Briedigkeit H, Klare I, Buder S, Reinke P, Badstübner D, Konstabel C, Halle E, Claus H, Witte W, Neumayer H H (1997): Genotypische Analyse von Enterococcus faecalis bei langzeitbesiedelten Patienten mit Harnwegsinfektionen nach Nierentransplantation
Nieren- und Hochdruckkrankheiten 26: 612-618.

The aim of the present investigation was to evaluate repeated Enterococcus faecalis bacteriuria of kidney transplant patients. In 141 patients the proportion of Gram-positive bacteria in urine specimens increased from 3% to 31%, those of E. faecalis from 2.2% to 21.4% during a period of 8 years (1987 - 1994). The increase of Gram-positive bacteria was associated with the introduction of new antibiotics, especially of ciprofloxacin. Thirty-one E. faecalis strains, collected over a period of 16 months from 10 patients were typed by DNS macrorestriction analysis. In all but one patient there were relapses with genotypically identical isolates, only in 1 patient a reinfection. In most cases patients presented only small clinical symptoms of infection, but leukocyturia or proteinuria or decrease of renal function. Therefore, it is necessary to treat enterococcal bacteriuria adequately. Because ciprofloxacin has variable activity against enterococci it should not be used for treatment of enterococcal infectious. In 1 patient the detection of different E. faecalis strains was not associated with typical clinical symptoms of urinary tract infection and therefore categorized as colonization. There was no causative epidemiological relation between these strains isolated from different patients.