，五個星期的平均值不得超過35單位 (CFU) 的腸球菌，否則該地區可能會發布警告，要求遠離海洋。[48] 2004年，腸球菌更取代了糞大腸菌群和大腸桿菌作為新的美國聯邦公共鹽水和淡水海域水質標準。[49]

參考資料

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原核生物：细菌分类（门和目）
陸細菌（英语：Terrabacteria）
BV1, BV3, BV5（英语：Bergey's Manual of Systematic Bacteriology）
滑行菌（英语：Glidobacteria）
BV1（英语：Bergey's Manual of Systematic Bacteriology）
初细菌（英语：Eobacteria）
其他
革蘭氏陽性菌
无细菌外膜
梭菌
梭菌纲（英语：Clostridia）
桿菌
热石菌目
CPR組細菌（英语：Candidate Phyla Radiation）
熱袍菌
水細菌（英语：Hydrobacteria）
BV2, BV4（英语：Bergey's Manual of Systematic Bacteriology）
梭桿菌
梭桿菌門
變形菌門ε-变形菌纲
螺旋體
迷微菌
PVC總門（英语：PVC superphylum）
（浮黴菌）
浮黴菌門
疣微菌門
衣原體門
其他
FCB總門（英语：FCB group）
（鞘脂桿菌）
纖維桿菌門
綠菌門
擬桿菌門
其他
變形菌
其他

细菌（分类）

gr+f／gr+a（t）／gr-p（c／gr-o

药物（J1p、w、n、m、疫苗、o）、抗體

芽孢桿菌綱
乳桿菌目
(Cat-)
鏈球菌屬
α
奧普托欣（英语：Optochin）易感:
奧普托欣耐:
β
A:
B（英语：Group B streptococcal infection）:
未分組:
γ
肠球菌
芽孢桿菌目
(Cat+)
葡萄球菌感染
Cg+（英语：Coagulase）:
Cg-（英语：Coagulase）:
芽孢桿菌屬
李斯特菌屬
梭菌綱
梭菌屬(孢子形成)
能動:
無動力:
消化鏈球菌（英语：Peptostreptococcus）(非孢子形成)
柔膜菌綱（英语：Mollicutes）
枝原體科（英语：Mycoplasmataceae）
厭氧原體目（英语：Anaeroplasmatales）

细菌（分类）

gr+f／gr+a（t）／gr-p（c／gr-o

药物（J1p、w、n、m、疫苗、o）、抗體

取自“https://zh.wikipedia.org/w/index.php?title=肠球菌&oldid=45979686”